New York Power of Attorney Form

Fill in a New York durable, medical or limited power of attorney online. Health care proxy built in; financial POAs use New York's statutory form. Free PDF, no signup.

1. Type and state

Durable (financial)Money and property. Keeps working if you become incapacitated.Medical / health careHealth care decisions when you can't make them yourself.General (financial)Broad financial powers that end if you become incapacitated.Limited (special)One task or a short period, like a house closing or a car title.

State where you live

New York signing rule: Sign and date it in front of two adult witnesses, who also sign. No notary is required. (N.Y. Public Health Law §2981) New York guide and sources

2. You (the principal)

Your full legal name

Phone (optional)

Address

3. Your health care agent

The person you trust to act for you. Choose an adult who is not your witness or notary.

Health care agent's full legal name

Phone (optional)

Address

4. Alternate health care agents (optional)

Steps in if your health care agent can't or won't act.

First alternate's full legal name

Phone (optional)

Address

Second alternate's full legal name

Phone (optional)

Address

5. Your health care wishes

Life-sustaining treatment

Let my health care agent decide based on my wishes and best interestsProlong my life as long as possibleDon't prolong my life if I'm terminally ill or permanently unconscious; keep me comfortable

Limits on your health care agent's authority (optional)

Nominate my health care agent as guardian if a court ever needs to appoint one

End date (optional)

6. Other terms

Special instructions (optional)

Revoke my earlier medical powers of attorney

Still blank: your name, health care agent name. You can download now and fill those in by hand.

🔒 Your answers stay in this browser. The PDF is made on your device and never uploaded. No signup, no card, no trial.

Paid extras · $9.99 once or $39/yr, nothing auto-renews on the $9.99

We are not a law firm and this is not legal advice. The tool fills your own choices into a template and adds signing blocks from the official rules we cite. For complex estates, special needs or business interests, talk to an attorney.

Live preview

Health Care Proxy

State of New York

1. Designation of health care agent

I, ________________, of ________________, appoint ________________, of ________________, as my health care agent to make health care decisions for me.

2. Alternate health care agents

I do not name an alternate health care agent.

3. Authority

My health care agent may make any and all health care decisions for me, including decisions to consent to, refuse or withdraw any care, treatment, service or procedure, to choose health care providers and facilities, and to provide, withhold or withdraw artificial nutrition and hydration and other life-sustaining treatment, except as limited below. My health care agent must act according to my known wishes and, where they are unknown, in my best interests.

4. When this takes effect

This document takes effect when I am unable to make or communicate my own health care decisions, as determined by my attending physician and any other professional my state's law requires. While I can make my own decisions, I keep the right to do so.

5. My wishes about life-sustaining treatment

I leave decisions about life-sustaining treatment to my health care agent, based on my known wishes, values and best interests.

6. Limitations on my health care agent's authority

None.

7. Health information (HIPAA)

My health care agent is my personal representative for purposes of HIPAA (45 CFR 164.502(g)) and may request, receive and review any of my medical records and health information, and sign releases for them.

8. Guardian

If a court needs to appoint a guardian of my person, I nominate my health care agent named above.

9. Other provisions

This document stays in effect until I revoke it. A copy of this document has the same effect as the original. This document is governed by the law of the State of New York.

Signature

Principal

SignatureDatePrinted name

Address

Witnesses and notary

Signing rule in New York: Sign and date it in front of two adult witnesses, who also sign. No notary is required. (N.Y. Public Health Law §2981).

Witness rules: Your health care agent may not be a witness. Witnesses must be adults.

I declare that the person who signed this document appeared to execute the proxy willingly and free from duress. I am not the person appointed as agent by this document.

Witness 1

SignatureDatePrinted name

Address

Witness 2

SignatureDatePrinted name

Address

Prepared with powerofattorneymaker.com. This is a template, not legal advice, and we are not a law firm. Laws change and differ by state; check your state's current rules or ask an attorney before signing.

Last updated October 13, 2026 · Written by the Power of Attorney Maker editorial team. State rules checked against official statute sources.

This page summarizes how a power of attorney must be signed in New York, taken from the statute and checked on October 13, 2026. The form above applies these rules automatically when New York is selected.

New York power of attorney at a glance

Financial: statutory short form only (12-point, notary, 2 witnesses, agent signs).
Health care proxy: 2 witnesses, no notary.

Signing requirements

Financial power of attorney (N.Y. Gen. Oblig. Law §5-1501B and §5-1513)

Rule: Use New York's statutory short form. You sign, date and initial it; your signature is notarized; two witnesses sign; your agent signs and is notarized too. It must be printed in at least 12-point type.

Law: N.Y. Gen. Oblig. Law §5-1501B and §5-1513

Witnesses:

A witness may not be an agent or a person who receives gifts under the power of attorney.

New York requires the "Caution to the Principal" and "Important Information for the Agent" wording from §5-1513. Because a home-made layout can fail these rules, we don't generate New York financial powers of attorney. Use the statutory short form in §5-1513.

Sources: N.Y. General Obligations Law §5-1501B (NY Senate); N.Y. General Obligations Law §5-1513 statutory short form (NY Senate)

Health Care Proxy (N.Y. Public Health Law §2981)

Rule: Sign and date it in front of two adult witnesses, who also sign. No notary is required.

Law: N.Y. Public Health Law §2981

Witnesses:

Your health care agent may not be a witness.
Witnesses must be adults.

Sources: N.Y. Public Health Law §2981 (NY Senate)

New York's statutory form

New York publishes the New York Statutory Short Form Power of Attorney (GOL §5-1513). For financial powers of attorney you must use it.

After signing

Give copies to your agent and successor, and to banks or doctors who will rely on it.
Keep the original safe and tell your agent where it is.
To cancel it, sign a written revocation and send it to everyone who has a copy.

General information, not legal advice. Laws change; confirm with the official source or a New York attorney. See all states on the requirements by state page.

Frequently asked questions

Does a power of attorney need to be notarized in New York?

Financial: Use New York's statutory short form. You sign, date and initial it; your signature is notarized; two witnesses sign; your agent signs and is notarized too. It must be printed in at least 12-point type. (N.Y. Gen. Oblig. Law §5-1501B and §5-1513). Medical: Sign and date it in front of two adult witnesses, who also sign. No notary is required. (N.Y. Public Health Law §2981).

How many witnesses does a New York power of attorney need?

For a financial power of attorney: 2. For a medical power of attorney (Health Care Proxy): 2.

Who can't be a witness in New York?

A witness may not be an agent or a person who receives gifts under the power of attorney. Your health care agent may not be a witness. Witnesses must be adults.

Does New York have an official power of attorney form?

Yes: the New York Statutory Short Form Power of Attorney (GOL §5-1513). New York requires this statutory short form for financial powers of attorney.

Is this New York form free?

Yes. Fill it in and download the PDF free, with no signup. Word, the signing packet and saved copies are optional paid extras.