Fill - Free fillable DURABLE POWER OF ATTORNEY PDF form

DURABLE POWER OF ATTORNEY

NOTICE TO THE PRINCIPAL: THE PURPOSE OF THIS POWER OF ATTORNEY

IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO

HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR

OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE

NOTICE TO YOU OR APPROVAL BY YOU.

THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO

EXERCISE GRANTED POWERS, BUT, WHEN POWERS ARE EXERCISED, YOUR AGENT

MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS

POWER OF ATTORNEY.

YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR

LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY

LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A

COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.

YOUR AGENT MUST [KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S

FUNDS.] ACT IN ACCORDANCE WITH YOUR REASONABLE EXPECTATIONS TO THE

EXTENT ACTUALLY KNOWN BY YOUR AGENT AND, OTHERWISE, IN YOUR BEST

INTEREST, ACT IN GOOD FAITH AND ACT ONLY WITHIN THE SCOPE OF AUTHORITY

GRANTED BY YOU IN THE POWER OF ATTORNEY.

THE LAW PERMITS YOU, IF YOU CHOOSE, TO GRANT BROAD AUTHORITY TO

AN AGENT UNDER POWER OF ATTORNEY, INCLUDING THE ABILITY TO GIVE

AWAY ALL OF YOUR PROPERTY WHILE YOU ARE ALIVE OR TO SUBSTANTIALLY

CHANGE HOW YOUR PROPERTY IS DISTRIBUTED AT YOUR DEATH. BEFORE

SIGNING THIS DOCUMENT, YOU SHOULD SEEK THE ADVICE OF AN ATTORNEY AT

LAW TO MAKE SURE YOU UNDERSTAND IT.

A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR

AGENT IS NOT ACTING PROPERLY.

IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND,

YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.

(Principal's Signature)

(Date)

________________________

click to sign

signature

click to edit

BE IT KNOWN TO ALL, that I, ________________________, being of the age of consent of

eighteen (18) years or older and currently residing at ________________________,

________________________, in the County of ________________________ located within the

State of ________________________ and whose zip code is ________________________, do

hereby designate, establish and appoint ________________________, as my official allocated

Attorney-in-Fact ("Agent") to perform in my name and stead as of ________________________.

The appointed Agent to the Durable Power of Attorney, as stipulated within the aforementioned

instrument, does not have the right to transfer nor convey any of the Principal's property, now

owned or later acquired, to himself or herself, the Agent's family member or any associate without

full and adequate consideration nor accept a gift of the Principal's property unless otherwise

stipulated within this Durable Power of Attorney. In the event that the designated Agent should

transfer any of the principal's Property to his/herself without precise detailed written authorization

contained with the Durable Power of Attorney, the Agent could be prosecuted, to the fullest extent

allowable by law, for fraud and/or embezzlement. Should it be determined that the Principal was

or is 65 years of age or older at the time said property was illegally transferred to the Agent without

precise detailed written authority, the Agent could be prosecuted pursuant to and in accordance

with the federal and/or state Elder Abuse Laws of ________________________. In addition to

criminal prosecution, the Agent may be sued in civil court as well.

This DURABLE POWER OF ATTORNEY, shall not be affected by subsequent incapacity of the

Principal.

I do hereby revoke and/or rescind any "General Power of Attorney" signed by me that was

previously in effect. HOWEVER, this does not revoke nor invalidate any Power of Attorney that

may be directly related to any Advance Health Care Directive previously signed by me.

THEREFORE, it is my wish that my Agent shall maintain full power and authority to act on my

behalf with respect to the following subjects:

My Agent's powers shall include the authority to:

The Agent shall have complete authority to manage and conduct all my affairs, as initialed above

and to exercise all of my legal rights and powers, including any and all rights and powers that I

may acquire in the future regarding the categories above.

THEREFORE, let it be known that this Power of Attorney shall be interpreted as a Durable Power

of Attorney, and as such the specific intentions are not meant to limit or impede the powers

conferred with regards to this Durable Power of Attorney in any way.

IN ADDITION, any right or authority that shall be extended to my Agent by way of this instrument

shall be limited to the degree deemed necessary as a means to prevent this Power of Attorney that

would create or trigger: (i) any portion of my current or any future acquired assets to become

subject to any general power of appointment by my Agent, (ii) my Agent to have any occurrences

of ownership with regards to any life insurance policies that I may purchase or possess on the life

of my Agent, and (iii) any portion of my income to become taxable to my Agent.

FURTHERMORE, let it be known that my Agent shall not be held liable, in any manner or aspect,

for any loss which may result from any judgment error made in good faith while performing on

my behalf. However, my Agent could be held and shall be held liable for any "willful misconduct

or failure to act in good faith" in the performance of their fiduciary responsibilities as my Agent

in accordance with this Durable Power of Attorney.

I hereby authorize my designated Agent to indemnify and hold harmless any third party who

accepts and acts under this instrument.

