(755 ILCS 45/3-3) (from Ch. 110 1/2, par. 803-3)

Sec. 3-3. Statutory short form power of attorney for property.

(a) The
 form prescribed in this Section may be known as "statutory property power" and may be used
to grant an agent powers with respect to property and financial matters.
The "statutory property power" consists of the following: (1) Notice to the Individual Signing the Illinois Statutory Short Form Power of Attorney for Property; (2) Illinois Statutory Short Form Power of Attorney for Property; and (3) Notice to Agent. When a power of attorney in substantially the form prescribed in this Section is used,
including all 3 items above, with item (1), the Notice to Individual Signing the Illinois Statutory Short Form Power of Attorney for Property, on a separate sheet (coversheet) in 14-point type and
the notarized form of acknowledgment at the end, it shall have the meaning
and effect prescribed in this Act.

(b) A power of attorney shall also be deemed to be in substantially the same format as the statutory form if the explanatory language throughout the form (the language following the designation "NOTE:") is distinguished in some way from the legal paragraphs in the form, such as the use of boldface or other difference in typeface and font or point size, even if the "Notice" paragraphs at the beginning are not on a separate sheet of paper or are not in 14-point type, or if the principal's initials do not appear in the acknowledgement at the end of the "Notice" paragraphs.

The validity of a power of attorney as
meeting the requirements of a statutory property power shall not be
affected by the fact that one or more of the categories of optional powers
listed in the form are struck out or the form includes specific
limitations on or additions to the agent's powers, as permitted by the
form.  Nothing in this Article shall invalidate or bar use by the
principal of any other or different form of power of attorney for property.
Nonstatutory property powers (i) must be executed by the principal, (ii) must
designate the agent and the agent's powers, (iii) must be signed by at least one witness to the principal's signature,  and (iv) must indicate that the principal has acknowledged his or her  signature  before a notary public.  However, nonstatutory property powers need not
conform in any other respect to the statutory property power.

(c) The Notice to the Individual Signing the Illinois Statutory Short Form Power of Attorney for Property shall be substantially as follows:

"NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY.

PLEASE READ THIS NOTICE CAREFULLY. The form that you will be signing is a legal document.  It is governed by the Illinois Power of Attorney Act.  If there is anything about this form that you do not understand, you should ask a lawyer to explain it to you.

The purpose of this Power of Attorney is to give your designated "agent" broad powers to handle your financial affairs, which may include the power to pledge, sell, or dispose of any of your real or personal property, even without your consent or any advance notice to you.  When using the Statutory Short Form, you may name successor agents, but you may not name co-agents.

This form does not impose a duty upon your agent to handle your financial affairs, so it is important that you select an agent who will agree to do this for you.  It is also important to select an agent whom you trust, since you are giving that agent control over your financial assets and property.  Any agent who does act for you has a duty to act in good faith for your benefit and to use due care, competence, and diligence.  He or she must also act in accordance with the law and with the directions in this form.  Your agent must keep a record of all receipts, disbursements, and significant actions taken as your agent.

Unless you specifically limit the period of time that this Power of Attorney will be in effect, your agent may exercise the powers given to him or her throughout your lifetime, both before and after you become incapacitated.  A court, however, can take away the powers of your agent if it finds that the agent is not acting properly.  You may also revoke this Power of Attorney if you wish.

This Power
of Attorney does not authorize your agent to appear in court for you as an attorney-at-law or otherwise to engage in the practice of law unless he or she is a licensed attorney who is authorized to practice law in Illinois.

The powers you give your agent are explained more fully in Section 3-4 of the Illinois Power of Attorney Act.  This form is a part of that law. The "NOTE" paragraphs throughout this form are instructions.

You are not required to sign this Power of Attorney, but it will not take effect without your signature.  You should not sign this Power of Attorney if you do not understand everything in it, and what your agent will be able to do if you do sign it.

Please place your initials on the following line indicating that you have read this Notice:

.....................

Principal's initials"

(d) The Illinois Statutory Short Form Power of Attorney for Property shall be substantially as follows:
"ILLINOIS STATUTORY SHORT FORMPOWER OF ATTORNEY FOR PROPERTY

1. I, ..............., (insert name and address of principal)
hereby revoke all prior powers of attorney for property executed by me and appoint:

..................................................................................................................................................

