Fillable WASHINGTON DURABLE POWER OF ATTORNEY

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WASHINGTON DURABLE POWER OF ATTORNEY

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Page 1 of 6
WASHINGTON DURABLE POWER OF ATTORNEY
On the ___ day of __________________, 20____ I, __________________, the
principal, of __________________, State of __________________, hereby designate
__________________, of __________________, State of __________________, my
Agent (hereinafter my “Agent”), to act as initialed below, in my name, in my stead and
for my benefit, hereby revoking any and all financial powers of attorney I may have
executed in the past.
EFFECTIVE DATE
(Choose the applicable paragraph by placing your initials in the preceding space)
________ - A. I grant my Agent the powers set forth herein immediately upon the
execution of this document. These powers shall not be affected by any subsequent
disability or incapacity I may experience in the future.
or
________ - B. I grant my Agent the powers set forth herein only when it has been
determined in writing, by my attending physician, that I am unable to properly handle my
financial affairs.
POWERS OF AGENT
My Agent shall exercise powers in my best interests and for my welfare, as a fiduciary.
My Agent shall have the following powers:
(Choose the applicable power(s) by placing your initials in the preceding space)
_________ BANKING - To receive and deposit funds in any financial institution, and to
withdraw funds by check or otherwise to pay for goods, services, and any other
personal and business expenses for my benefit. If necessary, to effect my Agent’s
powers, my Agent is authorized to execute any document required to be signed by such
banking institution.
_________ SAFE DEPOSIT BOX - To have access at any time or times to any safe-
deposit box rented by me or to which I may have access, wheresoever located,
including drilling, if necessary, and to remove all or any part of the contents thereof, and
to surrender or relinquish said safe-deposit box; and any institution in which any such
safe-deposit box may be located shall not incur any liability to me or my estate as a
result of permitting my Agent to exercise this power.
_________ LENDING OR BORROWING - To make loans in my name; to borrow
money in my name, individually or jointly with others; to give promissory notes or other
obligations therefor; and to deposit or mortgage as collateral or for security for the
payment thereof any or all of my securities, real estate, personal property, or other
Page 2 of 6
property of whatever nature and wherever situated, held by me personally or in trust for
my benefit.
_________ 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.
_________ RETIREMENT PLAN - To contribute to, select payment option of, roll-over,
and receive benefits of any retirement plan or IRA I may own, except my Agent shall not
have power to change the beneficiary of any of my retirement plans or IRAs.
_________ TAXES - To complete and sign any local, state and federal tax returns on
my behalf, pay any taxes and assessments due and receive credits and refunds owed
to me and to sign any tax agency documents necessary to effectuate these powers.
_________ INSURANCE - To purchase, pay premiums and make claims on life, health,
automobile and homeowners' insurance on my behalf, except my Agent shall not have
the power to cash in or change the beneficiary of any life insurance policy.
_________ REAL ESTATE - To acquire, purchase, exchange, lease, grant options to
sell, and sell and convey real property, or any interests therein, on such terms and
conditions, including credit arrangements, as my Agent shall deem proper; to execute,
acknowledge and deliver, under seal or otherwise, any and all assignments, transfers,
deeds, papers, documents or instruments which my Agent shall deem necessary in
connection therewith.
_________ PERSONAL PROPERTY - To acquire, purchase, exchange, lease, grant
options to sell, and sell and convey personal property, or any interests therein, on such
terms and conditions, including credit arrangements, as my Agent shall deem proper; to
execute, acknowledge and deliver, under seal or otherwise, any and all assignments,
transfers, titles, papers, documents or instruments which my Agent shall deem
necessary in connection therewith; to purchase, sell or otherwise dispose of, assign,
transfer and convey shares of stock, bonds, securities and other personal property now
or hereafter belonging to me, whether standing in my name or otherwise, and wherever
situated.
_________ POWER TO MANAGE PROPERTY- To maintain, repair, improve, invest,
manage, insure, rent, lease, encumber, and in any manner deal with any real or
personal property, tangible or intangible, or any interests therein, that I now own or may
hereafter acquire, in my name and for my benefit, upon such terms and conditions as
my Agent shall deem proper.
_________ GIFTS - To make gifts, grants, or other transfers (including the forgiveness
of indebtedness and the completion of any charitable pledges I may have made) without
consideration, either outright or in trust to such person(s) (including my Agent
hereunder) or organizations as my Agent shall select, including, without limitation, the
following actions: (a) transfer by gift in advancement of a bequest or devise to
beneficiaries under my will or in the absence of a will to my spouse and descendants in
Page 3 of 6
whatever degree; and (b) release of any life interest, or waiver, renunciation, disclaimer,
or declination of any gift to me by will, deed, or trust
_________ 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 instrument.
SPECIAL INSTRUCTIONS: On the following lines are any special instructions limiting
