Durable Power of Attorney Form

Document the appointment of an agent and the scope of powers granted through a durable power of attorney.

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Principal's First Name

Principal's Last Name

Date of Effectivity

Immediately Upon Incapacity On a Specific Date

Effective Date

Agent's Full Name

Real Estate Transactions

Banking Transactions

Business Operating Transactions

Insurance and Annuity Transactions

Estate, Trust, and Beneficiary Transactions

Claims and Litigation

Personal and Family Maintenance

Government Benefits

Retirement Plan Transactions

Tax Matters

Gifts

State Governing This Power of Attorney

First Witness's Signature

Witness's State

Second Witness's First Name

Notary's State

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