(insert name and address of agent)

(NOTE: You may not name co-agents using this form.)

as my attorney-in-fact (my "agent") to act for me and in my name (in any
way I could act in person) with respect to the following powers, as defined
in Section 3-4 of the "Statutory Short Form Power of Attorney for Property Law"
(including all amendments), but subject to any limitations on or additions
to the specified powers inserted in paragraph 2 or 3 below:


   (NOTE: You must strike out any one or more of the following categories of
powers you do not want your agent to have.  Failure to strike the title
of any category will cause the powers described in that category to be
granted to the agent.  To strike out a category you must draw a line
through the title of that category.)

(a) Real estate transactions.

(b) Financial institution transactions.

(c) Stock and bond transactions.

(d) Tangible personal property transactions.

(e) Safe deposit box transactions.

(f) Insurance and annuity transactions.

(g) Retirement plan transactions.

(h) Social Security, employment and military service benefits.

(i) Tax matters.

(j) Claims and litigation.

(k) Commodity and option transactions.

(l) Business operations.

(m) Borrowing transactions.

(n) Estate transactions.

(o) All other property transactions.

(NOTE: Limitations on and additions to the agent's powers may be included in this power of attorney if they are specifically described below.)

2. The powers granted above shall not include the following powers or
shall be modified or limited in the following particulars:

 (NOTE: Here  you may
include any specific limitations you deem appropriate, such as a
prohibition or conditions on the sale of particular stock or real estate or
special rules on borrowing by the agent.)

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3. In addition to the powers granted above, I grant my agent the
following powers:

 (NOTE: Here  you may add any other delegable powers including,
without limitation, power to make gifts, exercise powers of appointment,
name or change beneficiaries or joint tenants or revoke or amend any trust
specifically referred to below.)

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(NOTE: Your agent will have authority to employ other persons as necessary to enable the agent to properly exercise the powers granted in this form, but your agent will have to make all discretionary decisions.  If you want to give your agent the right to delegate discretionary decision-making powers to others, you should keep paragraph 4, otherwise it should be struck out.)

4. My agent shall have the right by written instrument to delegate any
or all of the foregoing powers involving discretionary decision-making to
any person or persons whom my agent may select, but such delegation may be
amended or revoked by any agent (including any successor) named by me who
is acting under this power of attorney at the time of reference.

(NOTE: Your agent will be entitled to reimbursement for all reasonable expenses incurred in acting under this power of attorney.  Strike out paragraph 5 if you do not want your agent to also be entitled to reasonable compensation for services as agent.)

5. My agent shall be entitled to reasonable compensation for services
rendered as agent under this power of attorney.

(NOTE: This power of attorney may be amended or revoked by you at any time and in any manner.  Absent amendment or revocation, the authority granted in this power of attorney will become effective at the time this power is signed and will continue until your death, unless a limitation on the beginning date or duration is made by initialing and completing one or both of paragraphs 6 and 7:)

6. ( ) This power of attorney shall become effective on

..................................................................................................................................................

(NOTE: Insert  a future date or event during your lifetime, such as a court
determination of your disability or a written determination by your physician that you are incapacitated, when you want this power to first take effect.)

7. ( ) This power of attorney shall terminate on

..................................................................................................................................................

(NOTE: Insert  a future date or event, such as a court determination that you are not under a legal disability or a written determination by your physician that you are not incapacitated, if  you want this power to terminate prior to your death.)

(NOTE: If you wish to name one or more successor agents, insert the name and address of each successor agent in paragraph 8.)

8. If any agent named by me shall die, become incompetent, resign
or refuse to accept the office of agent, I name the following
(each to act alone and successively,
in the order named) as successor(s) to such agent:

..................................................................................................................................................

..................................................................................................................................................

For purposes of this paragraph 8, a person shall be considered to be
incompetent if and while the person is a minor or an adjudicated
incompetent or a person with a disability or the person is unable to give prompt and
intelligent consideration to business matters, as certified by a licensed physician.

(NOTE: If you wish to, you may name your agent as guardian of your estate if a court decides that one should be appointed. To do this, retain paragraph 9, and the court will appoint your agent if the court finds that this appointment will serve your best interests and welfare.  Strike out paragraph 9 if you do not want your agent to act as guardian.)

