OHIO STATUTORY FORM POWER OF ATTORNEY
IMPORTANT INFORMATION
This power of attorney authorizes another person (your agent) to make decisions
concerning your property for you (the principal). Your agent will be able to make
decisions and act with respect to your property (including your money) whether or not
you are able to act for yourself. The meaning of authority over subjects listed on this
form is explained in the Uniform Power of Attorney Act (sections 1337.21 to 1337.64 of
the Revised Code).
This power of attorney does not authorize the agent to make health-care decisions for
you.
You should select someone you trust to serve as your agent. Unless you specify
otherwise, generally the agent's authority will continue until you die or revoke the power
of attorney or the agent resigns or is unable to act for you.
Your agent is entitled to reasonable compensation unless you state otherwise in the
Special Instructions.
This form provides for designation of one agent. If you wish to name more than one
agent you may name a coagent in the Special Instructions. Coagents are not required to
act together unless you include that requirement in the Special Instructions.
If your agent is unable or unwilling to act for you, your power of attorney will end unless
you have named a successor agent. You may also name a second successor agent.
This power of attorney becomes effective immediately unless you state otherwise in the
Special Instructions.
ACTIONS REQUIRING EXPRESS AUTHORITY
Unless expressly authorized and initialed by me in the Special Instructions, this power
of attorney does not grant authority to my agent to do any of the following:
(1) Create a trust;
(2) Amend, revoke, or terminate an inter vivos trust, even if specific authority to do so is
granted to the agent in the trust agreement;
(3) Make a gift;
(4) Create or change rights of survivorship;
(5) Create or change a beneficiary designation;
(6) Delegate authority granted under the power of attorney;
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(7) Waive the principal's right to be a beneficiary of a joint and survivor annuity,
including a survivor benefit under a retirement plan;
(8) Exercise fiduciary powers that the principal has authority to delegate.
CAUTION: Granting any of the above eight powers will give your agent the authority to
take actions that could significantly reduce your property or change how your property is
distributed at your death.
If you have questions about the power of attorney or the authority you are granting to
your agent, you should seek legal advice before signing this form.
DESIGNATION OF AGENT
Craig Allen Kendzierski
I, ____________________ (Name of Principal) name the following person as my agent:
Robert John Kendzierski
Name of Agent: ____________________
7350 Greenleaf Ave., Parma, OH 44130
Agent's Address: ________________________________________
440-212-8375
Agent's Telephone Number: ____________________
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
If my agent is unable or unwilling to act for me, I name as my successor agent:
Katherine Marie Kendzierski
Name of Successor Agent: ____________________
7350 Greenleaf Ave., Parma, OH 44130
Successor Agent's Address: ________________________________________
440-212-8374
Successor Agent's Telephone Number: ____________________
If my successor agent is unable or unwilling to act for me, I name as my second
successor agent:
Daniel Ryan Kendzierski
Name of Second Successor Agent: ____________________
3279 W. 128th St., Cleveland, OH 44111
Second Successor Agent's Address: ________________________________________
440-570-8506
Second Successor Agent's Telephone Number: ____________________
GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me with respect to
the following subjects as defined in the Uniform Power of Attorney Act (sections
1337.21 to 1337.64 of the Revised Code):
(INITIAL each subject you want to include in the agent's general authority. If you wish to
grant general authority over all of the subjects you may initial "All Preceding Subjects"
instead of initialing each subject.)
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(____) Real Property
(____) Tangible Personal Property
(____) Stocks and Bonds
(____) Commodities and Options
(____) Banks and Other Financial Institutions
(____) Operation of Entity or Business
(____) Insurance and Annuities
(____) Estates, Trusts, and Other Beneficial Interests
(____) Claims and Litigation
(____) Personal and Family Maintenance
(____) Benefits from Governmental Programs or Civil or Military Service
(____) Retirement Plans
(____) Taxes
(____) Digital Assets
(____) All Preceding Subjects
(____) My agent shall have access to the content of electronic communications sent or
received by me.
LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to
benefit the agent or a person to whom the agent owes an obligation of support unless I
have included that authority in the Special Instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines:
______________________________________________________________________
______________________________________________________________________
EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the
Special Instructions.
