This
is National Dog Week! The law office of
Thomas T. Tornow, P.C. is very dog friendly.
Tom and his brother Jack own the building and their lease encourages
tenants and employees to bring their dogs to work. Prospective tenants and employees are vetted
to make sure they are OK with dogs, which is usually not a problem in
Montana. Tom has photos of his dogs (and
his wife) on his office walls and often a dog sleeping under his desk. Visiting dogs make a beeline for the dog
treats and tennis balls Tom keeps in his desk drawer. There is a Frisbee by back door to play with
the dogs in the field next door and a water dish is waiting 24/7. The law office of Thomas T. Tornow, P.C. is
the attorney for the Flathead Valley’s preeminent animal clinic and veterinarians
and is a major contributor to the Whitefish dog park. As part of the celebration of National Dog
Week, the law office of Thomas T. Tornow, P.C. is making the following Durable
Power of Attorney for Veterinary Care available to the readers of this blog.
DURABLE
POWER OF ATTORNEY FOR VETERINARY CARE
NOTICE: THIS DOCUMENT GRANTS BROAD POWERS. IF YOU HAVE ANY QUESTIONS ABOUT
THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. YOU MAY REVOKE THIS POWER OF
ATTORNEY AT ANY TIME.
I hereby appoint:
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Telephones: ______________________________________________
Home
______________________________________________
Work
______________________________________________ Mobile
______________________________________________ Fax
Email: ______________________________________________
Personal
______________________________________________
Business
as my Attorney-in-fact (my “Agent”) to act for me and in my name in any
way I could act in person to make any and all decisions, approvals and
authorizations concerning the:
A.
Care, veterinary
treatment, hospitalization of my animal(s) named herein for any condition;
B.
Admission or discharge of my animal(s) from
any hospital, clinic or other institution;
C.
Withholding or withdrawal of
any type of veterinary procedure for said animal(s) even though death may occur;
and
D.
Disposition of
any part or all of said animal’s(s’) body for veterinary purposes, autopsy and
disposition of its remains.
If my Agent dies, becomes legally disabled,
incapacitated or incompetent, or resigns, refuses to act, or is unavailable, I
name the following as my Successor Agent with the same powers and authority as
my Agent.
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Telephones: ______________________________________________
Home
______________________________________________
Work
______________________________________________ Mobile
______________________________________________ Fax
Email: ______________________________________________
Personal
______________________________________________
Business
My veterinarian is:
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Telephone: ______________________________________________
Clinic
______________________________________________ After Hours
______________________________________________ Fax
Email: ______________________________________________
My Agent and Successor Agent can take my animals to my or any other any
other veterinarian and any veterinarian can rely on this Durable Power of Attorney.
The animal(s) to which this Durable Power of
Attorney applies are:
_____________________________________________ _____________________________
Name Type/Description
_____________________________________________ _____________________________
Name Type/Description
_____________________________________________ _____________________________
Name Type/Description
SPECIAL
INSTRUCTIONS:
ON THE FOLLOWING LINE,
YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS GRANTED TO
YOUR AGENT AND SUCCESSOR AGENT.
_________________________________________________________________________________
UNLESS YOU DIRECT
OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL
CONTINUE UNTIL IT IS REVOKED.
This Durable Power of Attorney for Veterinary Care is effective on the
date I signed it and continues to be effective, even if I become
disabled, incapacitated or incompetent.
I agree that any third
party who receives a copy of this Durable
Power of Attorney for Veterinary Care may act under it. I may revoke this Durable Power of Attorney for Veterinary Care by a writing to my Agent that expressly indicates
my intent to revoke. Revocation of this Durable Power of Attorney for Veterinary Care
is not effective as to a third part, such as a veterinarian, until the
third party learns of the revocation.
I agree to:
A. Pay
for any goods or services rendered by any third party in reliance on this Durable Power of Attorney for Veterinary
Care; and
B. Indemnify the third party for any
claims that arise against the third party because of reliance on this Durable Power of Attorney for Veterinary Care.
I am fully informed as to all contents of this Durable
Power of Attorney for Veterinary Care and understand the full importance of
this grant of power to my Agent and Successor Agent.
Signature: ________________________________________
Printed Name: ________________________________________
STATE OF
MONTANA )
: ss.
County of
Flathead )
Acknowledged before me
by the above named Principal on this_______day of _______________, 20__.
________________________________________
Notary
Public for the State of Montana
BY SIGNING,
ACCEPTING, OR ACTING UNDER THE APPOINTMENT, THE AGENT AND SUCCESSOR AGENT ASSUME THE FIDUCIARY AND OTHER LEGAL
RESPONSIBILITIES OF AN AGENT, THE AGENT AND
SUCCESSOR AGENT WORKS EXCLUSIVELY FOR THE BENEFIT OF THE PRINCIPAL. THE FOREMOST DUTY AS THE AGENT AND SUCCESSOR AGENT IS THAT OF LOYALTY
TO AND PROTECTION OF THE BEST INTERESTS OF THE PRINCIPAL. THE AGENT AND SUCCESSOR AGENT HAS A DUTY TO AVOID CONFLICTS OF INTEREST AND
TO USE ORDINARY SKILL AND PRUDENCE IN THE EXERCISE OF THESE DUTIES.
______________________________________________ _________________________
AGENT Date
______________________________________________ _________________________
SUCCESSOR
AGENT Date
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