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8.0 Power Of Attorney Confirmation
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Forrn 2
Queenslond
Powers of Attomey Act 1998
(Section 44(1))
rt
Shelley lGy priesflw
J.P. (Qurit) t&slt '
dated
that this is a hue copy
sighted on
have
POIF/ER OT AT*TGRNEY
$lr*rt F*r"*r
Use this document if you wish to oppoint the same ottorney/s for
both finonciol matters ond personol motters (including health
core).
You moy olso use it to oppoint an attorney (or attorneys) for
finonciol motters only or for personal motters (including heolth
core) only.
This document can be used by non-English-speokers if o
quolffied interpreter/tronslotor reads it to the person in the
person's own longuoge ond o signed Stotement of Interpreter/
Trqnslotor is ottoched.
Government
ver:?,*UO6/O2 and Attorney-Genelal
I
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Page 2
that this is a true copy / Shelley Kay Prlestlev I have J.P. (Qual) 78507 ' sighted on [OCR of page images] Lis that opie patel ifs ee aS Sp
Page 3
iART l. For the pelsoil appoirtlng an attorney
By cofipkling this docufienl, yau con give o person oflout choice the
power to mske .decisions on your bfholf
I certity that lhis is a true copy
) petsonaAheslthfiatte$ ol the orJoinal
E..e.o;.A. -.
onal/ot cateci.?e^Vl*. rhat I havc
siqhted on lll()A/.40........
a financial matters. J.P 78507 '
These poges elpl.litl, i, qnes|ion-anLl-ons\'ver form, hlhat you neeal to knaw
lo con plete the doturnent pro?erll.
What is endrrtii3.l.***. 6t ittt6lll1er:
Power of ottorney is t}Ie legol power to moke decisions on someolte
clsl"'s heholl. 'tnduring'simply meons lhot thc powcr conlinuei even il
the pe$on giving it lose.s the cofoclty to moke decisions-
rilhy give *or'treone endrrrinli ;]r,t ..rt attorrett .1.
There orq Some circumstonces in which you 41hy be unohle to rndke
decisions dbout motters thot c{rn em you.Ior exomple, yoE moy be
., overseos, or you moy be too ill: .. .. .,i,
Ifyou give someone o genercl power of ottomey, for instonce to sign
docume[ts for you in yourobseace, thqt power]rill come to on
immediate end if for soite reoron you iose your capqcity to ,nole
de.isions. This could be very owkword ifyour ottorney is in the process
af conduding business offoirs for you.
CiviBg someone endunng power meons thot lte/she is oble tl) contir[e
to aet for you iayou lose copocity to oct for yorlrell.
lilh;:r --1rDr.r: o! J;ri*rxrl
y6u inoy givc your ottomey power to make dccisions oborrl:
I Iersonlrl/heollhmoflers;
: linoncial matteIs.
Exomples of persondl/heolth rBotters sre deaisions about where ond
wilh whom y,)u livc. whelhcr vou work or undcrluke educution or
troining, whether you opply for o licence or permit, doy-to-doy issues
like diet al[d dress, ond whether to consent, refuse to coR3ent or
withdroh. coruent to porticulor lypes of heolth core lbr you (such os on
operotion).
An exqaple olo finonciol Eratle! is de€iding hoirr' y{lu. in.ome should
l
Page 4
I ce.tfy lhal this rs a kue copy
of the orornal
E..P,!)r",A
Shelley Kay Prlestley daledaalLl./rg. rhat I hav'
J P. (aual) 78507 sighiad.on .Il,/o!!.r4o.....;
Note.' You connot give your otlofiey powet to moke deasions obout
I speaio/ personoi mrtet5 surh os o deo:s,on obout yout will, oppoin irt sooetne
as yout alloney, voting ot election, ot consenljng to adoption or fioftioge;
a spe('al heotth rnctle,s. su<h as donoton of body ussue, sterrlisouon lregDan.v
tenninatigh, rcsea.ch ot exPerimenlol heolth core, or ceftoin psy<hitltic or.t)ret
neo h cdt? ot sp{died n the reg'.tlotnns.
Yout ot|arney con.onsent to lhe w)Urdro|'ro g ot "r'nnholdne of life-ustoinng aed;cot
trcotment tf, fot instdnce, you be.ome tetminol! ill or go into o stote of permoftent or
pers;slenl unconsciolsress. You c.in Sive lrstrr.nom obou, this type of de<jsion if you
make on AdvoncP Aeahh Dte(]ive.
fhese instrr.r,ors will ove ide ony de.isiott of yoot onorney.
