Power of Attorney - Fact Sheet 745 - How to Complete

Sep 15, 2026

A fact sheet for completing F204, a New York Public Employee Retirement System Special Durable Power of Attorney, prepared under New York General Obligations Law Article 5, Title 15. The form is limited to retirement benefit transactions with the listed NYC and New York retirement systems and includes member/principal identification fields and agent designation. It explains the purpose clause, principal cautions, agent authority and responsibilities, revocation and termination rules, limitations on health care decisions, and the governing law references.

LanguageEnglish

CategoryForms

FormatPDF

Pages5

Reading Time2 min

AccessFree to download

Purpose clause

Caution to the principal

Designation of agent(s)

Special durable power provisions

Revocation and termination

Health care limitation

Governing law

How to Complete F204 – Power of Attorney [sample only – do not submit] New York Public Employee Retirement System Special Durable Power of Attorney NYCERS USE ONLY F204 FACT SHEET \#745 This is a Public Retirement System Special Power of Attorney prepared pursuant to General Obligations Law Article 5, Title 15. This form has been prepared and circulated by the public retirement systems listed below as a convenience to their members, retirees and beneficiaries. This form is limited to retirement benefit transactions involving those retirement systems and does not apply to any other matters. If you have any questions regarding this form, please contact our Call Center at (347) 643-3000. Member Number OR Pension Number Last 4 Digits ofSSN Daytime Phone Number | | | | ( ) | | --- | --- | --- | --- | | | | | | --- | --- | --- | First Name M.I. Last Name (a) PURPOSE CLAUSE: The purpose of this Power of Attorney document is to authorize my agent to act in my name, place and stead with respect to retirement benefit transactions and my interest in benefits provided by one or more of the public retirement systems listed below pursuant to the Retirement and Social Security Law, the Education Law and the Administrative Code of the City of New York, as applicable. Please note: By executing this special Power of Attorney without placing any limitations in Section (g) MODIFICATIONS, you are authorizing your agent to conduct ANY transaction that you would be authorized to do (discuss retirement benefits, request access to personal information, change depository account information, etc.) to the exclusion of naming him or herself as beneficiary. If you want your agent to be able to name himself/herself as the beneficiary or change your current beneficiary, you must include this information in Section (g) MODIFICATIONS. A public retirement system for the purposes of this form shall include: • The New York State and Local Employees’Retirement System • The New York State and Local Police and Fire Retirement System • The New York State Teachers’Retirement System • The New York City Employees’Retirement System • The New York City Teachers’Retirement System • The New York City Police Pension Fund • The New York City Fire Department Pension Fund • The New York City Board of Education Retirement System (b) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the “principal,” you give the person whom you choose (your “agent”) authority to engage in retirement benefit transactions during your lifetime without telling you. You, however, do not lose your authority to act even though you have given your agent similar authority. When your agent exercises this authority, he or she must act according to any instructions you have provided or, where there are no specific instructions, in your best interest.“Important Information for the Agent” at the end of this document describes your agent’s responsibilities. PRINCIPAL-Sign this form and have it notarized, Page 3 R12/16 340 Jay Street, Brooklyn, NY Mezzanine level [www.nycers.org](www.nycers.org) (347) 643-3000 30-30 47th Avenue, 10th Floor Long Island City, NY 11101 Page 1 of 5 | NYCERS WALK-IN and CALL CENTER Hours: Monday & Wednesday 8 am – 6 pm | Tuesday & Thursday 8 am – 5 pm | Friday 8 am – 3 pm | | --- | --- | --- | How to Complete F204 Power of Attorney Fact Sheet \#745 Member Number OR Pension Number Last 4 ofSSN | | | | | --- | --- | --- | Digits NYCERS USE ONLY F204 FACT SHEET \#745 Your agent can act on your behalf only after signing the Power of Attorney before a notary public. You can request information from your agent at any time. If, by executing this Special Power of Attorney, you are revoking a prior authority with respect to retirement benefit transactions relating to an interest in any of the above-listed public retirement systems made under a previous Power of Attorney, you should p

FAQs

What is the purpose of the F204 Special Durable Power of Attorney?

It authorizes the agent to act on the principal’s behalf for retirement benefit transactions and related interests with the listed public retirement systems.

What authority does the agent have if no limitations are added in modifications?

Without limitations in Section (g) MODIFICATIONS, the agent may conduct any transaction the principal could do, such as discussing benefits, requesting information, and changing depository account information.

Can the principal’s incapacity revoke or terminate the agent’s authority under this durable power?

The subsequent incapacity of the principal does not revoke or terminate the authority of an agent acting under a durable power of attorney.

Sep 15, 2026

Uploaded by Olivia Brown