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NOMINATION OF GUARDIAN (OPTIONAL)
If it becomes necessary for a court to appoint a guardian of my estate or my person, I
nominate the following person(s) for appointment:
Name of Nominee for guardian of my estate: ____________________
Nominee's Address: ________________________________________
Nominee's Telephone Number: ____________________
Name of Nominee for guardian of my person: ____________________
Nominee's Address: ____________________
Nominee's Telephone Number: ____________________
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or a
copy of it unless that person knows it has terminated or is invalid.
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SIGNATURE AND ACKNOWLEDGMENT
Your Signature: ____________________________ Date: ____________________
Craig Allen Kendzierski
Your Name Printed: ____________________________
361 E Parkleigh Dr., Seven Hills, OH 44131
Your Address: ________________________________________
440-570-2450
Your Telephone Number: ____________________
State of Ohio
Cuyahoga
County of ____________________
This document was acknowledged before me on ____________________, 20____, by
____________________ (Name of Principal).
Signature of Notary: ____________________________
My commission expires: ____________________
This document prepared by: ____________________
IMPORTANT INFORMATION FOR AGENT
Agent's Duties
When you accept the authority granted under this power of attorney, a special legal
relationship is created between you and the principal. This relationship imposes upon
you legal duties that continue until you resign or the power of attorney is terminated or
revoked. You must:
(1) Do what you know the principal reasonably expects you to do with the principal's
property or, if you do not know the principal's expectations, act in the principal's best
interest;
(2) Act in good faith;
(3) Do nothing beyond the authority granted in this power of attorney;
(4) Attempt to preserve the principal's estate plan if you know the plan and preserving
the plan is consistent with the principal's best interest;
(5) Disclose your identity as an agent whenever you act for the principal by writing or
printing the name of the principal and signing your own name as "agent" in the following
manner:
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(Principal's Name) by (Your Signature) as Agent
Unless the Special Instructions in this power of attorney state otherwise, you must also:
(1) Act loyally for the principal's benefit;
(2) Avoid conflicts that would impair your ability to act in the principal's best interest;
(3) Act with care, competence, and diligence;
(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the
principal;
(5) Cooperate with any person that has authority to make health-care decisions for the
principal to do what you know the principal reasonably expects or, if you do not know
the principal's expectations, to act in the principal's best interest.
Termination of Agent's Authority
You must stop acting on behalf of the principal if you learn of any event that terminates
this power of attorney or your authority under this power of attorney. Events that
terminate a power of attorney or your authority to act under a power of attorney include:
(1) The death of the principal;
(2) The principal's revocation of the power of attorney or your authority;
(3) The occurrence of a termination event stated in the power of attorney;
(4) The purpose of the power of attorney is fully accomplished;
(5) If you are married to the principal, a legal action is filed with a court to end your
marriage, or for your legal separation, unless the Special Instructions in this power of
attorney state that such an action will not terminate your authority.
Liability of Agent
The meaning of the authority granted to you is defined in the Uniform Power of Attorney
Act (sections 1337.21 to 1337.64 of the Revised Code). If you violate the Uniform
Power of Attorney Act or act outside the authority granted, you may be liable for any
damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you
should seek legal advice.
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AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER
OF ATTORNEY AND AGENT'S AUTHORITY
State of Ohio
Cuyahoga
County of ____________________
I, ____________________ (Name of Agent), certify under penalty of perjury that
____________________ (Name of Principal) granted me authority as an agent or
successor agent in a power of attorney dated ____________________, 20____.
I further certify that to my knowledge:
(1) The Principal is alive and has not revoked the Power of Attorney or my authority
to act under the Power of Attorney and the Power of Attorney and my authority to
act under the Power of Attorney have not terminated;
(2) If the Power of Attorney was drafted to become effective upon the happening of
an event or contingency, the event or contingency has occurred;
(3) If I was named as a successor agent, the prior agent is no longer able or willing to
serve;
(4) _____________________________________ (Insert other relevant statements).
SIGNATURE AND ACKNOWLEDGMENT
Agent’s Signature: ____________________________ Date: ____________________
Agent’s Name Printed: ____________________________
Agent’s Address: ________________________________________
Agent’s Telephone Number: ____________________
State of Ohio
County of ____________________
This document was acknowledged before me on ____________________, 20____, by
____________________ (Name of Agent).
Signature of Notary: ____________________________
My commission expires: ____________________
This document prepared by: ____________________
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