(-"n ll,r,,i.,n, rr,.'r.-y r, .u .,.1
. Yes, you con specify decisions thot yoir do nol wont your dttomey to
moke. You cqn olso include porticulor instruclions obout whol you
. would like your ottomey to do. Your ottorney must oct in occordonce
with Your instruction
There orc (rko limits set by legiiJotion. tor exomple, the Trust Act
. nomes the type$ of investment that o hustee (in this cose youl
ottoEey) is 4lthorised to make. lf )'ou lose the copocity to moke
tinonciol decisions, the only trvestments yolr'qttomey con moke on
you! behalfore those that ote norled in the Att, unless the conseDt of
(he Courl r5 obtoined.
aaa t r',}{)r.it :!:rrc thrrr or:ts dttorn(.r-
Yes. Severol options ore pro\.ioed for In the Act. For exomple, yoLl mov
oppoint two or m9Je ottorneys to dct ioialy (together), or os o
moiority (simple, t!rd{hj!ds, etc.), or sererolly (ony one of your
qttom€ys con sigr), ol.st cce$sively (po1{er h given to o povtifillol
ottomey when the power given to onother ottomey ends, or when the
other ottolney is not ovdiloble lo moke decisions).
If you choose two or morc ottomeys to moke decisions iolntly, they
hove equol outharlaF ond(an oct only irith the ogreement ofthem oll
lfone ottoma), dies, the remoining ottoroeys exerclse the power.
It is importont thdt your inteltior$ be expressed deody. Ther€ is spoce
in this docurnent to oppoint up to three ottomeys.
at'p.. :,,- .r ':/ ,: . .. /:
You should dppoint someone you trust. Mony people choose thei!
spo$e or on odult chlld, but you moy prefer to oppoint onodrel
idmily member or friend 1!ith expe.ti$e in the oreo, or the Adult
Guordion lor penonol/hedlth irotteas, or the Public Trustee or o
trustee romponyforoll $otte6. {lheAdult Cuordiol is qppointed by
1
Page 5
Shelley K?y Prksllcy
J.P. (Oual) 78507
stahlte to look ofter the rights ond inter€sts of people rr/ith
I ceiliJv ihai tlrls G , t.Lre coPY disobilities and, in celtoin situotions, to give heolth-eore consent.)
.rl the or c lral
..E.P.o-"A .r.,.. .. .......... Your ottomey must bF over eighleer yeors of ogp. mu\l not be your
{lai.r Aa./l l/18 ,l'ir rhrve
s q1.) o" t[/o8/eo culrent poid corer ol heolth-coE provider (such os your nurse or
your doctor), ond (for finonciol motters) must nal be bonkrupt or
insolvent.
'Poid corcr' docs not neon someone r,c?ir'ing o .orer's pensirn or $mi,or b€neia ro
you ore Free to choose someone whq is re(eiving su(h d benzftt fot lookitg off.er you.
sh{,uld I pi/ ,rr, attorney?
You do not nep-d to pay your dttomey fo, th3 power to be effecllve.
' Normolly po)..nent is not mqde unless o t ust Ccimpqny is aating os
ottomey.
\irhefl ti€s ih6 atto&et'5 t gi:}?
'r.'ta.
With p€$onol/heolth motte$, your ottomey s power to.muke decisions
does not begin until (if ever) you ore incop.rble of undeiatqnding the
nqtuil and foresseing the effects of o decision, ond of communicoting
thot deLision.
With finonciol motters, you moy nominote when yolrr Ottomey's
power is to begir. lfyou do not.ncure o dote or an oacosion, it begins
immediqtely. Or1 the other hond, :f you lose the copocily to moke such
decisions before the dote or occasion you ndme, the power begins ot
rhot point.
,Vot€: Even if you g*e you onomey powet innediotely, you moy dlso rcntIltue to mokc
decisions youself while yo! ,re ohre to do so.
*rrl ..ritrol .vil, l]t }ta3rl]1il }'.'.ei
',arr. Once the power to mqke o decision begins, your ottorney will hove full
control over thot decjxion unless you hove explicitly limited thot power
in this document-
,{ot.i lt ,s bener noa to p/o<e too mony .esri.&'onr on your ottomey's p|wer, os this moy
,r,oke it diffEutt fot your o@rney to moke dctisions on yow beho[.
