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The SJcera Special Power of Attorney form serves as a vital tool for individuals looking to grant another person the authority to act on their behalf, particularly in matters involving their retirement benefits. This form is designed specifically for participants of the San Jose City Employees' Retirement Association (SJCERA), making it tailored to the unique needs of city employees and their retirement plans. Key components of the form include the designation of an agent, the specific powers granted, and the identification of the principal, ensuring clarity in the delegation of authority. By detailing the specific actions that the agent can undertake, the form helps protect the interests of the principal and streamline the management of retirement benefits. Additionally, understanding the protocol for submitting this form is crucial, as it typically requires notarization to ensure its validity. Overall, the SJcera Special Power of Attorney form is a valuable resource for those who wish to maintain control over their retirement affairs while allowing a trusted individual to assist them in navigating complex processes.

Form Sample

SPECIAL POWER OF ATTORNEY

SECTION 1

When completing this form, please be sure to print the requested information.

For the purpose of this form, a principal is defined as a person who empowers another to act as a representative on that person's behalf.

Creation of Special Durable Power of Attorney for Retirement-Related Business

 

 

 

 

 

Name of Principal (First Name, Middle Initial, Last Name)

 

Social Security Number or SJCERA ID

 

 

 

 

 

 

 

 

 

 

Address

 

County

 

 

 

 

 

(

)

 

 

 

City

State

Zip

Daytime Phone

By this document I intend to create a durable power of attorney by appointing the person named below to make retirement-related decisions for me as allowed by the California Probate Code. This power is expressly limited to decisions relating to my benefits under the San Joaquin County Employees' Retirement Association, hereinafter

SJCERA.

SECTION 2

You have the option of designating more than one Attorney-in-Fact.

Designation of Attorney-in-Fact

If you appoint more than one attorney-in-fact, and you want each attorney-in-fact to be able to act alone, check the appropriate box. If you do not check a box, or if you check “jointly,” then all of your attorneys-in-fact must act or sign together. Granting joint authority to two or more attorneys-in-fact is exercisable only by their unanimous action. If you choose to have your attorneys-in-fact act jointly, and one is unavailable because of absence, illness, or other temporary incapacity, the other attorney(s)-in-fact may exercise their authority under the power of attorney.

 

 

 

 

 

 

Name of Attorney-in-Fact

(First Name, Middle Initial, Last Name)

 

 

Birth Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

Social Security Number

 

 

 

 

(

)

City

 

State

Zip

Daytime Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Attorney-in-Fact

(First Name, Middle Initial, Last Name)

 

 

Birth Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

Social Security Number

 

 

 

 

(

)

City

 

State

Zip

Daytime Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Attorney-in-Fact

(First Name, Middle Initial, Last Name)

 

 

Birth Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

Social Security Number

 

 

 

 

(

)

City

 

State

Zip

Daytime Phone

I have designated more than one Attorney-in-Fact. They are to act (mark one box only): Jointly

Separately

Alternately, in the numerical order specified above. If you mark "Alternately," you must number the Attorneys- in-Fact in the order in which they are to act.

SJCERA Special POA

Page 1 of 5

Put your name and

Social Security

Number or SJCERA

ID at the top of every Name of PrincipalSocial Security Number or SJCERA ID page

SECTION 3 General Statement of Authority Granted

I hereby grant my Attorney-in-Fact full authority to transact all matters on my behalf relating to SJCERA, including, but not limited to, filing applications, making benefit elections, designating beneficiaries and endorsing warrants. I further give my Attorney-in-Fact full authority to perform every required act to be done to exercise any of the foregoing powers as fully as I might or could do if personally present, hereby ratifying and confirming all that my Attorney-in-Fact shall lawfully do or cause to be done. I understand that this authority is granted to the Attorney-in-Fact designated by me even if that person is related to be my blood, marriage, or legal domestic partnership. By signing this Special Power of Attorney form, I intend that:

My Attorney-in-Fact ( is;

is not) authorized to select any payment option available under the

retirement plan, even though it may reduce the monthly allowance that would otherwise be paid to me during my lifetime.

