Durable (Financial) Power of Attorney

Principal

Who is the Principal?

First

Last

The "Principal" is the person GIVING financial powers to someone else (the "Agent"). For example, Jon Smith gives power of attorney to his daughter to do his banking. Jon Smith would be the Principal.

Principal's Mailing Address

Street Address

Address Line 2

City

State

ZIP Code

Principal's Address is required.

Agent

Who will be RECEIVING powers to act on the Principal's behalf?

First

Last

Known as the "Agent" or "Attorney-in-Fact"

Agent’s Address

Street Address

Address Line 2

City

State

ZIP Code

Agent's Address is required.

2nd Agent

Would you like to have a 2nd Agent?

YesNo

This is someone who may work with the 1st Agent or if the 1st Agent is not able to perform their duties.

Name of 2nd Agent

First

Last

2nd Agent's Address

Street Address

Address Line 2

City

State

ZIP Code

The Agents (Decision-Making)

Would you like the 2 Agents to Act JOINTLY or SEPARATELY?

JOINTLYSEPARATELY

JOINTLY - For most decisions acting on my behalf I would like the Agents to act together.

SEPARATELY - The Agents may act separately with the 2nd Agent having full authority if the 1st Agent is not able to perform their duties.

Durable

Would you like this Power of Attorney Form to remain VALID if you should become Incapacitated?

Yes, I would like it to remain validNo, I would not like it to remain valid

Incapacitation is described as being in a medical condition where you cannot speak for yourself such as suffering from: a Coma, Dementia, Alzheimer's, etc.

Initial (Electronically or Hand-Written)

Do you wish to Initial this form Online or After Printing?

OnlineAfter printing

Absolute Financial Power

Do you wish to grant Absolute and Unlimited Financial Powers to your Agent(s)?

YesNo

This would be in regards to:

Real Property transactions
Tangible personal property transactions.
Stock and bond transactions.
Commodity and option transactions.
Banking and other financial institution transactions including complete access to any bank safe deposit box in my name and the authority to withdrawal or add to the contents.
Business operating transactions.
Insurance and annuity transactions.
Estate, trust, and other beneficiary transactions.
Claims and litigation.
Personal and family maintenance.
Benefits from social security, medicare, medicaid, or other governmental programs, or civil or military service.
Retirement plan transactions.
Tax matters.

E-Initials

Initial ONLY the Powers you would like your Agent(s) to have

Initial to give Absolute and Unlimited Financial Power to Your Agent(s)

Clear

With your Initials above, you are authorizing that the Agent(s) will have the power to do all of the following:

Real Property transactions

Tangible personal property transactions.

Stock and bond transactions.

Commodity and option transactions.

Banking and other financial institution transactions including complete access to any bank safe deposit box in my name and the authority to withdrawal or add to the contents.

Business operating transactions.

Insurance and annuity transactions.

Estate, trust, and other beneficiary transactions.

Claims and litigation.

Personal and family maintenance.

Benefits from social security, medicare, medicaid, or other governmental programs, or civil or military service.

Retirement plan transactions.

Tax matters.

Real Property Transactions

Clear

Tangible personal property transactions.

Clear

Stock and bond transactions.

Clear

Commodity and option transactions.

Clear

Banking and other financial institution transactions.

Clear

Business operating transactions.

Clear

Insurance and annuity transactions.

Clear

Estate, trust, and other beneficiary transactions.

Clear

Claims and litigation.

Clear

Personal and family maintenance.

Clear

Benefits from social security, medicare, medicaid, or other governmental programs, or civil or military service.

Clear

Retirement plan transactions.

Clear

Tax matters.

Clear

Special Instructions

Will there be any Special Instructions given to the Agent(s)?

YesNo

In addition to the Powers already given, the Agent has special instructions to:

Notary

This form must be signed in the presence of a Notary Public. A Notary Public can be found at almost every Branch Bank in the United States or you may use one (1) of the following links:

The UPS Store - More than 4,500 locations nationwide with Notaries
American Association of Notaries - Directory of Licensed Notaries

I Agree to Complete and Sign the Rest of this Document in front of a Notary Public with my Agent(s) present

Yes, I Agree