Power of Attorney Form

DURABLE POWER OF ATTORNEY

Financial matters — general form

IMPORTANT INFORMATION FOR THE PRINCIPAL — read before signing This document lets the person you name (your agent) handle your money and property for you. The agent can act without telling you first. Unless you choose otherwise in Part 4, the agent’s authority starts as soon as you sign, and it continues if you later cannot manage your own affairs. It does not let the agent make health-care decisions — that is a separate document (health care power of attorney or advance directive). Many states have their own statutory power of attorney form and signing rules (witnesses, notary, warnings). If your state has one, banks may expect it — use it or have a lawyer adapt this form. You may revoke this power of attorney at any time while you have capacity.

PART 1. DESIGNATION OF AGENT

I, [PRINCIPAL FULL LEGAL NAME], residing at [STREET ADDRESS, CITY, STATE ZIP], appoint the following person as my agent (attorney-in-fact):

Agent [AGENT FULL NAME] · [RELATIONSHIP]

Address [ADDRESS]

Phone / email [PHONE] · [EMAIL]

PART 2. SUCCESSOR AGENT (OPTIONAL)

If my agent dies, resigns, becomes incapacitated, is not qualified to serve or declines to serve, I appoint as successor agent: [SUCCESSOR AGENT FULL NAME], [RELATIONSHIP], [ADDRESS], [PHONE]. [If more than one agent is named at the same time, they shall act [jointly / each independently].]

PART 3. DURABILITY

This power of attorney is durable. It is not terminated by my later incapacity or by lapse of time.

PART 4. WHEN THIS POWER OF ATTORNEY TAKES EFFECT (INITIAL ONE)

_____ Immediately when I sign it.

_____ Only when I become incapacitated. I am incapacitated when [one / two] licensed physician(s) [or a licensed psychologist] state in a signed writing that I am unable to manage my property or financial affairs.

PART 5. GENERAL AUTHORITY (INITIAL EACH SUBJECT YOU GRANT)

My agent may act for me in every lawful way with respect to the subjects I initial below:

_____ Real property _____ Tangible personal property (vehicles, household goods)

_____ Stocks, bonds and other securities _____ Commodities and options

_____ Banks and other financial institutions _____ Operation of an entity or business

_____ Insurance and annuities _____ Estates, trusts and other beneficial interests

_____ Claims and litigation _____ Personal and family maintenance

_____ Benefits from governmental programs or civil or military service _____ Retirement plans

_____ Taxes (see the note on IRS Form 2848) _____ Digital assets and online accounts, as far as the law and account terms allow

_____ ALL of the subjects listed above.

PART 6. SPECIFIC AUTHORITY (INITIAL ONLY WHAT YOU GRANT)

My agent may do the following ONLY if I have initialed it. These acts can reduce what I own or change who receives my property, so grant them with care:

_____ Create, amend, revoke or terminate a living (inter vivos) trust

_____ Make gifts, limited to [AMOUNT / “the annual federal gift tax exclusion amount”] per recipient per year, and only to [PERSONS]

_____ Create or change rights of survivorship

_____ Create or change a beneficiary designation

_____ Authorize another person to exercise the authority granted under this power of attorney

_____ Waive my right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan

_____ Exercise fiduciary powers that I have authority to delegate

_____ Disclaim or refuse an interest in property, including a power of appointment

PART 7. LIMITATIONS AND SPECIAL INSTRUCTIONS

[WRITE ANY LIMITS, e.g. “My agent may not sell my home at [ADDRESS] without the written consent of [NAME].” If none, write “None.”]

PART 8. COMPENSATION

My agent is entitled to reimbursement of reasonable expenses incurred on my behalf and to [reasonable compensation / no compensation / compensation of [AMOUNT]].

PART 9. NOMINATION OF CONSERVATOR OR GUARDIAN (OPTIONAL)

If a court proceeding is started to appoint a conservator or guardian of my estate, I nominate [NAME] to serve.

PART 10. RELIANCE, COPIES AND PRIOR DOCUMENTS

A photocopy or electronically transmitted copy of this signed power of attorney has the same effect as the original. [I revoke all prior general financial powers of attorney, except: [LIST OR “none”].] This power of attorney is governed by the law of the State of [STATE].

PART 11. SIGNATURE

I have read this document and I understand it. I sign it voluntarily.

______________________________ [PRINCIPAL FULL NAME], Principal Date: [DATE]

WITNESSES (if your state requires them — usually two adults who are not the agent)

______________________________ Witness 1: [NAME] [ADDRESS] ______________________________ Witness 2: [NAME] [ADDRESS]

NOTARY ACKNOWLEDGMENT — use the exact wording required by your state

State of [STATE] ) County of [COUNTY] ) ss. On [DATE], before me, [NAME OF NOTARY], a notary public, personally appeared [PRINCIPAL FULL NAME], proved to me on the basis of satisfactory evidence to be the person whose name is signed on this instrument, and acknowledged that he/she/they signed it voluntarily. ______________________________ Notary Public My commission expires: [DATE] (Seal)

AGENT’S ACCEPTANCE AND ACKNOWLEDGMENT OF DUTIES

I, [AGENT FULL NAME], accept appointment as agent under the power of attorney signed by [PRINCIPAL FULL NAME] on [DATE]. I understand that, when I act as agent, I must:

• act in good faith and only within the authority granted;

• act in the principal’s best interest and according to the principal’s reasonable expectations;

• keep the principal’s property separate from my own;

• keep records of all receipts, payments and transactions;

• avoid conflicts of interest and not use the principal’s property for my own benefit unless authorized;

• try to preserve the principal’s estate plan, as far as I know it;

• sign as “[PRINCIPAL NAME], by [AGENT NAME], agent”.

______________________________ [AGENT FULL NAME], Agent Date: [DATE]

REVOCATION OF POWER OF ATTORNEY

I, [PRINCIPAL FULL NAME], of [ADDRESS], revoke the power of attorney dated [DATE] in which I appointed [AGENT NAME] as my agent [and [SUCCESSOR AGENT NAME] as successor agent]. All authority granted under it ends as of [DATE].

I am sending a copy of this revocation to my agent and to: [BANKS, BROKERS, OTHER PERSONS WHO HAVE A COPY OF THE POWER OF ATTORNEY].

______________________________ [PRINCIPAL FULL NAME] Date: [DATE] ______________________________ Notary acknowledgment (if the original was recorded or your state requires it)

NOTES — delete this page before signing

• Before you use this form: check whether your state has a statutory power of attorney form or extra signing rules. Examples are the New York Statutory Short Form, the California Uniform Statutory Form Power of Attorney and the Texas Statutory Durable Power of Attorney.

• Many states have adopted the Uniform Power of Attorney Act. Under it a power of attorney is durable unless it says otherwise (s.104), a notarized signature is presumed genuine (s.105), and the powers in Part 6 must be granted expressly (s.201).

• Taxes: to let your agent represent you before the IRS, also sign IRS Form 2848.

• Social Security does not accept a power of attorney for benefit payments; it appoints a representative payee.

• If the agent will sell or mortgage real estate, the county recorder may require the original, notarized power of attorney to be recorded.

• Give copies to your agent, your bank and your lawyer. In Layers you can send the signed copy with tracking and see who opened it.

Field labels in [SQUARE BRACKETS, CAPITALS] must be completed or deleted. Alternatives are separated by a slash (e.g., [HIS/HER]). © Layers (layers.md), licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). You may adapt and reuse this template with attribution. Template, not legal advice. Check your state’s law and statutory form.