How ;., ., I ., t 1.. r .rwe| co,,i ..
'
For personol/heolth motte.s, it contilues ro long os you ore.incopirble
''' of understanding the nature ond foreseei4g the effects of o decision,
ond ot communicoting thot decision.
With finonciol mofle$. it continuer until il is revokeLl.
While (if ever) you ore unoble t6 owtsee your otlomey's decisions, the
Adult Cuodian ond the Court hove the power to prot€ct your
. intereslr. Your ottomey moy be requiled to produce o summory of
'-,:: receipts and expenditur€ or mor€ detoiied dccounts) ond these may
qudited. An ottomey who does not odequotely prctect your
' be
interesls (on he temovcd or chonged,
5
Page 6
n
//l .e fy that th s is a true copy
//(tu. rr'l-e.no-h".rrr/(Jo'a&^
.rl iire onorna
Shetley Kay Prieslley -'.1 ii'i^-e t't
---t ru '
cen lchangeorrevoKe (l' \poweroJa-(r'.<rl Jpioual)?8507'
Yes, you moy chd11i]o or revoke it (r1 ony time, so long os you ore
copubie of understandjng whot you are doing. ln other \^iords, so
ldng os you how.i.ire copocity to mok€ on endu Irg power of
ott,,mev. yuu oho huve the (opo(iN ln thongc or levokc il.
If you do chonge (, rFvole thir po\ pr. you mu\r inlorm vour
utlorney,
ls tl1er€ anything e:3* t|*t.r/ill end th;s prwerl
.. Yes,.severol other ci(umstonces wiil ttrlrg this cndu ng power of
olturney to on end:
I Ifyou gel mor ed. llyou morry. Ihc power o, orl'rney N
revoked unless your new spouse it olreqdy your otlorney. (Ifyour
new spouse is your ottorney, the only power thot i5 revoked is the
lro\ er of ony other qttorney you moy hove.)
. I If you get divorced..Ifyou divorce, the power of ottirmey is
,. rcvoked to the extlrxl lhot it wos given to your former spouse.
!f you die. llyou die the endudng power of ottomey js rcvoked
ill lts entirety.
I lf you mo](e oD itraorsistent documert. This power is revoked
lo lhe cxln,rl 6f on) rn,,nnsisren{ } wt,h .rnv l(lryr d, (unrpnt you
.. compiete, such os an Advalnce-tlecLllh Direco"e or onother
endutnq puw{rr ol orlom' !
I Ifyour ottorney withdtows. Your ottorney moy withdrow by
giving you o signed l]ottce or by getting lhe Court's leove to
withdrow.
I If you! ottorney becomes your poid corer or heolth-care
provider. ll rhr\ lrdpp. n\. y(,ur dllornr') \ l,uxc .\ tFvt,kp.i
! Ifyour oltorney becomes incupoble. l'rur ,lrrornel r por{er i\
revoked if he/she becomes incopoble ofundalstonding the nalur€
on(l foresecin!l thc effects olo decision, ond of communicdting
thot declsion.
I lfyour attorney becomes bonkrupt or insolvena.
I Ifyour dttorney dies.
AI leosl three people:
I Yot, os p.incipol, complete lhe section oi Port 1 .olled
Appoinling on.{llnrn€, (Clou\e\'l to 8,.
' lliou hove o physicol disobiliq/ which pyevents you from
.signjng, you moy insbuct onothcr person to sign lbr you, but you
musi give the instnl.tion ir hont of the wilness, ond lhe sigr}ing
musl be done in !our prpspnce. fhi, persor must be elqhrcen
yeors old or moae, ond must not l)e lttd witness or you, cltlomey.
He/she n)ust complele the stoienteta b$lde the plo.e tor his/her
\iUnoture.
6
Page 7
: The wi.lrert must sign f'crt 1 qfter cl(ruse.S lnd musa olso
complcre rhp sF.tion ol nod 2 collFd I h" Wlnctr's Ccrlifi.otc
t,
S relley Kay Priestley
I P (Qdall78507
(Clouse 9),
The witrteso must be q luslice of the pe{rce, commissioner for
decloaotions, lowy€. or notory public. The witn€s5 must not olso
sign for you ond *lust not be your ottorney, q.-aelotion of yours or
of the persolr/s yatl oppoint os ottorney. If tha pow€r includes
deolrng hilb hpollh m;flers. lhe wirnes\ m!rtl nor bn your currcnr
lcedify thal rhrs rs a hLr? copy pojd corer or heolth{ore provider.
o!the ofioraal
E. P. CI. A the witness rtsl st6te thot Jrou oppeared to understoBd v/hot you
dated 3.2.11\/\?,. thar I have were doing. lltha witness is not sure thot you under$lond the
slqht.d cn \\/c6la/o...... . noture and etfect oflhe oppointment, he/she shoujd rcfuse to
sign the document.