9. If a guardian of my estate (my property) is to be appointed, I
nominate the agent acting under this power of attorney as such guardian,
to serve without bond or security.

10. I am fully informed as to all the contents of this form and
understand the full import of this grant of powers to my agent.

(NOTE: This form does not authorize your agent to appear in court for you as an attorney-at-law or otherwise to engage in the practice of law unless he or she is a licensed attorney who is authorized to practice law in Illinois.)

11. The Notice to Agent is incorporated by reference and included as part of this form.
Dated: ................
Signed .....................................................................................................................

(principal)

(NOTE: This power of attorney will not be effective unless it is signed by at least one witness and your signature is notarized, using the form below.  The notary may not also sign as a witness.)

The undersigned witness certifies that ..............., known to me to be
the same person whose name is subscribed as principal to the foregoing power of
attorney, appeared before me and the notary public and acknowledged signing and
delivering the instrument as the free and voluntary act of the principal, for
the
uses and purposes therein set forth.  I believe him or her to be of sound mind
and memory. The undersigned witness also certifies that the witness is not: (a) the attending physician or mental health service provider or a relative of the physician or provider; (b) an owner, operator, or relative of an owner or operator of a health care facility in which the principal is a patient or resident; (c) a parent, sibling, descendant, or any spouse of such parent, sibling, or descendant of either the principal or any agent or successor agent under the foregoing power of attorney, whether such relationship is by blood, marriage, or adoption; or (d) an agent or successor agent under the foregoing power of attorney.

Dated: ................

..............................

Witness

(NOTE:  Illinois requires only one witness, but other jurisdictions may require more than one witness. If you wish to have a second witness, have him or her certify and sign here:)

(Second witness) The undersigned witness certifies that ................, known to me to be the same person whose name is subscribed as principal to the foregoing power of attorney, appeared before me and the notary public and acknowledged signing and delivering the instrument as the free and voluntary act of the principal, for the uses and purposes therein set forth. I believe him or her to be of sound mind and memory. The undersigned witness also certifies that the witness is not: (a) the attending physician or mental health service provider or a relative of the physician or provider; (b) an owner, operator, or relative of an owner or operator of a health care facility in which the principal is a patient or resident; (c) a parent, sibling, descendant, or any spouse of such parent, sibling, or descendant of either the principal or any agent or successor agent under the foregoing power of attorney, whether such relationship is by blood, marriage, or adoption; or (d) an agent or successor agent under the foregoing power of attorney.

Dated: .......................

..............................

Witness

State of ............)
) SS.
County of ...........)

The undersigned, a notary public in and for the above county and state,
certifies that ......................., known to me to be the same person
whose name is subscribed as principal to the foregoing power of attorney,
appeared before me and the witness(es) ............. (and ..............)   in person and acknowledged
signing and delivering the
instrument as the free and voluntary act of the principal, for the uses and
purposes therein set forth (, and certified to the correctness of the
signature(s) of the agent(s)).

Dated: ................

..............................

Notary Public

My commission expires .................

(NOTE: You may, but are not required to, request your agent and successor agents to provide specimen signatures below.  If you include specimen signatures in this power of attorney, you must complete the certification opposite the signatures of the agents.)

Specimen signatures of         I certify that the signatures
agent (and successors)         of my agent (and successors)
                               are genuine.
..........................     .............................
         (agent)                       (principal)
..........................     .............................
    (successor agent)                  (principal)
..........................     .............................
    (successor agent)                  (principal)

(NOTE: The name, address, and phone number of the person preparing this form or who assisted the principal in completing this form should be inserted below.)

Name: .......................
Address: ....................
..............................
..............................
Phone: .................... "

(e) Notice to Agent. The following form may be known as "Notice to Agent" and shall be supplied to an agent appointed under a power of attorney for property.

"NOTICE TO AGENT

When you accept the authority granted under this power of attorney a special legal relationship, known as agency, is created between you and the principal. Agency imposes upon you duties that continue until you resign or the power of attorney is terminated or revoked.

As agent you must:
(1) do what you know the principal reasonably expects you to do with the principal's