Filed for record at the request of:
DURABLE POWER OF ATTORNEY
I, ______________________________, resident of the State of Washington,
revoke any powers of attorney I may have given in the past and give
______________________________________ (referred to below as "the agent")
a durable power of attorney. I intend that it not be limited by any disability I may
have in the future.
A. The agent shall act on my behalf and for my benefit, and shall have all
powers over my estate that I have or acquire. These shall include, but not be
limited to, the following: the power to make deposits to, and payments from, any
account in my name in any financial institution; the power to open and remove
items from any safe deposit box in my name; the power to sell, exchange or transfer
title to stocks, bonds or other securities; the power to sell, convey or encumber
any real or personal property.
B. The agent shall have the power to consent to, or to withhold consent
from, medical treatment, shall have all powers necessary or desirable to provide
for my support, maintenance, health and comfort; the agent shall be entitled to
obtain and use any of my medical records or other individually identifiable health
information to the same extent as I would myself. This is intended as a full
release of all information governed by the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
C. I authorize the agent to revoke any community property agreement and
to transfer any property to my spouse or registered domestic partner as a gift.
_____ (Initial here if revocation of a community property agreement and gifts to
a spouse or registered domestic partner are authorized. If they are not authorized,
cross out all of paragraph C.)
D. I authorize the agent to make gifts of my property to the following
person or persons: _____________________________________________.
Gifts under this paragraph may be:
_____ in any amount
_____ not more than $_____________ per year
(If gifts are authorized under paragraph D, either initial next to “in any amount”
or initial next to “no more than” and fill in a dollar amount. If gifts are not