Ihe ottomey must complete the sertion in Port 3 called
Attomey: s Acceptonce (Clouses 10-12).
t our ollomey musl br dt leost eighteen vedrs old ond must not
be your Lurrent poid corer c'r heolth-core provider.
\rYt.r. .ar'r I tr t. rrYi.ri
The Adult Guqrdion, the Publjc Trusiee or o solicitor con odvise you
oboirl lhe enduring power cfotlorney ond how to completc this
do.ument.
lI you ore .ompleting on enduring power of ottonley fbr peNonol./
heolth moiters, it is strongly recommendcd that you nolify your
doctor.
V.laa happl.ns It Llii ik,..i:jt1,i".t wh.t i. i! co,-rilie!*r:
You should leove the original in o sofe place, suah os with youl bonk,
but it's importont ro keep o copy to r.efer to.
You should oLo give o copy lo onyone else who
involved, such os:
I your ottorneyi
I your doctor;
! Your solicitor;
! your occountont;
I your stockbrokcr.
You mdy olso wish to corry o cqrd in ,-our pu.se or woilet, sloting thot
you hove mode on endudrlo power of otlomey ond giving detoils of
lhot 4ppoinlment
If your ottomey will be moking decisions obout buyingolselling lond,
lhrs document mu\t bc registered wilh $e Lorld Iirler. Omcr.
It is not necessory to do so unless it is likely to be used in tronsoctions
reloaed to buying or selling lond. If ),ou regisler tie document, you
must tdke the originol to the Lond Iitles Office ond p6y the fee.
If the power is revoked, you musl dereg;ster the document by Iodging a
revocotion form in &e Lond Titles Of{ice.
1
Page 8
this is a true copy
have
sighted on \\/o?/.
AFFOINTING AN ATTOHNfY J.P 78sO7
As principal, you complete this form by writing on the lines and ticking the
appropriate boxes.
1. I, lnltLLl84 t- t'" '/ r:- T-; /; hK/ tiAD f n( 5d
1<'
of to g Btn CK tYo
lPrint
4 N&€ ,4 04b
[Print your herel
,L
Loo a
oppointAuox [7 RE-r H B UTL{ &
tull first ottomey
tPrint the nome of your herel
of 2Aa Btrqc k ty 0 /{ R nru&€ RON DcJ
first
^/fft/IPrint odfuess herel
/.oor<c,t /r- 3 Ph 07 5++76 s#
ond KARE:V L /NbA L €OTVARD
lPrint the full nome of your second ottomey if you wish to oPpoint more thon one
OB rule o line thraugh thls and the next 5 lines if you wlsh to appoint only one.l
of )s EUTvGELLA bRtt/{ attorneyl
[Print here the oddress
R INCK Ho U/V Ph: 0 d t0
ond
IPrint full nome of third ottorney if you wish to oppr:int three
OR rule a llne through line ond the 2 llnes if you wish to oppoint only two ottomeysl
of
:l IPrint the oddress your third ottorneyl
Ph:
os my ottorney/s, under this enduring power of ottorney, for (Tick one box on$);
I finonciol motters
[l personol/heolthmotters
ff no""cial and penonol/heolth motters.
Do you wont to set ony terms for the Ircwer given in clouse I (i.e. give specific
information obout your wishes)?
E'*o + Go to 4.
Yes.
8
Page 9
3. Write these terrns here: fior example: oMy attomeyls is not authorised to inraesf in ABC
Pty Ltd shates" or "If I need nurs'ng-home care, I want my attomey to try XYZ Nursing
Home first".)
Note: fhese tefins may llmit your attomey ln making decriions about ffnancial malters.
4 Hqve you given your oftorney/s Dower to moke decisions obout finonciol
'
motters? n
,ru.