My Attorney-in-Fact (☐ is; ☐ is not) authorized to designate or change my beneficiary.

My Attorney-in-Fact (☐ is; ☐ is not) authorized to designate himself or herself as my beneficiary.

I give the following instructions that limit or extend the powers granted to my Attorney-in-Fact:

SECTION 4

Please be careful in choosing when you want your power of attorney to commence or terminate.

Duration of Power of Attorney

Please check one box to indicate your choice.

Unless I indicate otherwise, this power of attorney is effective immediately and will continue until it is revoked. My Attorney-in-Fact is hereby instructed to notify SJCERA in writing of my disability, incapacity, or death immediately upon its occurrence.

This special durable power of attorney is to commence immediately and to remain in effect for my lifetime or until I specifically cancel it.

This special limited power of attorney is to commence on ____________________ and

terminate on ____________________________ .

Date (mm/dd/yyyy)

Date (mm/dd/yyyy) or Event

 

This special contingent power of attorney is to commence only upon a determination that I am incapacitated and/or unable to handle my own affairs. The determination of whether I am incapacitated and/or unable to handle my own affairs shall be made by

____________________________________________________________ .

Name or Title of Person to Make the Determination

This special general power of attorney is to terminate in its entirely if I become incapacitated.

SJCERA Special POA

Page 2 of 5

Put your name and

Social Security

Number or SJCERA

ID at the top of every Name of PrincipalSocial Security Number or SJCERA ID page

SECTION 5

Agent is the Attorney-in-Fact.

Notice to Person Executing Durable Power of Attorney

The authority granted by the SJCERA Special Power of Attorney form is limited to matters related to SJCERA. The person designated as your Attorney-in-Fact does not have any authority over your other real or personal property. If you wish that your Attorney-in-Fact have authority over your real and/or personal property, it is recommended that you seek legal counsel.

You may notice that the language contained in the following (Warning) statement refers to more extensive authority than granted by the SJCERA Special Power of Attorney. This (Warning) statement is required by California Probate Code Section 4128 to be included in all pre-printed power of attorney forms even though the SJCERA Special Power of Attorney does not authorize your Attorney-in-Fact to do many of the things mentioned in the following (Warning) statement. Also, if you are concerned with the (Warning) statement or the extent of the authority being granted by the SJCERA Special Power of Attorney form, we again urge you to consult with an attorney.

(Warning): Notice to Person Executive Durable Power of Attorney

A durable power of attorney is an important legal document. By signing the durable power of attorney, you are authorizing another person to act for you, the principal. Before you sign this durable power of attorney, you should know these important facts:

Your agent has no duty to act unless you and your agent agree otherwise in writing.

This document gives your agent the powers to manage, dispose of, sell, and convey your real and personal property, and to use your property as security if your agent borrows money on your behalf. This document does not give your agent the power to accept or receive any of your property, in trust or otherwise, as a gift, unless you specifically authorize the agent to accept or receive a gift.

Your agent will have the right to receive reasonable payment for services provided under this durable power of attorney unless you provide otherwise in this power of attorney.

The powers you give your agent will continue to exist for your entire lifetime, unless you state that the durable power of attorney will last for a shorter period of time or unless you otherwise terminate the durable power of attorney. The powers you give your agent in this durable power of attorney will continue to exist even if you can no longer make your own decisions regarding the management of your property.

You can amend or change this durable power of attorney only by executing a new durable power of attorney or by executing an amendment through the same formalities as an original. You have the right to revoke or terminate this durable power of attorney at any time, so long as you are competent.

This durable power of attorney must be dated and must be acknowledged before a notary public or signed by two witnesses. (Please choose one or the other, but not both!) If it is signed by two witnesses, they must witness either (1) the signing of the power of attorney or (2) the principal’s signing or acknowledgment of his or her signature. A durable power of attorney that may affect real property should be acknowledged before a notary public so that it may be easily recorded.