IN SO MUCH, that my Agent carries out and abides by my wishes, s/he shall be entitled to

reasonable compensation for any of his/her services provided as my Agent.

IN ADDITION, my Agent shall be reimbursed of any and all reasonable expenses which may

have been incurred in connection with the aforementioned Power of Attorney.

LASTLY, my Agent shall furnish and deliver a comprehensive report for any and all accounts

controlled or any activities performed in accordance with federal and state laws, and in whatever

manner as instructed or requested by me or any authorized personal Agent, governmental bureau

or official organization which may be acting on my behalf.

THE AFOREMENTIONED Durable Power of Attorney shall become effective immediately

following the signing of this instrument on the date indicated. This instrument shall not be affected

should I become disabled or be deemed mentally incompetent, except as may otherwise be

provided or stipulated herein or by applicable state statute. This Durable Power of Attorney shall

remain in effect until my demise or is revoked by me through written notification to my Agent.

Dated ________________________.

(Principal Signature - ________________________)

(Agent Signature - ________________________)

(Signature of Witness #1 - ________________________)

(Signature of Witness #2 - ________________________)

click to sign

signature

click to edit

click to sign

signature

click to edit

click to sign

signature

click to edit

click to sign

signature

click to edit

STATE OF ________________________,

COUNTY OF ________________________

On __________________ the aforementioned parties appeared before me, a Notary Public, for the

above state and county, and is known to me or provided photo identification and that such

individuals executed the foregoing instrument, and being duly sworn, such individuals

acknowledged that s/he executed said instrument for the purpose therein contained of his/her free

will and voluntary act.

(SIGNATURE NOTARY PUBLIC)

My Commission expires: ______________________________

click to sign

signature

click to edit

WITNESS VERIFICATION

________________________, on the abovementioned date, acknowledges and declared that s/he

appointed ________________________, in our presence, to be his/her Power of Attorney. We,

the below listed witnesses, in his/her presence and at his/her request, and in the presence of each

other, verify and confirm to the same and hereby sign our names as attesting witnesses.

(Signature of Witness #1)

________________________

________________________, ________________________ ________________________

________________________

(Signature of Witness #2)

________________________

________________________, ________________________ ________________________

________________________

SIGNATURE OF NOTARY PUBLIC

Signed (or subscribed or attested) before me on ______________________________(date) by

________________________.

____________________________________________ Notary Seal

Notary Signature

click to sign

signature

click to edit

click to sign

signature

click to edit

click to sign

signature

click to edit

SIGNATURE OF NOTARY PUBLIC

Signed (or subscribed or attested) before me on ______________________________(date) by

________________________.

____________________________________________ Notary Seal

Notary Signature

click to sign

signature

click to edit

NOTICE TO PRINCIPAL REGARDING INDIVIDUAL EXECUTING

POWER OF ATTORNEY

The implementation of a Power of Attorney is an important legal document, and should not be

undertaken lightly. With the signing of the Durable Power of Attorney, you are hereby authorizing

another individual to act on your behalf. There are significant facts that you should be aware of

and familiar with prior to you signing the aforementioned Power of Attorney.

- Your appointed Agent (the Attorney-in-Fact) shall have no obligation to perform unless

both you and your Agent shall agree otherwise in writing.

- The above Durable Power of Attorney provides your Agent with the authority to

administer, dispense with, trade, sell and transfer your real and personal property, as well

as the option to use said property as security should your Agent borrow money on your

behalf, unless otherwise provided in writing within this Durable Power of Attorney.

- As your Agent, s/he shall have the right to receive reasonable compensation for any and

all functions, activities and services provided and/or contained within the aforementioned

Power of Attorney unless you provide otherwise within this instrument.

- Please note that any power you convey to your Agent shall continue to endure your entire

lifetime, unless a shorter duration of time is stipulated or should you otherwise terminate

your authorized Durable Power of Attorney.

- The powers provided to the Agent within the aforementioned Power of Attorney shall

continue to exist even if you should become mentally or physically incapacitated and thus

unable to make decisions with regards to the management of assets, finances, and

property (real and personal), unless otherwise stipulated within said Durable Power of

Attorney.

- Changes or corrections to any of the terms contained within the aforementioned Power of

Attorney can be made only by the execution of a new Power of Attorney, or through the

execution of an amendment by way of the same formalities as the original. The Principal

of the Durable Power of Attorney shall maintain the right to change, revoke and/or

terminate this agreement at any time as long as said Principal is deemed competent.

- The aforementioned Power of Attorney must be dated and acknowledged before a notary

public and signed by two (2) witnesses. Witnesses to the aforementioned Power of

Attorney must be deemed mentally competent and will also be required to witness the

principal's signing of the Power of Attorney and/or the principal's

signing/acknowledgment of his/her signature. Any legal document or instrument that

could affect a principal's real property should be acknowledged before a notary public for

ease of recording.

