Who are you GIVING power of attorney to? A spouse or partnerA parent or family memberA child (adult child)A friend or trusted individualOther Who is this Power of Attorney for? First Last The "Principal" also known as the individual GIVING financial powers to another person. Mailing Address Principal's Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Who will be RECEIVING powers to act on the Principal's behalf? First Last Also known as the "Agent" or "Attorney-in-Fact" Agent's Address Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code Select the categories of powers you want your agent to have: Select the categories of powers you want your agent to have: Real estate transactionsFinancial institution transactionsStock and bond transactionsTangible personal property transactionsSafe deposit box transactionsInsurance and annuity transactionsRetirement plan transactionsSocial Security, employment, and military service benefitsTax mattersClaims and litigationCommodity and option transactionsBusiness operationsBorrowing transactionsEstate transactionsAll other property transactions Do you want to include any other powers? Do you want to include any other powers? YesNo Here you may add any other delegable powers including, power to make gifts, exercise powers of appointment, name or change beneficiaries or joint tenants, or revoke or amend any trust. Describe those other powers below: Special Instructions Do you want to include any specific limitations? Do you want to include any specific limitations? YesNo Here you may include any specific limitations you deem appropriate, such as a prohibition or conditions on the sale of particular stock or real estate or special rules on borrowing by the agent. Describe those limitations below: Do you want to name alternative agents? Do you want to name alternative agents? No — I don't wish to name any successor / alternative agentsYes — I'll name one successor / alternative agentYes — I'll name two successor / alternative agents Enter the name of the alternative agent: Enter the address of the alternative agent: Enter the second alternative agent's name: Enter the second alternative agent's address: When will this Power of Attorney begin? When will this Power of Attorney begin? Immediately once signedUpon my incapacitationOn a specific date When? When will this power of attorney terminate? When will this power of attorney terminate? At the time of my deathOn a specific date When? Notary Public Does the Principal AGREE to have this Power of Attorney signed in front of a Notary Public and One (1) Witness? Does the Principal AGREE to have this Power of Attorney signed in front of a Notary Public and One (1) Witness? Yes Next Save Save and finish later