You should read this durable power of attorney very carefully. When effective, this durable power of attorney will give your agent the right to deal with property that you now have or might acquire in the future. The durable power of attorney is important to you. If you do not understand the durable power of attorney, or any provision of it, then you should obtain the assistance of an attorney or other qualified person.

SJCERA Special POA

Page 3 of 5

Put your name and

Social Security

Number or SJCERA

ID at the top of every Name of PrincipalSocial Security Number or SJCERA ID page

SECTION 6

To be reviewed and signed by the Attorney in-Fact

Notice to Person Accepting the Appointment of Attorney-in-Fact

By acting or agreeing to act as the agent (attorney-in-fact) under this power of attorney, you assume the fiduciary and other legal responsibilities of an agent. These responsibilities include:

The legal duty to act solely in the interest of the principal and to avoid conflicts of interest

The legal duty to keep the principal’s property separate and distinct from any other property owned or controlled by you.

You may not transfer the principal’s property to yourself without full and adequate consideration or accept a gift of the principal’s property unless this power of attorney specifically authorizes you to transfer property to yourself or accept a gift of the principal’s property. If you transfer the principal’s property to yourself without specific authorization in the power of attorney, you may be prosecuted for fraud and/or embezzlement. If the principal is 65 years of age or older at the time that the property is transferred to you without authority, you may also be prosecuted for elder abuse under Penal Code Section 368. In addition to criminal prosecution, you may also be sued in civil court.

Print Name of Agent

 

 

Signature of Agent

Date (mm/dd/yyyy)

 

 

 

 

Print Name of Agent

 

 

 

 

 

Signature of Agent

Date (mm/dd/yyyy)

 

 

 

 

 

 

Print Name of Agent

 

 

 

 

 

Signature of Agent

Date (mm/dd/yyyy)

SECTION 7

To be completed and signed by the Principal.

Principal's Acknowledgement and Execution

I am of sound mind and either understand my elections or talked with an attorney. I am executing this legal document under my own free will.

 

 

 

Print Name of Principal

Social Security Number or SJCERA ID

 

 

 

 

 

 

Signature of Principal

County

 

 

 

 

 

 

 

City

State

Date Executed (mm/dd/yyyy)

SJCERA Special POA

Page 4 of 5

Put your name and

Social Security

Number or SJCERA

ID at the top of every Name of PrincipalSocial Security Number or SJCERA ID page

SECTION 8

To be completed and signed by two witnesses who are not named as Attorneys- in-Fact.

Witness Information

I have witnessed the Principal's signature or the Principal's acknowledgment of the signature designating power of attorney. I attest to the Principal's knowledge that I am of sound mind. I am an adult at least 18 years old and not the Attorney-in-Fact. My signature certifies that the Principal is known to me, is the same person who signed and dated this affidavit and that the Principal is of sound mind.

 

 

 

Signature of Witness 1

 

Date (mm/dd/yyyy)

 

 

 

 

 

 

Print Name of Witness 1

 

 

 

 

 

 

 

 

Witness 1 Address

 

 

 

 

 

 

 

 

City

State

Zip

 

 

 

 

 

 

 

 

 

Signature of Witness 1

 

Date (mm/dd/yyyy)

 

 

 

 

 

 

Print Name of Witness 1

 

 

 

 

 

 

 

 

Witness 1 Address

 

 

 

 

 

 

 

 

City

State

Zip

SECTION 9

To be completed by a notary public.

This section does not need to be completed if you have completed Section 8. SJCERA images these documents. Please be advised embossed seals may not appear when this document is imaged. An inked stamp is preferred.

Notary Public Acknowledgement

Notary

StateCounty

On _______________________ before me ________________________________________________,

Date (mm/dd/yyyy)Printed Name of Notary Public

personally appeared ________________________________________, who proved to me on the basis of

Printed Name of Principal

satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. I certify under Penalty of Perjury under the laws of the State of California that the foregoing paragraph is true and correct.

Witness my hand and official seal.

