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Connecticut Durable (Financial) Power of Attorney Form

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Connecticut Durable (Financial) Power of Attorney Form appoints a proxy status on an agent from a principal. In other words, this paperwork should be used when an individual seeks to have someone stand in their place to transact business if he or she is incapacitated. This version of the form goes into effect after a person becomes unable to think or communicate for themselves. That’s why it is called “durable.” Note: Since this is a document that confers power on someone else to transact business in your name and to have access to your financial affairs, it is extremely important that you implicitly trust the person to whom you are granting this power.

Laws – Chapter 7, Section 1-43 (Form)


Medical Power of Attorney – Also referred to in this State as the “Appointment of Health Care Representative,” this enables healthcare decisions to be made by a trusted individual should the Principal become unable to do so.

How to Write

1 – Set The Form In Motion

The form required for a Principal to set Authority over some or all of his or her affairs may be accessed through any of the three buttons beneath the form preview image.

2 – Name The Concerned Parties

Each participant of this appointment of authority will need to be documented in this paperwork. The first few empty spaces in this form will require such information.

Locate the empty line labeled “Insert Name and Address of Principal.” Use this area to document the Identity of the Principal along with his or her current Residential Address.

Next on the blank line after the phrase “Do hereby appoint” must have the Name and Residential Address of the Attorney-in-Fact/Agent.

The section will also require a determination if multiple Agents have the Authority to act on behalf of the Principal. If there are multiple Principal Agents in play and the Principal wishes them to each have the power to act independently, then write in the word “Severally” in the blank space following the words “…To Act.” If the Principal requires the Agents to consult one another before enacting Principal Authority, then leave this line blank or write in the word “Jointly.”

3 – Identify Any Limitations On Granted Authority

The Principal Power granted through this document will operate under the guidelines of the Connecticut Power of Attorney Act. In some cases, a Principal may not wish to grant carte blanche powers to an Agent. To this end, a list of sub-divisional powers has been provided in the next section of this form. The Principal has the option of restricting any of these sub-divisional powers from the Attorney-in-Fact/Agent by crossing it out then initialing the blank space corresponding blank space.

In order to disallow the Attorney-in-Fact/Agent from acting with any Principal Authority in respect to the Principal’s Real Property, the Principal must cross out Item A then initial the blank line on this line.

If the Principal does not wish to give the Attorney-in-Fact/Agent Authority in his or her Tangible Personal Property matters, then Item B must be crossed out. The blank space on this line must be initialed.

Item C must be struck through and initialed if the Principal does not wish to appoint the Attorney-in-Fact/Agent powers in his or her Stocks and Bonds.

Should the Principal wish to restrain the Attorney-in-Fact/Agent from using Principal Authority in with his or her Commodities and Options then, he or she must draw a line through Item D and initial the empty line.

The Attorney-in-Fact/Agent will be unable to act with Principal Power relating to the Principal’s Banks and Financial Institutions if Item E has been struck through and the blank line initialed.

If Item F is crossed out and initialed by the Principal, the Attorney-in-Fact/Agent will not be able to utilize Principal Authority in the Operation of the Principal’s Business Entities.

Should the Principal wish to withhold Principal Powers in his or her Insurance and Annuities from the Attorney-in-Fact/Agent, then Item G should be crossed out and the corresponding blank space initialed by the Principal.

The Principal must strike through Item H and initial the blank space on this line if he or she does not wish to appoint the Attorney-in-Fact/Agent any Power regarding his or her Estates, Trusts, and Other Beneficial Interests.

The Attorney-in-Fact/Agent will not have the Authority to act on the Principal’s behalf regarding the Principal’s Claims and Litigation matters so long as the Principal strikes through Item I and supplies his or her initials on the blank space.

The Principal must eliminate Item J by crossing it out and initialing it if he or she wishes to restrict power over his or her Personal and Family Maintenance

The Attorney-in-Fact/Agent will be unable to use Principal Authority over the Principal’s Benefits from Government Programs or Civil or Military Service when the Principal eliminates and initials Item K

The Principal should draw a horizontal line across the words in Item L and initial the appropriate blank line if he or she wishes to restrict the Attorney-in-Fact/Agent from exerting authority over the Principal’s Retirement Plans.

To restrict the Attorney-in-Fact/Agent from acting with Authority in the Principal’s Taxes, he or she must cross out Item M. The Principal must also initial the blank space on this line.

Principal Power in all other matters will be restricted from the Attorney-in-Fact/Agent if the Principal crosses out Item N, initials the blank space on this line, then specifies the items the Attorney-in-Fact/Agent will not be given Principal Authority in.

4 – Successor Agent Appointment (Optional)

The Principal may name two individuals to succeed the Primary Attorney-in-Fact/Agent, should this entity no longer be able or desire to continue acting on the Principal’s behalf.

Enter the Name and Address of the First Successor Agent on the first two blank line following the Fifth Statement.

Enter the Name and Address of the Second Successor Agent, who will assume Principal Authority, should the Primary Attorney-in-Fact/Agent and the First Successor Agent be unable to act Principal Power.

5 – Effective Signature

The Principal must provide a Signature Approval to this form. The opportunity to satisfy this requirement will be available in the Sixth Statement. Locate the phrase “In Witness Whereof,” the Principal must enter the Date of Signature using the three blank spaces in this statement.

Next, on the blank space labeled “Signature of Principal,” the Principal must sign his or her Name in the Presence of two Signature Witnesses and a Notary Public.

Each of two blank spaces, labeled “Witness,” must be signed by one of the Witnesses viewing the Principal Signing.

Below the Principal and Witness Signatures will be the Notary Public portion. Make sure the Notary Public fills this in fully and provides his or her notarization seal.


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