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Connecticut Statutory Durable Power of Attorney Account Form


Connecticut Statutory Durable Power of Attorney Account Form
Connecticut Statutory Durable Power of Attorney Account Form
CONNECTICUT STATUTORY DURABLE POWER OF
ATTORNEY ACCOUNT
I, _____________________________(Insert name and address of principal),
do hereby appoint _____________________________(Insert name and address
of the agent, or each agent, if more than one is designated. 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.)
my attorney-in-fact to deposit to my credit in account No.
_____________________________ (Insert account number) in
_____________________________ (Insert name of financial institution)
moneys, negotiable instruments or credits acceptable by said financial
institution for deposit, to withdraw from said account, either personally or by
order payable either to said agent individually or to another payee, all moneys
now and hereafter deposited in my name and to my credit in said account, and
to sign in my name any and all required receipts, orders, drafts and withdrawal
slips therefor, giving said agent full power and authority to do and perform
anything whatsoever requisite and necessary to be done with respect to said
account as fully as I might or could do if personally present, hereby ratifying
and confirming all that said agents shall do or cause to be done by virtue
hereof.
This power of attorney shall not be affected by my subsequent disability or
incompetence.
Signed this ______ day of _____________________________, 20_____
Witnessed by:
Principal’s Signature _____________________________
Agent’s Signature _____________________________
Witnessed By:
_____________________________
_____________________________
(Acknowledgment)
(Acknowledgment)
Connecticut Statutory Durable Power of Attorney Account Form
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