 

 

 

 

 

 

Signature of Notary Public

Notary Seal

 

 

 

 

 

 

 

 

 

 

Printed Name of Notary Public

 

 

 

MAIL TO:

 

SJCERA • 6 S. El Dorado Street, Suite 400 Stockton, California 95202-2804

SJCERA Special POA

Page 5 of 5

05/2020

Document Specifications

Fact Name Description
What is SJCERA SJCERA stands for the San Joaquin County Employees' Retirement Association.
Purpose The Special Power of Attorney form allows designated individuals to act on behalf of members regarding retirement matters.
Governing Law This form is governed by the laws of the State of California.
Eligibility Only SJCERA members can execute this form to designate an agent.
Agent Responsibilities The appointed agent can manage retirement benefits and make decisions as specified by the member.
Revocation Members can revoke the Special Power of Attorney at any time, provided they notify SJCERA in writing.
Submission The completed form must be submitted to SJCERA for processing and verification.

Steps to Filling Out Sjcera Special Power Of Attorney

Filling out the Sjcera Special Power Of Attorney form allows you to grant someone the authority to act on your behalf. After completing the form, you'll be able to provide it to the designated agent, ensuring they have the necessary power to manage your affairs as specified.

  1. Obtain the form: Download the Sjcera Special Power Of Attorney form from the official website or acquire a physical copy from your local office.
  2. Title Information: At the top of the form, write your name and address. Clearly indicate that you are the "Principal" granting the power.
  3. Agent Information: In the designated section, write the name and address of the individual you are appointing as your "Agent." Make sure the person is trustworthy and understands your wishes.
  4. Authority Granted: Specify the powers you want to grant. You may list the specific actions your agent can take on your behalf.
  5. Effective Date: Indicate when the power of attorney takes effect. This can be immediately or at a later date as you choose.
  6. Signature: Date and sign the form at the bottom. Your signature must be in your legal name.
  7. Witnesses: In some cases, you’ll need a witness or two to sign, verifying they saw you sign the document. Follow the form’s instructions regarding witnesses.
  8. Notarization: Check if notarization is required. If so, sign the document in the presence of a notary public, who will then add their seal.
  9. Store Safely: Keep the completed form in a safe place. Provide copies to your agent and any relevant parties.

More About Sjcera Special Power Of Attorney

What is the Sjcera Special Power Of Attorney form?

The Sjcera Special Power Of Attorney form is a legal document that allows an individual to designate another person to act on their behalf in specific matters. This is particularly relevant in scenarios where the principal may be unable to handle their own affairs due to absence, illness, or incapacity. The powers granted can be limited to particular transactions or broader, depending on the principal's needs.

What are the common uses for this form?

This form is commonly used in a variety of circumstances, such as real estate transactions, financial dealings, or medical decisions. For instance, if an individual is selling property but cannot be present to sign necessary documents, they may grant a trusted person the authority to sign on their behalf. In healthcare settings, this form can facilitate medical decision-making when the individual is unable to communicate their wishes directly.

How do I complete the Sjcera Special Power Of Attorney form?

Completing the Sjcera Special Power Of Attorney form requires several key steps. First, the individual appointing the agent should carefully read the entire form. Next, they should fill in the necessary information regarding themselves and the appointed agent, detailing the specific powers granted. It is crucial to sign and date the document in the presence of a notary public to ensure it is legally binding. Attention to detail is vital, as any mistakes could invalidate the document.

Can I revoke a Special Power Of Attorney once it is established?

Yes, a Special Power Of Attorney can be revoked. The principal has the right to revoke this authority at any time, provided they are mentally competent to do so. To initiate this process, a written notice of revocation should be drafted and can be delivered to the appointed agent and any relevant third parties who were notified of the original power of attorney. It is wise to also destroy any copies of the original document to prevent misuse.

Common mistakes

  1. Overlooking the Specificity Requirement: Many individuals forget that a Special Power of Attorney requires specific details regarding the powers being granted. Vague language can lead to misinterpretations and complications in the future.

  2. Not Identifying the Agent Clearly: It's crucial to clearly identify the agent who will act on your behalf. Failure to provide accurate name and contact information might render the document ineffective when it’s needed.

