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BNY Mellon Brokerage Services P.O. Box 9008 Hicksville, NY 118029008CERTIFICATION FOR NONBNY MELLON LEGAL/DURABLE POWER OF ATTORNEY Use this form to certify the validity of a Power of Attorney for
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How to fill out hsa durable power of

01
Obtain the HSA Durable Power of Attorney form from a legal website or your attorney.
02
Read the instructions carefully to understand the specific powers you are granting.
03
Fill in your personal information, including your name and contact details.
04
Designate the individual you are granting power to, ensuring they are trustworthy.
05
Specify the powers being granted, such as managing your HSA account or making health-related financial decisions.
06
Sign and date the document in front of a notary public or witnesses, as required by your state.
07
Provide copies of the signed document to your appointed agent, financial institutions, and keep a copy for your records.

Who needs hsa durable power of?

01
Individuals who want to ensure their healthcare and financial decisions are managed by a trusted person in case they become incapacitated.
02
People with Health Savings Accounts (HSAs) who plan for potential future health challenges or emergencies.
03
Those who wish to simplify their financial management during periods of incapacity.
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HSA durable power of attorney is a legal document that allows an individual to designate another person to make health care and financial decisions on their behalf if they become incapacitated.
Any individual who wishes to ensure that their health care and financial decisions are made according to their wishes in case of incapacity should file an HSA durable power of attorney.
To fill out an HSA durable power of attorney, individuals should obtain the appropriate form, provide their personal information and that of their designated agent, specify the powers granted, and sign the document in the presence of required witnesses or a notary public, if necessary.
The purpose of an HSA durable power of attorney is to ensure that an individual's health care and financial affairs are managed according to their preferences if they are unable to make those decisions themselves.
The information that must be reported on an HSA durable power of attorney includes the individual's name, the name of the designated agent, the powers granted to the agent, and any specific instructions or limitations.
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