I certify that this is a true copy
tr No+ Goto6. g:h:.H-'frI
Srrerev Kav priesrrev d-ai;a da7ilAd..,'ihat i [;;;
Yes
.r p iorai) zasoz'-' sighted on IVCA/A,Q.
5 l{Ihen do you wont the power of your attonrey/s for finqnciol motters to begin?
(Iick one box only)
pf lmmediately.
tr on this dote:
[Write here the dote when you wont the power of yourottorney/s to begin]
On this occosion:
[Write here the occosion when you wont the power of your ottorney/s to begin]
(If you do rwt camplete this clause the power begins immediately.)
6. Are you oppointing more than one ottorney?
No r Goto I
d Yes.
7. How do you prefer that they moke their decisions? (fick one box only)
tr Severally (ony one of them may decide)
ff lointty (unonimousty)
As o mojority (if you ore appointing more thon three ottorneys, pleose specifz,
e.g.'Simple mojority','Two-thirds mojority')
tr othep
'Note Ifte Powers of Attomey Act t99E allows you to apryint successiye aftomey/s fot a matter so that the paryer ls
glven to a Partianlar attamey anly when pawer to a pr*iaus attomey ends. You can noninate the ctrcunstances
that a pwer will end 1e-9. tf x k absmt from the iufudtction y may act).
I
Page 10
8. STATEMENT OF I.'NDERSTANDING
(1) I fuIly understond t}ot, by signing this document I give power to the ottorneyls
mentioned in clouse 1 to make decisions on my behalf obout motters mentioned
in the some clouse.
Q I understond thot I moy specify or limit the ottorney/s power, ond instruct the
attorney/s obout the exercise of the power.
(3) I understand thot this gives the attorney/s power to do, for me, anything I could
Iowfully do myself in relotion to these motters (except for speciol personoUheulth
motters), subtect to ony terms mentioned in this form.
(4) I understond thot:
(o) the power of ottomey for financiol motters (if opplicoble) begins ot the time
stoted in Clouse 5 ond continues even if I lose copocity;
(b) the power of ottorney for personol/heolth motters (if opplicoble) begins only
if/when I lose copocity.
(5) I understond thot I moy chcnge or revoke this enduring poryer of ottoiney ot ony
time so long os my power to make such o decision is not impoired-in other
words, so long os I om capoble of making another enduring power of ottorney.
[Principol signs here]
or
If you ore signing for principol:
signs herel
(o) I am ot leost eighteen yeors old
(b) I om not o witness for this enduring
power of ottomey or on ottomey for It I
the principol. IWitness the date herel
[Person stgning for the principol signs herel
I certity that this is a true copy
[Person signing for the principal of the orioinal
print your full nome herel E-P-.o"".A-
Shelley Kay Priestley oated afl/.iVis... ih;t i'h;;;
J.P. (Qual) 78507 sighted on .tllOa/.?"o.,.,.,...
fWrite the dote here]
Page 11
For the witness
\AlITNESS'S CERTIFICATE
Cortplete this fomt by writirtg on the lines and ticking the appropriate boxes.
9. l,
[Print your I nome herel
stote thot-
(o) I om a:
I certify that this is a true
justice of the peoce
,A
of the orioinal
commissioner for decl arotions .E,'.eD^n..
lowyer dated 4X4E18.... tnat r
Shelley Kay priesilev
sighted on ,lIIcB/4"O
notory public, J.P. (Qual) 78s07
(b) I om not'
. on ottorney for the principol
a or o relation of the principol or of the principol's ottorney
(c) ('Iick one fux only)
tr I om not a current poid corer or heolth provider for the principol
n I om o current poid corer or heolth provider for the prindpol, but this enduring
power af attorney appoinb on ottorney/s for financiol motters only.
Note.' 'Paid core( does not rneon sorneone receiving o core/s pension or simtlar beneftt
(d) (Tickone fux only)
m the principol signed this enduring power of ottorney in my presen(e
u in my presence, the principol instructed o person to sign this enduring power of
attorney for the principol, and thot person signed it in my presence ond in the
presence of the principal
and
(e) at the time thot this enduring por rer of ottorney was signed, the principol
oppeored to me to understond the motters stoted in Clause 8.
signs herel
rr / rx
IWitne,ss the herel
J
Page 12
I cedify thatthisjs a kue copy
ofih! oriorn3l r',
€,P-o.A.....,....,..:,.,.. ...........
dated aAl.l/!6.. ihal I have
_ Shelley Kay Pnestley sighled on .lt/tdla.*..........
