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Power of Attorney PDF

Power of Attorney

Step 1 of 7

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- Email*
  
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- Can you name the person for whom the Power of Attorney will be created (the Principal)?
- Enter Name:
- What address does the Principal have?
- Enter Address:
- Enter City:
- Select State:
- Enter Zip Code:
- Enter County:
- Do you want to specify the day on which this power of attorney will take effect?
- Specify Date:
  - Yes
  - No
- Effective Date:
  DD slash MM slash YYYY
- Who is the person chosen to serve as the Principal's Agent?
- Enter Name:
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- What are the Agent's residence and contact information?
- Enter Address:
- Enter City:
- Select State:
- Enter Zip Code:
- Enter Telephone Number:
- This Power of Attorney shall be subject to the laws of which State?
- Select the State's Elder Abuse Law:
- Do you agree to provide the Agent access to your financial accounts?
- The Agent will have the authority to handle and manage any of the Principal's bank accounts (e.g. checkings, savings, money market, etc.) and other related accounts with any financial institution:
  - Yes
  - No
- Do you want to give the Agent the power to look after your assets and property?
- The Agent will have the authority to manage (i.e. sell, exchange, dispose, purchase, invest, reinvest) any assets or property—income producing or non-income producing—owned by the Principal in the present and future:
  - Yes
  - No
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- Do you want to authorize the Agent to obtain and keep your insurance on your behalf?
- The Agent will have the authority to purchase and maintain any insurance—including life insurance—on behalf of the Principal:
  - Yes
  - No
- Do you want to give the Agent permission to pursue your debts?
- The Agent will have the power, within legal means, to collect debt or money owed to the Principal and resolve/reconcile any outstanding claims:
  - Yes
  - No
- Would you give the Agent permission to enter into contracts on your behalf?
- The Agent will have the power to create or enter into any binding contracts deemed necessary on behalf of the Principal:
  - Yes
  - No
- Do you wish to give the Agent permission to run any potential businesses you may own?
- The Agent will have the authority to manage, maintain, administer, and operate any business owned by the Principal:
  - Yes
  - No
- Do you wish to give the Agent the go-ahead to make whatever arrangements are required to take care of your family?
- The Agent will have the authority to make any necessary arrangements (e.g. food, medicine, school, housing, transportation, etc.) to support the Principal's spouse and minor children and meet all other support obligations:
  - Yes
  - No
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- Would you give the Agent permission to manage your financial instruments?
- The Agent will have the authority to purchase, sell, trade, exchange or transfer any financial instruments (e.g. stocks, bonds, commodities, options, debentures, etc.) on behalf of the Principal:
  - Yes
  - No
- Do you want to give the Agent the power to hire or contract with someone on your behalf?
- The Agent will have the authority to contract or employ any professional or business assistance deemed appropriate on behalf of the Principal:
  - Yes
  - No
- Do you want to give the Agent the right to look after your real estate or personal property?
- Agent will have the authority to manage, lease, transfer, sell, insure or repair any property or real estate that is currently owned or might be acquired in the future by the Principal:
  - Yes
  - No
- Do you wish to give the Agent the power to handle every aspect of your governmental affairs?
- Agent will have the authority prepare, sign, and file all necessary governmental documents and interactions with the government and file them with the appropriate organization(s):
  - Yes
  - No
- Do you wish to give the Agent the power to make contributions from your assets to people or nonprofits?
- The Agent shall have the power to distribute gifts from among the Principal's assets to any designated individuals or charitable organizations the Principal is affiliated with. The Agent may not distribute gifts to himself / herself, his/her family members and friends, or any other Agent:
  - Yes
  - No
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- Do you wish to give the Agent the power to move your assets into a trust you set up?
- The Agent may transfer any of the Principal's current assets to a trustee or agent of any revocable trust created by the Principal:
  - Yes
  - No
- Do you want to give the Agent the right to reject any transferred interest?
- The Agent may renounce any interest transferred or allocated to the Principal from another entity:
  - Yes
  - No
- Do you agree to give the Agent control over your digital assets?
- Agent may deal with (i.e. organize, administer, terminate, etc.) all digital assets (e.g. online accounts, computer memory, electronic devices, etc.) of the Principal:
  - Yes
  - No
- Do you wish to give the Agent the power to decide on your behalf when it comes to your health?
- The Agent shall have full power to make all decisions for the Principal’s healthcare, including the power to direct the withholding or withdrawal of life-prolonging treatment, including artificially supplied nutrition and hydration/tube feeding.:
  - Yes
  - No
- If there are any foreseeable circumstances that weren't addressed in the previous sections, would you like to include any particular instructions?
- Include Special Instructions:
  - Yes
  - No
- Enter additional specific instructions for the Agent:
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- Who signed this durable power of attorney as the first witness?
- Enter Name:
- Enter Address:
- Enter City:
- Select State:
- Enter Zip Code:
- Enter Telephone Number:
- What is the name of the second witness to this Durable Power of Attorney?
- Enter Name:
- Enter Address:
- Enter City:
- Select State:
- Enter Zip Code:
- Enter Telephone Number:
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