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Massachusetts Durable (Financial) Power of Attorney Form

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Massachusetts Durable (Financial) Power of Attorney Form can be used to designate someone to handle your financial affairs as well as additional (relevant) areas of life on your behalf.  This type of form can be useful during traumatic or even life-threatening medical events as it can be set to remain in effect even if you become incapacitated. That means that if you get to the point where you are mentally incompetent and can no longer make your own decisions when determined by your doctor, your agent will still be able to make decisions on your behalf.

Laws – Massachusetts General Law Chapter 190B


Health Care Proxy – If you become incapacitated and unable to communicate effectively, this form will enable your pre-approved agent to make critical health care judgments on your behalf.

How to Write

1 – Locate And Select The File Type You Wish To Work With

This page will present three buttons underneath the displayed image. As you may note, each button is named after a type of file. Select the file format you would like to work to open the form.

2 – The Principal Declaration Requires Information

The first statement will structure the Principal designation of the Attorney-in-Fact as an entity approved to use the Principal’s Authority relating to the Principal’s affairs.

The first empty spaces on this form must have the Principal’s Legal Name recorded accurately. This should consist of his or her First Name, Middle Name, Last Name, and any Title that should be applied (i.e. Dr., Esq, etc.)

Next report the Principal’s Address on the second and third blank spaces. Use the second blank space to enter the Principal’s Building Number, Street, County, and City. Then use the third blank space to document the Principal’s State of Residence. Next, use the first, second, and third empty spaces, after the word “designate,” to record the Attorney-in-Fact’s Legal Name, Residential County/City, and Residential State.

2 – The Determined Effective Date Of The Attorney-in-Fact’s Principal Authority Should Be Declared

The section, “Effective Date,” will require the Principal to initial the statement that best describes the durability of the Authority designated to the Attorney-in-Fact.

If the Principal wishes the Attorney-in-Fact’s Principal Authority accessible immediately upon the Principal Signing of this paperwork, the Principal should initial the empty line preceding Choice “A.” The Principal may elect to only designate this Attorney-in-Fact with Principal Authority upon receiving a written diagnosis, from his or her Physician, as unable to attend to his or her financial affairs.

3 – The Principal Will Need To Deliver Direct Approval Of The Authority Delegated To The Attorney-in-Fact

The first subject to be discussed is labeled “Banking.” Here, if the Principal initials the empty line preceding this label, the Attorney-in-Fact will be approved of using the Principal’s Authority in Principal Banking Matters. In the next paragraph, “Safe Deposit Box,” the Principal will deliver Principal Access and Authority to his or her Safe Deposit Boxes to the Attorney-in-Fact. The Attorney-in-Fact will be granted Principal Authority in “Lending and Borrowing” on behalf of the Principal if the Principal initials the third statement. The Principal’s Authority over his or her “Government Benefits” will be delegated to the Attorney-in-Fact with the Principal act of initialing the blank line corresponding to the fourth paragraph. The fifth statement, titled “Retirement Plan,” discusses the Principal Power in relation to Retirement Plans. The Principal can give the Attorney-in-Fact the Authority by initialing the appropriate empty line. If the Principal has determined the Attorney-in-Fact should be empowered to act on his or her behalf “Taxes,” then he or she should initial the sixth paragraph to include such a delegation to the Attorney-in-Fact.     The Principal can designate the Attorney-in-Fact with Principal Power with his or her “Insurance” by initialing the seventh statement

The Authority to handle the Principal’s interests and affairs regarding “Real Estate,” the Principal will need to provide his or her initials on the blank line next to the term “Real Estate.”The ninth statement shall address the actions the Attorney-in-Fact may take in the Principal’s Name when empowered by Principal Authority with the Principal’s “Personal Property.” The Principal may deliver this Authority by initialing the blank line provided. The Principal can empower the Attorney-in-Fact with the same Management Authority under his or her control by initialing the “Power To Manage Property” paragraph. If the Attorney-in-Fact should have the ability to exert the same Authority the Principal can regarding “Gifts,” the Principal will need to initial the blank line corresponding to the tenth paragraph. The Principal may empower the Attorney-in-Fact with the ability to act in his or her Name regarding “Legal Advice and Proceedings” by initialing the eleventh blank space. The next area that may only be tended to by the Principal is labeled “Special Instructions.” Below this heading, the Principal may formally declare any additional instructions or provisions relating to such subjects as the Attorney-in-Fact named above, his or her use of Principal Authority, and the Authority delegated through this document using the blank lines presented or by citing a properly labeled attachment that is titled appropriately.

4 – This Form Must Be Verified Through The Principal’s Signature And Signature Date

The next area will serve as proof of the Principal’s delegation of the Authority above. Here, the Principal will need to enter the Date he or she signs this form using the spaces provided in the “In Witness Whereof” statement. The Principal’s signature must be supplied by the Principal on the same Date he or she reported. The Principal may use the “Principal’s Signature” line to supply this item.

5 – Two Witnesses Will Need To Testify To Their Observance Of The Principal Signing

Everyone who is acting as a Witness to this Principal signing will need to read the paragraph beginning with the words, “We, the witnesses, each do hereby declare…” Once this task is completed, each Witness will need to sign the “Witness’s Signature” line and provide his or her Residential Address on the “Address” line. Just after the Witness statement, the Notary Public serving this execution will provide the items in the next area.

6 – The Attorney-in-Fact’s Signed Acknowledgment Is A Required Item

The “Specimen Signature And Acceptance Of Appointment” section requires the Attorney-in-Fact to print his or her name in the blank line presented in this statement. Once this task is complete, he or she must sign the “Attorney-in-Fact’s Signature” line. The next area may only be tended to by the Notary Public obtained for this form’s signing.


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