  3. Ignoring Witness Signatures: Some forms require the signatures of witnesses. Neglecting to obtain these signatures can invalidate the Power of Attorney, leaving your intentions unfulfilled.

  4. Filling It Out Without Consulting State Requirements: Each state has specific laws governing powers of attorney. Not complying with these regulations can complicate matters and create legal hurdles.

  5. Failing to Include an Date: The absence of a date is a common oversight. Without a date, the authority granted might be questioned, leading to potential disputes over the document's legitimacy.

  6. Not Discussing the Powers with the Chosen Agent: Many people complete the form without discussing it with their chosen agent. If the agent is unaware of their responsibilities or expectations, this can lead to confusion and challenges in executing your wishes.

Documents used along the form

The Sjcera Special Power of Attorney form serves a specific purpose, enabling one person to act on behalf of another in various matters. Several other documents often accompany this form to provide additional support or clarity regarding the authority granted. Below is a list of these forms and documents that may be relevant in conjunction with the Sjcera Special Power of Attorney.

  • Durable Power of Attorney: This document grants authority to an agent even after the principal becomes incapacitated. It ensures that financial or medical decisions can still be made on behalf of the individual.
  • Advance Healthcare Directive: This sets forth the medical preferences of an individual about treatment in situations where they cannot communicate their wishes. It often includes a living will and designation of a healthcare proxy.
  • Financial Power of Attorney: Similar to the general power of attorney, this specific document focuses solely on financial decisions, allowing agents to access bank accounts, pay bills, and manage investments on behalf of the principal.
  • Wills: A will outlines how an individual’s assets should be distributed upon their death. It can also designate guardianship for minor children.
  • Trust Documents: These documents establish a trust, which can manage assets during a person's life and determine how they will be distributed after death. They provide ongoing management and support for beneficiaries.
  • Living Will: This is a type of advance directive that specifically addresses an individual’s wishes regarding life-sustaining treatment should they become terminally ill or permanently unconscious.
  • Affidavit of Identity: This form may be required to verify the identity of the person granting authority in a power of attorney situation, especially in financial transactions.
  • Authorization for Release of Information: This document allows an agent to receive sensitive information, such as medical records or financial statements, necessary for them to act on behalf of the principal.
  • Property Transfer Documents: These documents facilitate the transfer of real estate or other property from one person to another and may be used in conjunction with a power of attorney for selling or managing property.

Having these documents organized and ready can greatly simplify the process of managing someone’s affairs. By understanding each of these forms, you ensure that the appropriate actions can be taken when needed, thus providing peace of mind for all parties involved.

Similar forms

The Sjcera Special Power of Attorney (POA) form shares similarities with the General Power of Attorney, which grants broad authority to an agent to act on behalf of a principal. Both documents allow individuals to delegate decision-making powers, ensuring that someone can manage financial matters, property, or other affairs when the principal is unavailable. However, while the General POA provides comprehensive powers, the Special POA is limited to specific tasks or timeframes, making it more focused in its application.

Another document related to the Sjcera Special Power of Attorney is the Durable Power of Attorney. This type of POA remains effective even if the principal becomes incapacitated. Like the Special POA, it allows an appointed individual to make decisions on behalf of the principal. The key difference lies in the durability; while the Sjcera Special POA may expire, the Durable POA remains in effect until revoked or the principal's death, ensuring continuity of care and decision-making even during a crisis.

The Healthcare Power of Attorney also bears resemblance to the Sjcera Special POA in that it permits an agent to make medical decisions on behalf of the principal. Both documents authorize another individual to take actions when the principal cannot, but the Healthcare POA specifically focuses on health-related matters. This document becomes particularly relevant in situations where serious medical decisions need to be made, contrasting with the financial or legal specificities that the Sjcera Special POA addresses.

A Living Will is another important document that overlaps in purpose with the Sjcera Special Power of Attorney. While the Special POA allows an agent to make decisions on behalf of the principal, a Living Will directs healthcare providers about the principal's wishes regarding medical treatment in end-of-life situations. Both documents emphasize the importance of personal agency and ensuring that one’s wishes are respected, but they serve different functions in the context of healthcare planning.