- A Power of Attorney should be reviewed and read carefully prior to signing. Once the

instrument becomes effective, said Durable Power of Attorney shall provide your Agent

the power and authority to manage any and all property you now own or may acquire in

the future. A Durable Power of Attorney is an important instrument/document, and as

such, should you not understand any item or provision contained therein, you should seek

the assistance of an attorney or qualified individual to advise you accordingly.

(Principal's Signature)

(Date)

________________________

________________________, ________________________ ________________________

click to sign

signature

click to edit

NOTICE TO AGENT REGARDING INDIVIDUAL ACCEPTING

APPOINTMENT

AS ATTORNEY-IN-FACT

Acceptance of or the agreement to act as the Agent (Attorney-in-Fact) with regards to the

aforementioned Power of Attorney, you undertake the fiduciary and other legal duties and/or

responsibilities of a Agent. These duties/responsibilities include:

- The Agent shall have the fiduciary and legal duty to act solely in the interest of the

principal; with faithfulness, devotion, trustworthiness, dependability, care, competence

and/or diligence as required to avoid any misunderstandings or conflicts of interest.

- The Agent shall have the fiduciary and legal duty to maintain and to keep account of any

and all transactions, dealings and communications that transpired on behalf of the

Principal named in the Durable Power of Attorney. Such transaction records shall

include, but are not limited to, receipts for purchases, sales, transfers and deposits,

disbursements, collection of money owed, payment of bills or liabilities to or for the

principal, and any other dealings or transactions with regards to any of the principal's

assets or liabilities.

- In the event that the principal should appoint a separate Health Care Agent to administer

any health care decisions, the Agent to this Durable Power of Attorney shall cooperate

fully with the principal's duly appointed Health Care Agent in making decisions pursuant

with the principal's desires/wishes or that which is deemed in the best interest of the

principal.

- The Agent shall have the fiduciary and legal duty related to maintain and uphold any

estate plan that the principal may have in effect, if any.

- The Agent shall have the fiduciary and legal duty to preserve the principal's property

separate and well-defined from any other property that the Agent may have under his/her

power and possession.

- The Agent shall have the fiduciary and legal duty to cease and/or terminate actions as

Agent (Attorney-in-Fact) related to the aforementioned Durable Power of Attorney upon

the occurrence of any of the following items:

- The Principal's demise;

- The cancellation or revocation of aforementioned Durable Power of Attorney;

- The onset of any date which may be contained within the stipulated Durable

Power of Attorney, stating or stipulating a date terminating the Durable Power of

Attorney, if any; or

- No additional action required under the Durable Power of Attorney.

- In the event that the Agent (Attorney-in-Fact) is the spouse of the principal, said Durable

Power of Attorney shall be terminated upon legal separation or dissolution of the

marriage.

- At any time should the Agent willfully violate, misuse, exploit, mishandle or abuse the

power or authority conveyed or granted under this Durable Power of Attorney, you, as

the Agent, may be held accountable, responsible and/or liable for any said intentional

actions pursuant to federal and state laws governing this Durable Power of Attorney.

- In addition, as the Agent (Attorney-in-Fact), you shall have the right to pursue and obtain

legal advice should you not understand any stipulated duties and responsibilities as Agent

or any provisions contained within the Durable Power of Attorney.

As the appointed Agent to the Durable Power of Attorney, as stipulated within the aforementioned

instrument, you do not have the right to transfer nor convey any of the principal's property, now

owned or later acquired, to yourself, family member or any associate without full and adequate

consideration nor accept a gift of the principal's property unless otherwise stipulated within the

aforementioned Durable Power of Attorney. In the event that the designated Agent should transfer

any of the principal's property to his/herself without precise detailed written authorization

contained with the Durable Power of Attorney, the Agent could be prosecuted, to the fullest extent

allowable by law, for fraud and/or embezzlement. Should it be determined that the principal was

or is 65 years of age or older at the time said property was illegally transferred to the Agent without

precise detailed written authority, the Agent could be prosecuted pursuant to and in accordance

with the federal and/or state Elder Abuse Laws of ________________________. In addition to

criminal prosecution, the Agent may be sued in civil court as well.

THEREFORE, I hereby acknowledge that I have read the foregoing notice and that I understand

all contained fiduciary and legal duties and responsibilities that I hereby assume by action of

signing as the Agent (Attorney-in-Fact) in accordance with the terms and conditions contained

within the Durable Power of Attorney.

(Agent's Signature)

(Date)

________________________

________________________, ________________________ ________________________

________________________

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

DURABLE POWER OF ATTORNEY

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank DURABLE POWER OF ATTORNEY Form

Related forms

Fillable DURABLE POWER OF ATTORNEY

Fill Online, Printable, Fillable, Blank DURABLE POWER OF ATTORNEY Form

Related forms

First 20 documents completely FREE!