PAR-T 3: I-of me ilfol,ney J.P. (omr)76507
II{PO!T&'IT NOTICE
lfyou qrcept this power ofottomey, you will be loking on scrious
rcsporLsihillties. lf you ioil to observe these responsibilities, you could
be aemoved os oltorney or e!?r convicted of on offeqce ond required
to poy $mpeBotion
Besides the porticulor responsibilities mentlaned in Port I ofthis
do( ument. there ore responsibilities impos ed bl Lhe PowPrs nt Allomey
Acl 1998.
l^/hat arlf l-h.se ftrspc,rsiirilitiesr'
They ore both generql ond specific.
Generol tesponsibilities (to guide you in decision-moking)
You must exercise the powe. qiven to you honestly oIId with.
reosonoble (ore. lt is oE offence not to do qo, ond you mov olso be
re{.lulred to (,'mpen\dte lhe principol.
yau must comply with the terms ofthe e[dutng power of qttorney,
any o.th€r Court requircment. In oddition, you must obide by the
qanerol ond heol*1-cole principles on which lhe Act is bosed.
6 e n ero I pr inc iple s itclude:
i prcsuming thot the plincipol hos the copocity to moke o
particular decision until there is conclusive evidence thot this is
not the cose;
I rccognising hislher right to participot€ in decislons ofleding I'tis/
her life to the lnoximum exteni for which helshe hos copocity;
!l respecting the pdncipol's humon worth ond dignity ond equol
cloim to bosic humon rights, regordless ofhis/her copocity;
I recognising the principol's role os {: vqlued member of society
ond en.ouroging his/her self-relionce old porticiE)tion in
community lile;
I toking into qccount the impotonce of the principolt existjng
supportive rclationships, values ond culturul qnd linguistic
environIrlertl;
I ensuriog thot your decision$ oie oppropriote lo t]1e plincipoi's
chorLrclenstics and needs;
I recognising the principol's right to confideDtiolity of information
t2
Page 13
I certity that this is atrue copy
,/, g:p:
$lell€Y Kay P,ie.l'ey
J.P. (Quar) 76507 daied I havc
siohte dc.
TI1€ het lth-care prin.iples it:
Any heolth-core decislon you moke for the prircipol must:
! mointoin or promote th€ principol's heolth or well-being or ts
rn oll lhe (ircumslonces, in the princiltot s bpst lnLprest!:
t be &ode in the ,ray thot is leost re3tidive otlhs plincipal's
rights:
I where possible, toke occount of the principql's views ond
wishes, ol.)ng with inJomotion given by the pfincipol's
heolth'core provider.
llnon.ial decisions
Any investments you moke on the principol's behqlf while he/she
locks the copocity to moke llnoncial decisions must be those lhqt Are
named in the Trusti Act os invesarents o lrustee is outhorised to
moke or ore opproved by the Coud.
Loua mpoa' eirner rl}e SJprtnc t oLtt rt fte auotdianship d-d Nk\njno d lnbunol.
Eor oll decklods
If the principol hos other cttorneys, you must consult with them
regulorly ond moke your Je( isrons os drrected rn ciorrse 7. lf you ore
a joint oltorney, for eromple, you ond lhe other ottornqyls must
moke yoLrr decisions unonimously.
Spe( ifi c responsibilities
I Dury lo keep records. lf vou hove the power lo moke finonciol
decisions, you must keep reosonoble recori! of deolings ond
lrcns(tctions mode under the power. It is on offence not fo do
so, ond the Court or Adult Cuordion moy requirc you to
produce them.
I Duty to keep property 6eporote. You must keep your property
seforote from the principol's properry utless you ond the
principol own the propety jointly.
I Duty to present o moDagement plan odd get qpproyol aor
unouthorised trqrsoctions. If yox inarke o finonciol dacisiorl,
you must presenl o plon ol monogpment to the Court il the
Court requires it.
lf the priicipo|s copocity to moke decisions is impoired, you
must olso get opprovol from the Court for ony tronsoctions thot
htrve nol bepn oLrthonsed in lhi\ documenl.
I Duty to ovoid trqnsoctio!$ thqt involve aonflict of interest.
You must not enter into bqnioctions thot .ould or do bring
you} inte.ests (or those of your relation, business ossociote or
close friend) into conflicl with those of the principol. Fo!
