1. This is an important legal document. By signing it, you are v
giving another individual broad powers to handle your property and finances.
2. Warning! Do not sign this document unless you fully understand the
consequences of having a durable power of attorney for finances.
3. There is no standard form for a durable power of attorney. If this form
does not reflect your wishes or suit your needs in any way, seek advice from a
4. In using this document, you must choose whether you want your agent to
have powers now, or only if you become unable to handle your finances.
5. This document does not give your agent power to make medical
6. You can revoke this power of attorney by notifying your agent in writing.
1. Read over the following document carefully. If there is anything you do
not understand, you should ask a lawyer to explain it to you.
2. If the document suits your needs, complete the blanks on the form or
direct someone to do it for you. Make sure to initial one choice under "Effective
3. Sign the document or direct someone else to sign your name in your
presence, and have two witnesses sign.
4. If your agent will have power to deal with real estate, make sure a notary
public signs the document.
5. Keep the original document in a safe place, accessible to you and your
agent. You can make and use photostatic copies of the original.
I, __________________________________________, am of sound mind, and I
(Print or type your full name)
voluntarily make this designation. I revoke any financial powers of attorney I have
signed in the past.
I designate ___________________________________, my ________________,
(Insert name of agent) (Spouse, child, friend ... )
living at ______________________________________________________________,
to act for me as my agent, with the powers set forth in this document. If my first choice
cannot serve or cannot continue to serve, I designate ___________________________, , l
(Name of successor agent)
my ________________, living at __________________________________________,
(Spouse, child, friend ... )
to act for me as my agent. I have discussed this appointment with the individual or
individuals I have designated.
(You must choose one paragraph by writing your initials on the line)
____________ My agent has the powers set forth in this document immediately upon
my signing it. These powers shall not be affected by any mental or physical disability I
may have in the future.
____________ My agent shall only have the powers set forth in this document when it
is determined I am unable to manage my property and financial affairs effectively. That
determination shall be made by my attending physician, who shall put it in writing.
My agent shall exercise powers in my best interests and for my welfare, as a fiduciary.
My agent shall have the following powers:
. BANKING - To receive funds, deposit funds in any financial institution, and make
withdrawals by check or otherwise to pay for goods, services, and any other personal
and business expenses for my benefit. To effect her or his powers, my agent has power
to sign a power of attorney drafted by the institution, and shall have access to my safe
deposit box.
2. GOVERNMENT BENEFITS - To apply for and receive any government benefits for
which I may be eligible or become eligible, including but not limited to, Social Security,
Medicare and Medicaid.
3. INVESTMENTS - To invest and reinvest my funds, and to withdraw funds to the
extent needed to pay for my needs.
4. RETIREMENT PLAN - To contribute to, select payment option of, roll-over, and
receive benefits of any retirement plan or IRA, except my agent shall not have power to
change the beneficiary of any plan or IRA.
5. T
AXES - To complete and sign any local, state and federal tax returns, pay any
taxes and assessments due and receive credits and refunds, to sign any IRS documents
necessary to effectuate these powers.
6. INSURANCE - To purchase, pay premiums and make claims on life, health,
automobile and homeowners' insurance, except my agent shall not have the power to
cash in or change the beneficiary of any life insurance policy.
7. REAL ESTATE - To purchase, sell, lease, repair, improve, mortgage, and make
mortgage and utility payments upon real property. A legal description is attached.
8. PERSONAL PROPERTY - To hold personal property for safekeeping, and to buy
and sell personal property, including motor vehicles.
9. LEGAL ADVICE AND PROCEEDINGS - To obtain and pay for legal advice, to
initiate or defend legal and administrative proceedings on my behalf, including actions
against third parties who refuse without cause to honor this document.
1 0. ESTATE PLAN - My agent has no authority to make or amend a will on my
behalf, and has no power to make gifts on my behalf except to my spouse. My agent has
access to my will; in exercising powers, my agent shall take into account my estate plan
as known to the agent.
On the following lines are any special instructions limiting or extending the powers I
give to my agent. ______________________________________________________
No person in Michigan or in any other state who relies upon representations of
my agent under this durable power of attorney shall be liable to me or my estate without
actual knowledge my agent did not have power to act.
My agent shall not incur any liability to me under this power except for a breach
of fiduciary duty.
My agent is entitled to reimbursement for reasonable expenses incurred in
exercising powers, and to reasonable compensation for services as agent.
I can amend or revoke this power of attorney through a writing delivered to my
agent. Revocation is not effective as to a third party until the third party learns of it.
Photocopies of this document can be relied upon as though they were originals.
I sign this document voluntarily, and I understand its purpose.
Dated: _______________ Signed: ______________________________________
(Your signature)
We sign below as witnesses. This declaration was signed in our presence. The
declarant appears to be of sound mind, and to be making this designation voluntarily,
without duress, fraud or undue influence. Neither of us is an agent named in this
_____________________ _____________________________________________
(Print name) (Signature of witness)
____________________ ______________________________________________
(Print name) (Signature of witness)
Sworn to and signed by __________________________ this ___ day of 20__.
(Signature of notary public)
County _______________________________
My commission expires ______________
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