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 2nd Agent Does the Principal want to elect a 2nd Agent? Does the Principal want to elect a 2nd Agent? YesNo If any Agent shall die, become incompetent, resign or refuse to accept the office of Agent, this is a person that will be able to act in the Principal's place. Name of 2nd Agent First Last 2nd 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 Powers Select which Powers to Give the Agent Select which Powers to Give the Agent Real property transactionsTangible personal property transactionsStock and bond transactionsCommodity and option transactionsBanking and other financial institution transactionsBusiness operating transactionsInsurance and annuity transactionsEstate, trust, and other beneficiary transactionsClaims and litigationPersonal and family maintenanceBenefits from Social Security, Medicare, Medicaid, or other government benefitsRetirement plan transactionsTax mattersDigital assets and the content of an electronic communication (✓) Check ALL that apply Gifts Will the Agent be allowed to make Gifts? Will the Agent be allowed to make Gifts? YesNo (recommended) If the Agent has the ability to make gifts, the Agent will be able to give or compensate anyone for anything at anytime. Additional Powers Do you want to write any Additional Powers or Instructions to the Agent? Do you want to write any Additional Powers or Instructions to the Agent? YesNo Write the Additional Powers or Instructions: Agent Compensation Would you like to Compensate ($) the Agent for acting on your behalf? Would you like to Compensate ($) the Agent for acting on your behalf? YesNo Some principals choose to compensate their Agent while performing acts on their behalf. The Agents How are the Agents supposed to act? How are the Agents supposed to act? Each of my co-agents may act independently for me.My co-agents may act for me only if the co-agents act jointly.My co-agents may act for me only if a majority of the co-agents act jointly. Start Date When does this Power of Attorney begin? When does this Power of Attorney begin? Immediatelyupon my Incapacity (not able to think for oneself) Incapacity - When a person loses their ability to make rational decisions. Caused mostly by Dementia, Alzheimer's Disease, Stroke, etc. Notary Public Does the Principal AGREE to have this Power of Attorney signed in front of a Notary Public? Does the Principal AGREE to have this Power of Attorney signed in front of a Notary Public? Yes Next Save Save and finish later
