Sec. 1-43. Form.
Sec. 1-43. Form. (a) The use of the following form in the creation of a power of
attorney is authorized, and, when used, it shall be construed in accordance with the
provisions of this chapter:
"Notice: The powers granted by this document are broad and sweeping. They are
defined in Connecticut Statutory Short Form Power of Attorney Act, sections 1-42 to
1-56, inclusive, of the general statutes, which expressly permits the use of any other or
different form of power of attorney desired by the parties concerned. The grantor of any
power of attorney or the attorney-in-fact may make application to a court of probate for
an accounting as provided in subsection (b) of section 45a-175.
Know All Men by These Presents, which are intended to constitute a GENERAL
POWER OF ATTORNEY pursuant to Connecticut Statutory Short Form Power of Attorney Act:
That I .... (insert name and address of the principal) do hereby appoint .... (insert name
and address of the agent, or each agent, if more than one is designated) my attorney(s)-in-fact TO ACT .....
If more than one agent is designated and the principal wishes each agent alone to be
able to exercise the power conferred, insert in this blank the word `severally'. Failure
to make any insertion or the insertion of the word `jointly' shall require the agents to
act jointly.
First: In my name, place and stead in any way which I myself could do, if I were
personally present, with respect to the following matters as each of them is defined in
the Connecticut Statutory Short Form Power of Attorney Act to the extent that I am
permitted by law to act through an agent:
(Strike out and initial in the opposite box any one or more of the subdivisions as to
which the principal does NOT desire to give the agent authority. Such elimination of
any one or more of subdivisions (A) to (K), inclusive, shall automatically constitute an
elimination also of subdivision (L).)
To strike out any subdivision the principal must draw a line through the text of that
subdivision AND write his initials in the box opposite.
(A) real estate transactions;( )
(B) chattel and goods transactions;( )
(C) bond, share and commodity transactions;( )
(D) banking transactions;( )
(E) business operating transactions;( )
(F) insurance transactions;( )
(G) estate transactions;( )
(H) claims and litigation;( )
(I) personal relationships and affairs;( )
(J) benefits from military service;( )
(K) records, reports and statements;( )
(L) all other matters;( )
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(Special provisions and limitations may be included in the statutory short form power
of attorney only if they conform to the requirements of the Connecticut Statutory Short
Form Power of Attorney Act.)
Second: With full and unqualified authority to delegate any or all of the foregoing
powers to any person or persons whom my attorney(s)-in-fact shall select;
Third: Hereby ratifying and confirming all that said attorney(s) or substitute(s) do or
cause to be done.
In Witness Whereof I have hereunto signed my name and affixed my seal this .... day
of ...., 20...
.... (Signature of Principal) (Seal)
(ACKNOWLEDGMENT)
The execution of this statutory short form power of attorney shall be duly acknowledged by the principal in the manner prescribed for the acknowledgment of a conveyance
of real property.
No provision of this chapter shall be construed to bar the use of any other or different
form of power of attorney desired by the parties concerned.
Every statutory short form power of attorney shall contain, in boldface type or a
reasonable equivalent thereof, the "Notice" at the beginning of this section.
(b) A power of attorney is a "statutory short form power of attorney", as this phrase
is used in this chapter, when it is in writing, has been duly acknowledged by the principal
and contains the exact wording of clause First set forth in subsection (a) of this section,
except that any one or more of subdivisions (A) to (K) may be stricken out and initialed
by the principal, in which case the subdivisions so stricken out and initialed and also
subdivision (L) shall be deemed eliminated. A statutory short form power of attorney
may contain modifications or additions of the types described in section 1-56.
(c) If more than one agent is designated by the principal, such agents, in the exercise
of the powers conferred, shall act jointly unless the principal specifically provides in
such statutory short form power of attorney that they are to act severally.
(d) (1) The principal may indicate that a power of attorney duly acknowledged
in accordance with this section shall take effect upon the occurrence of a specified
contingency, including a date certain or the occurrence of an event, provided that an
agent designated by the principal executes a written affidavit in accordance with section
1-56h that such contingency has occurred.
(2) The principal may indicate the circumstance or date certain upon which the
power of attorney shall cease to be effective.
(February, 1965, P.A. 573, S. 2; P.A. 90-71, S. 1; P.A. 93-203, S. 5; P.A. 95-316, S. 1; P.A. 07-252, S. 1.)
History: P.A. 90-71 amended form by adding health care decisions; P.A. 93-203 added Subsec. (d) re indication by
principal that power of attorney shall be effective upon occurrence of specified contingency, provided designated agent
executes affidavit that contingency has occurred, and that power may be of limited duration; P.A. 95-316 amended notice
form in Subsec. (a) by adding provision re application to probate court for accounting; (Revisor's note: In 2001 the reference
in this section to the date "19.." was changed editorially by the Revisors to "20.." to reflect the new millennium); P.A. 07-252 removed references to health care decisions in the short form power of attorney.