or extending the powers I give to my Agent (Write “None” if no additional instructions
are given):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
AUTHORITY OF AGENT: Any party dealing with my Agent hereunder may rely
absolutely on the authority granted herein and need not look to the application of any
proceeds nor the authority of my Agent as to any action taken hereunder. In this regard,
no person who may in good faith act in reliance upon the representations of my Agent
or the authority granted hereunder shall incur any liability to me or my estate as a result
of such act. I hereby ratify and confirm whatever my Agent shall lawfully do under this
instrument. My Agent is authorized as he or she deems necessary to bring an action in
court so that this instrument shall be given the full power and effect that I intend on by
executing it.
LIABILITY OF AGENT: My Agent shall not incur any liability to me under this power
except for a breach of fiduciary duty.
REIMBURSEMENT OF AGENT: My Agent is entitled to reimbursement for reasonable
expenses incurred in exercising powers hereunder, and to reasonable compensation for
services provided as Agent.
AMENDMENT AND REVOCATION: I can amend or revoke this power of attorney
through a writing delivered to my Agent. Any amendment or revocation is ineffective as
to a third party until such third party has notice of such revocation or amendment.
STATE LAW: This Power of Attorney is governed by the laws of the State of
Washington.
PHOTOCOPIES: Photocopies of this document can be relied upon as though they were
originals.
IN WITNESS WHEREOF, I have on this ____ day of __________________, 20____,
executed this Financial Power of Attorney.
________________________________________
Principal’s Signature
Page 4 of 6
NOTICE: THE PRINCIPAL’S SIGNATURE MUST EITHER BE SIGNED WITH TWO (2)
WITNESSES PRESENT OR ACKNOWLEDGED BY A NOTARY PUBLIC.
We, the witnesses, each do hereby declare in the presence of the principal that the
principal signed and executed this instrument in the presence of each of us, that the
principal signed it willingly, that each of us hereby signs this Power of Attorney as
witness at the request of the principal and in the principal’s presence, and that, to the
best of our knowledge, the principal is eighteen years of age or over, of sound mind,
and under no constraint or undue influence.
________________________________________
Witness’s Signature
________________________________________
Address
________________________________________
Witness’s Signature
________________________________________
Address
STATE OF __________________
__________________ County, ss.
On this ____ day of __________________, 20____, before me appeared
____________________, as Principal of this Power of Attorney who proved to me
through government issued photo identification to be the above-named person, in my
presence executed foregoing instrument and acknowledged that (s)he executed the
same as his/her free act and deed.
________________________________________
Notary Public
My commission expires: ____________________
Page 5 of 6
AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY
AND AGENT'S AUTHORITY
State of ______________________
[County] of ______________________]
I, (Name of Agent), [certify] under penalty of perjury that ______________________
(Name of Principal) granted me authority as an agent or successor agent in a power of
attorney dated ______________________, 20____.
I further [certify] that to my knowledge:
(1) I am acting in good faith pursuant to the authority given under the power of
attorney;
(2) The principal is alive and has not terminated, revoked, limited, or modified the
power of attorney or my authority to act under the power of attorney; nor has the
power of attorney or my authority to act under the power of attorney been
terminated, revoked, limited, or modified by any other circumstances;
(3) When the power of attorney was signed, the principal was competent to execute
it and was not under undue influence to sign;
(4) All events necessary to making the power of attorney effective have occurred;
(5) If I was married or a registered domestic partner of the principal when the power
of attorney was executed, there has been no subsequent dissolution, annulment,
or legal separation, and no action is pending for the dissolution of the marriage or
domestic partnership or for legal separation;
(6) If the power of attorney was drafted to become effective upon the happening of
an event or contingency, the event or contingency has occurred;
(7) If I was named as a successor agent, the prior agent is no longer able or willing
to serve, or the conditions stated in the power of attorney that cause me to
become the acting agent have occurred; and
(8) ________________________________________________________________
_____________________________________ (Insert other relevant statements)
SIGNATURE AND ACKNOWLEDGMENT
________________________________________
Agent’s Signature
________________________________________
Date
________________________________________
Agent's Name Printed
______________________________________________________________________
Agent's Address
________________________________________
Agent's Telephone Number
Page 6 of 6
This document was acknowledged before me on ______________________, 20____.
by ________________________________________ (Name of Agent)
________________________________________
Signature of Notary
(Seal, if any)
My commission expires: ______________________, 20____
[This document prepared by: ______________________________________________]
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WASHINGTON DURABLE POWER OF ATTORNEY

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Completed 30 July 2021

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