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Checklist for Completing
NDPERS’ Durable Power of Attorney
This checklist is provided to help you make certain that you have completed all information required on
NDPERS’ Durable Power of Attorney prior to submitting it to NDPERS. (It is not necessary to return this
checklist to NDPERS.)
1. I am of sound mind and acting of my own free will.
2. The individual I have selected as my attorney-in-fact to make retirement system-related
decisions for me is at least 18 years old.
3. I realize that in the event I become incompetent, or upon my request, my attorney-in-fact
has the power and authority to transact all matters relating to the Public Employees
Retirement System or the Highway Patrol System.
4. I have spoken with the individual I have selected as my attorney-in-fact and this individual
has agreed to participate.
5. I have signed and dated the durable power of attorney.
6. I have had the durable power of attorney notarized.
7. I have given a notarized copy of the completed durable power of attorney to those people,
including my attorney-in-fact and family members, who may need it in case an emergency
arises which requires a decision.