€xample, you must not buy the prircipql's cor udess you IEy ot
reosl il\ morxet volue,
t3
Page 14
into sutll o.tldnsoction
t or lry th.; Cor.lrt, or if the tronsociion
plovides of someona. thol the principol could
reosonoblV be elapected to provi.le fbr, suclr qs hiilher child
PriestleY
74507
. I Duty in .€lation to bifts. You must
proPerty except where the principol
exomple os d morrioge gift to o relotion of the priicipol or o
rhal,l ls iS a true copy'
donotion to his/her fcrrourite chafty ($o long qs the size ofthe
gift is rcosonsble in the circumstances).
rhat I
sighted 0n a*a*.
*a.t a.:; ' :::i:rtitaa , t.a:.jrt.i:: -,,':- ii:,r ..i.iri{iP:rj?
If you hove the powea to execute (complete) o clocument for the
' principol, you do !o in the ordinory woy, but you must note on the
' docuEte4l thot you ore execuhng rt os the pflncrl,cll s ottomey unde,
enduring power of ottorney (e.9. 'lohn Smith, by his duly oppointed
ottorney, Mory Jones).
WEen d$,.' rrry qower l:{) :?:riaa ta:atsicr)s telin-l
It depenrls whethe. the power concerDs peronal/heolth mqtters or
finqrlial motters.
Pe6onol/heqlth motte$. Your power 1(} moke decisions for the
prillcipol ohoul personol/heolth motters does not begin until (if
eler) the principal is incopable dlunderctonding the noture ond
foreseeing the effucts ofa decision, and ofcommunicotlng that
decision. However, you must continue to allow, ohd ossist, the
pdn.ipol to moke decisions in so for os helshe is copoble.
Financiol motter6. The principol moy nominole in this
document when yo{rr power to moke finoDeiol decisions begins.
If the principo.l does not nominate o dote, then your power
begin\ rmmedjotely.
\A.,:, .. . .ry pori . ., .
Though there is no limc Iimit on E ddrjn0 lL.uFr rr, ollomey, ceatoin
oclio[s by you, thr pincipdl or the Court c(rn bing your power to arl
er]d.
In pe$onol/hedlth motteN, yonr power olso ends ifthe princip.ll
regailts the obility to mqke the decision ill qi]estion.
t4
Page 15
I corltyllla.llhis 13 a true coPY
o,the b.ioinal
,E,,P. .o;.4......,....... ........ .
/, dated eall\/rg. thal I have
Sheldv'Kay Prieslley sightad on I l./.06l. e,o
Yo[r qctions J.P.iOudD 78s07
I Your withdrowol. So long os the pdncipol is cqpobte of using
the power given to you, yau con v/ithdraw by givirg himlher a '
lrgned nolice or hy qemng the Coun \ laove lo wilhdrow
I Be( oming I he principol's poid corcr or heol th-core provider.
'. ,.ffthis happeis,.your power is rev;ked.
'Pod (o,?i does ,.ot rl,ean \on?one re.eIng o coteti Den$on o. s,nro, Dene/il
I Becoming incopoble. Your poweris revoked if you become
incopoble of unilerst.rnding the noture ord forese"irig the effects
of o de.ision, ond of communicoting thot decision.
I Becoming bonkrupl or insolvent. tf this hoppcns, your power is
I Your deolh.
Ihe principol's qcdons
I Revoking your power. fhe principol moy revoke i6u! po\rer ot
ony time, {o long os hir/hcr ( opo(ity to mo(e the de( ision is
unimpaired. In other words, so long os the princilol hos the
.opocity Iu /noip on enduring powcr ot ottomev, he/she ol)o hos
lhP rof,o.it! lo fevole it.
Ii lhe prirlcipo! revokes youi p.oiier, he/she ml]st inform you in
!witinq.
I Appointing {r new ottorney lo hdve vour powcrs. lI the
prir,( rtrxrl , ornplele5 o ne$ do(ument giving yo r powers to
onother otfonley, your por{ers ore revoked to thol extent.
Becquse lhe new document hos q later dcte, it ovenides the filst.
Gcttirg m.rded. If the prirlcipol morries, your power of ottomey
is ievoked unless you ore the ptincipol's new spouse. (If you ole
tlie pri.cipol's new spouse, ihe only power thot is revoked is the
powrr ^f ony othcr ollornpv.)
Cetti.rg divor{ed. If the principoi divoacei ond you were the
priocipol's former spou:Jer yo[r powe. of attorney is revoked.
