Power of Attorney Form

Power of Attorney

A power of attorney allows another individual, your agent, to act on your behalf. This authorization can be either general or specific. A general power of attorney is a very powerful document, allowing someone to act as if they are you in all respects. A specific or special power of attorney limits the authority of your agent to only that matter which you designate. For example, a specific power of attorney may only grant your agent the authority to sell your car or or lease an apartment, but nothing else. A power of attorney becomes effective upon signing or it may be designated to become effective at a future date or upon a specific occurrence.

If you would like a power of attorney drafted for you, please complete the form below and I will be in contact with you.

Name

The person giving authority to someone to act. Include middle initial with the first name if the person has one.

First Name

Last Name

Email Address

Email address of the person giving authority.

Agent's Name

This is the person that you are giving authority to. Include middle initial with the first name if the person has one.

First Name

Last Name

Agent's Address

Insert the address of your agent here.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agent's Phone Number

(###)

###

####

Effective Date

When is this power of attorney to take effect?

Upon signing before a notary

At a future date (see next question)

Upon a future event (see next question)

Future Effective Date or Occurrance

If this power of attorney is to take effect at a future date or event, please indicate that date or the conditions here. If none are provided, this power of attorney will be effective upon signing.

Power Granted

Briefly describe the authority that you would like to grant your agent. (e.g. Sell my 2001 Toyota Tacoma, purchase an apartment located at ADDRESS, or general authority to act.) You may also specifically limit the agent's authority by describing certain acts that you do not want your agent to do.

Durability

If this power of attorney is to specifically survive the principal's incapacity, please check this box.

Yes, this power of attorney is to specifically survive the principal's incapacity.

Expiration Date

You may include an expiration date for this power of attorney to terminate. Absent an expiration date, this authority may expire in the following ways: death of the principal, incapacity of the principal (if not durable), the purpose of the power of attorney is accomplished, or it is revoked.

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