Durable Power of Attorney for Finances

2
DURABLE POWER OF ATTORNEY FOR FINANCES
I, __________________________________________, am of sound mind, and I
(Pr i nt or type your full name)
voluntarily make this designation. I revoke any financial powers of attorney I have
signed in the past.
APPOINTMEN T OF AGENT
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
i
(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.
EFFECTIVE DATE
(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.
or
____________ 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.
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