The principol's deoth. lf the principol dies, your endu rg power
of ottorney is tevoked in its entirety.
.{ctiors by tie Court
Your porver moy okti lio *iongcd or rcvoki'd by tLe Court il_you hov€
fqiled to oct in the rrliicipol's interesls.
t5
Page 16
Car i )-:,llri
,il
SlElley Kay Presltey
J.P. (Ouar) 78s07
lcerliil lhal this is a lrlre acpy
ol ihe.rio nal
E,P.O:A
daied *altut8. lhar I havs
slghled on .I\./.o8/a,.O......
Yes, you con be held liqble if you ure the endudng power of ottoiney
... krowing thot it hos been chonged or revoked. or knowing of on event
thdt effectively revokes it, or even ifyou hove reqson to believe thot it
hus been revoked.
The Court ond the Adult Cuordion hove the porrer to protect the
pdncipol's inlere$1s. You moy be requi.ed to p.oduce o tummory of
receipts ond expenditure or more detoiled oc'coun15, ond these moy be
{rudited. You rroy olso be required to gi!€ evidence in relotion to the
elercise ofyourpovr'ers. If the Court or Adult Cuordion believes thot
you hqve not qdeqlately prctected tire principol's interests, you moy
be removed or your endunng power of ottorney mcy be revoked, ond
you moy be rcquired to compensote the principol. :
:
.i,:.. .t ,
The Coufi, the ,\dull Cuordian, the Putlli. Trustee or o solicitor con
odvise you oLrout this document ond your power ond responsibilities
under it. i
The Court con olso make o declordtion obout th6 voltdity of this .
documenl or whpther your power to mokc o de(ision for the pnncipol
hos begun.
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Page 17
I certifu that this is a true copy
of the orioinal
E-P,.o,lH
hava
ATTORNEY'S ACCETT&NCE sighted on .I
As attomey, you complete the section of this form that applies to you by
writtng on the lines and ticking the boxes. lf you are not able to tick all the
boxes truthfully, then you must not accept this appointment as attomey.
{Fimt attorney {ompJ*tes this ss{tisn}
10. r, frUOREY REfn €At , stote that:
[Prlnt your full nome here]
w I om eighteen or over,
w I am not a current poid corer of the principol,
w I om not o current health-care provider for the principal,
I hove read Port 1, giving me enduring power of attorney,
I understond that, by signing this document, I toke on the responsibility of
exercising the power I hove been given in the document,
I olso understond thot I must exercise the power in occordance with t}re Powers of
Attomey Act 1998 and the Guardianship and Administration Act 2N0.
. '.')),.'--.-:,, o
[Sign here]
,4rt fr*{nu
I
(&f*r aoa'o
{S*trrnd attorney, if any, {$mpletet this section)
11. t, Knnew Lrnrbfr lfauneD , stote thot:
[Prtnt your full name here]
ff tom eighteen orove!
ff tam not o current poid corer of the principol,
ff t am not o current health-core provider forthe principol,
ff thove reod Part 1, giving rne endudng polver of ottorney,
ff t understqnd thot, by signing this document, I take on the responsibility of
exercising the power I hove been given in the document,
I olso understond thot I must exercise the pou/er in occordonce with the Powers of
Attomey Acl 1998 ond the Guardianship and Administration Act 2ON.
tu
[Sign here]
ffir,*rx
the dote herel
S'€.veo"*,
{ ffry"st QcJo.
t7
Page 18
that this is a true copy
(Third attorney, if any, completer thie section) si on .t.
12. l, , stote thot:
[Print your full name herel
I om eighteen or over,
I qm not o current poid corer of the principol,
I om not o current heolth-core provider for the prindpol,
I hove reod Part 1, giving me enduring power of attomey,
I understond that, by signtung this document, I toke on the responsibility of
exercising the power I hove been given in the document,
I olso understcrnd thot I must exetcise the power in sccordance with the Powers of
AttomE Ad 1998 ond the Guardianshtp and Adminktration Act 200A.
[Sign here]
[Write the dote here]
r8
Page 19
is a true copy
have
t9
[OCR of page images]
dete aes ee
het Saas
eee. eae
ee
Page 20
q lrue copy
,/,
glelhy {ay Pnesllev
J.P. (O!al) 78507
ffi aceelelelCleyetluery
Depannent oI ,t€dc6 srd Atloftey-G.n r.(
lune 2002
20