FREE POWER OF ATTORNEY FORM TEMPLATE

A power of attorney form is a document where a person chooses someone to to act on his or her name as an agent.

It should only be issued to a trustworthy person and who will act in your best interests in all matters.

When your physical ability becomes limited it’s time to think about choosing someone to handle your affairs and name him or her your agent through a poa. 

You may use a power of attorney form when:

  • Traveling out of state or country for an extended period of time
  • Having a scheduled medical operation and/or hospital stay 
  • When you limited ability to physically move and need a friend or a family member to act on your behalf, such as elderly people

TYPES OF POA:

  • General - is comprehensive and gives your attorney-in-fact all the powers and rights that you have yourself.
  • Durable - can be general or limited in scope, but it remains in effect after you become incapacitated
  • Special or Limited - gives someone else the power to act in your stead for a very limited purpose.
  • Medical - gives the agent specific control upon the consent of your doctor over the your healthcare decisions should you become incapacitated or unable to do so. 
  • Springing - it does not become effective until you are incapacitated.

POWER OF ATTORNEY SAMPLE


Made this _________day of ____________________ (month) of ____________ (year)


I, the undersigned,

Grantor: ____________________________________________________________

Address: __________________________________________________________

SSI Number: ____________________________

Telephone Number: ____________________________

hereby appoint and authorize

Agent: ____________________________________________________________

Address: __________________________________________________________

SSI Number: ____________________________

Telephone Number: ____________________________

as my true and lawful agent (attorney-in-fact) to have full power and authority to act on my behalf in any lawful way with respect to the following:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Operation of Entity or Business, Bank Accounts and Other Financial Matters, Taxes Issues, Buy and sell Real Property,  Estates, and Other Beneficial Interests Claims and Litigation, Tangible Personal Property, Stocks and Bonds, Commodities and Options,  Insurance and Annuities, Personal and Family Maintenance, Hiring Representatives, Benefits from Governmental Programs or Civil or Military Service,  Social security, Medicaid, Medicare, Retirement Plans. Also: Exercise the right to make a disclaimer on my behalf, Execute, amend or revoke any trust agreement, Make gifts within gift tax limits except to himself / herself, Buy, sell or manage real estate, Enter safety deposit boxes, Collect debts, Borrow money... etc


DESIGNATION OF SUCCESSOR 

In the event that ________________________________ (AGENT 1) is unwilling or unable to act on my behalf for any reason, then I constitute and appoint 

Name of Successor Agent (AGENT 2): ______________________________________

Address: ____________________________________________________

SSI Number: ____________________________

Telephone Number: ____________________________

as successor Attorney-in-Fact/Agent.


My Agent shall receive $_____________ for services rendered.

or

My Agent shall receive NO compensation for services rendered. 


SPECIAL INSTRUCTIONS

______________________________________________________

______________________________________________________

______________________________________________________

EFFECTIVE DATE: This power of attorney is effective immediately unless I have stated otherwise in the special Instructions. And shall not be affected by my disability or mental incompetency, except as may be provided otherwise by an applicable state statute governed by the laws of the state of __________________.


____________________________ (Grantor’s Signature)  ___/___/____ (Date) 

____________________________ (Grantor’s Name Printed)

______________________________________________________ (Grantor’s  Address)

______________________________________________________ (Grantor’s  Address)

___________________________________________ (Grantor’s  Telephone Number)

in the presence of the undersigned witnesses:

Witness 1.

Name: ______________________

Address: _____________________________________________

Signature: ________________________

Witness 2.

Name: ______________________

Address: _____________________________________________

Signature: ________________________

NOTARY

State of Nebraska                     )

                                                 ) ss.

[County] of                              )

This document was acknowledged before me ___/___/_____,  (Date) _________________

on by . _____________________________________(Name of Principal) who is/are personally known by me or who has/have produced: ___________________________ as identification and who ____ DID___ DID NOT take an oath.

 _________________________________________  (Signature of Notary)

(Seal, if any)

My commission expires: ___/___/_____


In most States, a Power of Attorney Form MUST be signed IN THE PRESENCE of a notary public to comply with State Law.

A written notice of revocation to your agent  is necessary to REVOKE a Power Of Attorney in most states.

STATES: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, D.C., Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming.

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