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The form defines key roles, limits authority to financial and health benefit matters, and states that medical decisions are not authorized. 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Checking multiple boxes may invalidate the form, and the person determining incapacity must be at least 18 years old at designation.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},274849,1790224817,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},1099523885074,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","State of California  \nCalifornia Public Employees’ Retirement System [www.calpers.ca.gov](www.calpers.ca.gov)  \nSpecial Power of Attorney  \n Section 1  Creation of Durable Power of Attorney for Retirement-Related Business  \nWhen completing this form, please be sure to print the requested information.  \nFor the purpose of this form, a “principal” is defined as a person who empowers another to act as a representative on his or her behalf.  \nThe “agent” is the attorney-in-fact.  \nName of Principal (First Name, Middle Initial, Last Name) Social Security Number or CalPERS ID  \nAddress County  \n   ( )   \nCity State ZIP Daytime Phone  \nBy this document I intend to create a power of attorney by appointing the person(s) named below to make retirement-related decisions for me as allowed by the California Probate Code. The authority granted pursuant to this power of attorney is expressly limited to decisions relating to my financial and health benefits under the California Public Employees’ Retirement System, the Judges’ Retirement System or the Judges’ Retirement System II, and the Legislators’ Retirement System, hereinafter CalPERS, JRS, JRS II, and LRS, respectively. I give my agent, also called an attorney-in-fact, the powers specified herein with the understanding that these powers will be used for my benefit and will be exercised only in a fiduciary capacity. This power does not authorize the appointed agent to make any medical decisions for me.  \n Section 2  Designation of Attorney-in-Fact (Agent)  \nIf you appoint more than one attorney-in-fact and do not check a box, all of your attorneys-in-fact must actor sign together (jointly) .  \n*If you choose“Alternately,” identify the order of your attorneys-infact in the boxes below.  \n\\#  \nYou have the option to designate one attorney-in-fact. Your attorney-in-fact must be at least 18 years old at the time this document is executed.  \nIf you appoint more than one attorney-in-fact, choose the jointly, separately, or alternately check box below: c Jointly – All designated attorneys-in-fact must sign for any action. Granting joint authority to two or  \nmore attorneys-in-fact means that the agents’ authority is exercisable only by their unanimous action. If one is unavailable because of absence, illness, or other temporary incapacity, the other attorneys-infact may exercise their authority under the power of attorney.  \nc Separately – Any one designated attorney-in-fact may act without the other(s) .  \nc Alternately – Your attorney-in-fact will act in the numerical order you assign in the boxes below.* The successor attorney-in-fact will act if the person you originally appointed is unavailable because of absence, illness, or other temporary incapacity. Delegation of powers to any third party who is not named as an alternate attorney-in-fact is not permitted under this document.  \nName of Attorney-in-Fact (First Name, Middle Initial, Last Name) Birth Date (mm/dd/yyyy) Relationship  \nAddress Social Security Number or CalPERS ID  \n   ( )   \nCity State ZIP Daytime Phone  \n\\#  \nName of Attorney-in-Fact (First Name, Middle Initial, Last Name) Birth Date (mm/dd/yyyy) Relationship  \nAddress Social Security Number or CalPERS ID  \n   ( )   \nCity State ZIP Daytime Phone  \n\\#  \nName of Attorney-in-Fact (First Name, Middle Initial, Last Name) Birth Date (mm/dd/yyyy) Relationship  \nAddress Social Security Number or CalPERS ID  \n   ( )   \nCity State ZIP Daytime Phone  \nPut your name and Social Security number or CalPERS ID at the top of every page  \nName of Member Social Security Number or CalPERS ID  \n\n| \u003Cbr>Section 3\u003Cbr>You must check a box to indicate whether you are granting the specific authority to your attorney(s)-in-fact. If you do not check a box, your attorney(s)-in-fact will not be granted this specific authority.\u003Cbr>See A Guide to the CalPERS Special Power of Attorney (PUB 30) for a detailed explanation of the authority you are granting. | General Statement of Authority Granted\u003Cbr>I hereby gr","cbCaii02aVkH7bnr","https://ap.wps.com/l/cbCaii02aVkH7bnr","pdf",172269,"English","# Section 1  Creation of Durable Power of Attorney for Retirement-Related Business\n# Section 2  Designation of Attorney-in-Fact (Agent)\n# Section 3  General Statement of Authority Granted\n# Section 4  Duration of Power of Attorney","[{\"question\":\"What decisions can the appointed attorney-in-fact make under this form?\",\"answer\":\"The attorney-in-fact is authorized to make retirement-related decisions limited to the principal’s financial and health benefits under CalPERS and related retirement systems. Medical decisions are not authorized by this power of attorney.\"},{\"question\":\"Can more than one attorney-in-fact be appointed, and how do they act?\",\"answer\":\"Yes. The form allows options for jointly, separately, or alternately appointed attorneys-in-fact. Joint authority requires unanimous action for any action; separately allows any single agent to act; alternately uses a numerical order with a successor agent acting if the original agent is unavailable.\"},{\"question\":\"How does the form handle when the power of attorney begins and ends?\",\"answer\":\"The principal must carefully choose commencement and/or termination by checking the appropriate box. Checking multiple boxes may invalidate the form, and the person determining incapacity must be at least 18 years old at designation.\"}]","Special Power of Attorney | PDF",1789483450]