The Revocation of Power of Attorney document relates closely to the Sjcera Special POA, as it formally cancels any previously granted powers to an agent. This document can be used to revoke a Special POA when the principal decides to alter their course of action or appoint a different agent. Ensuring clarity in relationships and responsibilities, it emphasizes the principal’s control over their designations and reinforces the need for an updated document if changes occur.

The Financial Power of Attorney operates similarly to the Sjcera Special POA but specifically pertains to financial matters. This document empowers another person to manage financial transactions, such as paying bills or buying and selling property. The main distinction lies in its exclusively financial focus, while the Special POA can include a wide range of specific tasks beyond just finances.

The Medical Power of Attorney parallels the Sjcera Special POA in that it delegates specific health-related decision-making authority to a trusted individual. Although both types of documents have similar purposes in facilitating care, the Medical POA strictly pertains to medical issues. It gives the agent the ability to make choices about treatment, examination, and other health-related matters that the Special POA does not generally cover.

The Power of Attorney for Minor Children is another document that shares a functional similarity with the Sjcera Special POA. This document allows a caregiver to act on behalf of a parent or legal guardian when making decisions regarding the child’s welfare. As with the Special POA, it can be limited in scope and duration but focuses on guardianship and basic child care rather than general adult responsibilities.

Lastly, the Limited Power of Attorney is akin to the Sjcera Special POA in that it restricts the authority granted to a specific timeframe or task. Much like the Special POA, it is intended for particular situations—like selling a particular property instead of overseeing broader financial or healthcare decisions. Both ensure that the principal retains control over what decisions can be made and by whom, fitting particular needs and contexts without granting overarching powers.

Dos and Don'ts

When filling out the Sjcera Special Power of Attorney form, careful attention to detail is crucial. This form enables you to designate someone to act on your behalf in specific matters. Consider the following do's and don'ts to ensure a smooth process.

  • Do: Read the instructions carefully before starting.
  • Do: Provide accurate personal information for both you and your agent.
  • Do: Be specific about the powers you are granting to your agent.
  • Do: Sign and date the form in the appropriate sections.
  • Do: Keep a copied version of the completed form for your records.
  • Don't: Leave any required fields blank; incomplete forms may be rejected.
  • Don't: Use outdated forms; always check for the latest version.
  • Don't: Add additional powers or clauses that are not allowed in this form.
  • Don't: Forget to have the form witnessed or notarized if required by your state.
  • Don't: Alter the content of the form after signing it.

Misconceptions

The Sjcera Special Power Of Attorney form is often misunderstood. Here are five common misconceptions:

  • It can only be used for financial transactions. Many believe this form is restricted to finances. In reality, it can also grant authority for health care decisions and other matters, depending on how it is drafted.
  • Only lawyers can fill out the form. While legal advice can be helpful, individuals can complete the form themselves as long as they clearly understand their intentions and the authorities they wish to grant.
  • Once signed, it cannot be changed. This is not true. The form can be revoked or modified at any time, as long as the principal is mentally competent and follows the appropriate process.
  • It must be notarized to be valid. Although notarization is recommended to enhance the document’s credibility, many jurisdictions accept a witness signature in lieu of notarization.
  • It becomes effective immediately upon signing. Some believe the authority starts right away. However, the form can specify that it takes effect only under certain conditions, such as when the principal becomes incapacitated.

Key takeaways

Here are some important points to keep in mind when working with the Sjcera Special Power Of Attorney form:

  • Understand the Purpose: This form allows you to designate someone to act on your behalf in specific matters. Ensure you know what decisions your agent can make.
  • Choose Your Agent Wisely: Select someone you trust completely. The person you choose must be responsible and understand your wishes.
  • Complete the Form Carefully: Fill out the form accurately. Any mistakes or omissions could affect its validity.
  • Consult a Professional: If you have questions about filling out the form or your specific situation, seek guidance from a legal expert.

Using this form thoughtfully can give you peace of mind, knowing that someone you trust can handle important matters when you are unable to do so.