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Fillable Nycers F203 Form in PDF

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The NYCERS F203 form plays a crucial role for individuals holding a Power of Attorney that was executed over a year ago. This affidavit serves as a formal declaration affirming that the Power of Attorney remains valid and in full effect. It requires the attorney-in-fact to provide specific information about the principal, including their pension number and contact details. The form includes a declaration that the attorney-in-fact has no knowledge of any revocation or termination of the Power of Attorney, ensuring that the principal is alive and has not revoked their authority. Additionally, the affidavit must be notarized, adding a layer of authenticity and trustworthiness. By submitting this form, the attorney-in-fact enables NYCERS to accept the Power of Attorney for processing, which is essential for managing the principal's pension benefits. Understanding the importance of this document can help streamline the process for both the principal and the attorney-in-fact, ensuring that all parties are on the same page regarding the legal authority granted.

Preview - Nycers F203 Form

NYCERS USE ONLY

F203

 

*203*

Affidavit That Power Of Attorney is in Full Force

This affidavit should be submitted by anyone with a Power of Attorney that was signed over one year ago. Should you have any questions regarding this affidavit, please contact our Legal Unit at (347)643-3510.

Pensioner Information

Pension Number

Last 4 Digits of SSN

Home Phone Number

( )

Work Phone Number

()

First Name

M.I.

Last Name

 

 

 

 

 

 

 

 

Address

 

 

 

Apt. Number

 

 

 

 

 

 

City

 

 

State

 

Zip Code

 

 

 

 

 

 

I, the undersigned, depose and say:

1.The Principal above did, in writing, appoint me as the Principal’s true and lawful ATTORNEY(S)-IN-FACT in the Power of Attorney dated ___________________________.

2.I have no actual knowledge or actual notice of revocation or termination of the Power of Attorney by death or otherwise, or knowledge of any facts indicating the same. I further represent that the Principal is alive, has not revoked or repudiated the Power of Attorney and the Power of Attorney still is in full force and effect.

3.I make this affidavit for the purpose of inducing NYCERS to accept delivery of this affidavit, as executed by me in my capacity as the ATTORNEY(S)-IN-FACT, with full knowledge that this affidavit will be relied upon in accepting the execution and delivery of the Power of Attorney and in paying good and valuable consideration therefor.

Signature of Power of Attorney-in-Fact

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This form must be acknowledged before a Notary Public or Commissioner of Deeds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

County of

 

 

On this

 

day of

 

 

 

2 0

 

, personally appeared

before me the above named,

 

 

 

 

 

 

, to me known, and known to

me to be the individual described in and who executed the foregoing instrument, and he or she acknowledged to me that he or she

executed the same, and that the statements contained therein are true.

If you have an official seal, affix it

Signature of Notary Public or

 

 

Commissioner of Deeds

 

 

 

 

 

 

 

 

Official Title

 

 

 

 

 

 

Expiration Date of Commission

 

 

 

 

 

 

 

 

R07/27/11

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Form Characteristics

Fact Name Fact Description
Form Purpose The NYCERS F203 form is an affidavit confirming that a Power of Attorney is still valid and in full force.
Submission Requirement This affidavit must be submitted by individuals holding a Power of Attorney that was signed more than one year ago.
Contact Information For questions regarding the affidavit, individuals can contact the NYCERS Legal Unit at (347) 643-3510.
Pensioner Information The form requires specific details, including the pension number and the last four digits of the Social Security Number.
Principal's Status The affidavit states that the Principal is alive and has not revoked the Power of Attorney.
Notarization Requirement This form must be acknowledged before a Notary Public or Commissioner of Deeds to be valid.
Governing Law The form is governed by New York State law regarding Powers of Attorney.
Signature Requirement The Attorney-in-Fact must sign the affidavit, affirming the truth of the statements made.
Expiration of Commission The Notary Public or Commissioner of Deeds must provide their official title and the expiration date of their commission.
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