Durable Power of Attorney

Durable Power of Attorney Form

Step 1 of 18

Who is this power of Attorney being created for?
Example: Richard P. Parker, Las Vegas, Nevada 89117. The person named in the Power of Attorney who is giving authority to someone else is called the "Principal".
Name (Principal)
First Last
Address (Principal)
Street Address Address Line 2 City State ZIP Code
Phone (Principal)
Where will this Power of Attorney be signed?
Enter the city, county (if known) and the state where this document will be signed.
City
County (not to be confused with country)
State

Who will be appointed as Agent(s) to act on your behalf?
Here you can appoint (select) a sole Agent or Co-Agent who will act on your behalf. A "Co-Agent" means you select two agents to serve. If you select Co-Agents, you'll be asked later whether they can act independently of each other or whether they must act jointly.
Will you be appointing a Sole Agent or Co-Agents?
- Sole Agent
- Co-Agents
Who are you appointing as the first Agent or Co-Agent to act on your behalf?
If you are appointing a Sole Agent, please fill out the first agent information section. If you are appointing Co-Agents, complete any additional sections for each agent.
Primary Co-Agent Name
First Last
Primary Co-Agent Address
Street Address Address Line 2 City State ZIP Code
Primary Co-Agent Phone

Who are you appointing as the second Co-Agent to act on your behalf?
If you are appointing a second Co-Agent, fill out the information below. If not, leave blank.
Secondary Co-Agent Name
First Last
Secondary Co-Agent Address
Street Address Address Line 2 City State ZIP Code
Secondary Co-Agent Phone

Agent(s) Questionaire
Is one of the Co-Agents your spouse?
- Yes
- No
May the Co-Agents act independently of each other?
- Each Agent may act independently, without the consent of the other
- Both Agents must act jointly, with the consent of the other agent

If both Agents are unable to serve, do you want to select a successor Agent?
If you would like to appoint a successor Agent. Please name the alternate Agent who will serve only in the event both primary Agents are unable to serve.
Will you be appointing a successor Agent?
- Yes
- No
Successor Agent Name
First Last
Successor Agent Address
Street Address Address Line 2 City State ZIP Code
Successor Agent Phone

Do you want this Power of Attorney to replace any prior Power of Attorney documents you have used in the past?
- Yes
- No
Replacing a prior Power of Attorney will "revoke" or cancel the terms of any prior Power of Attorney document.
Will any prior health care Power of Attorney documents remain in effect?
- Yes
- No
Select "Yes" to Indicate that any Power of Attorney documents related to health care will remain in effect.
Do you want your Agent to have access to your Medical Records?
- Yes
- No
Due to new health information privacy laws, your Agent may not be allowed access to your Medical Records unless specifically given the authority. Your Agent may need this access to dispute or verify charges when paying your medical bills and submitting any insurance claims.
Would you like your Agent to act on your behalf in all situations or only in specific situations?
- All Situations (General Power of Attorney)
- Specific Situations (Special Power of Attorney)
If you give your Agent the authority to act for you in all situations, then you are granting a "General Power of Attorney". If you Authorize your Agent to act only in specific matters, then you are granting a "Special Power of Attorney".
Will your Agent be authorized to hire business professionals to help with Agent's duties?
- Yes
- No
This might include lawyers, accountants, or real estate agents.

Power of Attorney - Bank Account Authority
Will your Agent have access to your bank accounts?
- Yes
- No
*Important: you may skip this question until later if you are unsure or do not have the information on hand. Do you consent to giving your Agent authority to handle banking transactions on your behalf?
What bank accounts will your Agent have authority over?
- All Bank Accounts
- Only Specific Bank Accounts
This includes the authority to open, maintain, and close bank accounts. Important: you can skip this section if you do not know

If Power of Attorney over Bank Accounts have been granted. Please indicate which bank accounts the Agent will have authority over?
Important: you can skip this section and return later if unsure. If bank account information is available. Please indicate each bank account you are giving the Agent authority over.
Bank / Financial Institution
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Account Type

Additional Bank or Financial Account (Two)
Bank / Financial Institution
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Account Type

Additional Bank or Financial Account (Three)
Bank / Financial Institution
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Account Type
Which of the following powers will your Agent be granted?
- Select All
- Handle Treasury Securities
- Begin or Defend Lawsuits
- Access Safe Deposit Boxes
Select all that apply and are true.

Will your Agent be allowed to sell real estate that you own?
- Yes
- No
What real estate will your Agent have the authority to sell?
- Any real estate
- Only specific real estate

Real Estate Property Address
Please include the address of the property that your Agent is authorized to make decisions on your behalf.
Property 1: Address
Street Address Address Line 2 City State ZIP Code
Property 2: Address
Street Address Address Line 2 City State ZIP Code
Property 1: Minimum Sale Price
Property 2: Minimum Sale Price
Property 1: Agent may mortgage this property?
- Yes
- No
Property 2: Agent may mortgage this property?
- Yes
- No
Property 1: Upload Property Resource Files
Max. file size: 512 MB.
Upload resources pertaining to the property. Photos, Description, etc.
Property 2: Upload Property Resource Files
Max. file size: 512 MB.
Upload resources pertaining to the property. Photos, Description, etc.

Property 3: Address
Street Address Address Line 2 City State ZIP Code
Property 4: Address
Street Address Address Line 2 City State ZIP Code
Property 3: Minimum Sale Price
Property 4: Minimum Sale Price
Property 3: Agent may mortgage this property?
- Yes
- No
Property 4: Agent may mortgage this property?
- Yes
- No
Property 3: Upload Property Resource Files
Max. file size: 512 MB.
Upload resources pertaining to the property. Photos, Description, etc.
Property 4: Minimum Sale Price
Property 4: Upload Property Resource Files
Max. file size: 512 MB.
Upload resources pertaining to the property. Photos, Description, etc.

Who will be appointed as substitute Agent to handle your real estate?
In case your spouse is restricted from selling your residence, name a substitute Agent for that purpose.
Real Estate Substitute Agent Name
First Last
City
State
Will your agent be allowed to mortgage your real estate?
- Yes
- No
Will your Agent be authorized to obtain credit or borrow money on your behalf?
- Yes
- No

Will your Agent be authorized to manage, control, and operate any business that you own?
- Yes
- No
Will your Agent be autorized to handle governmental matters for you?
- Yes
- No
For example, tax returns for the Internal Revenue Service.
Will your Agent be authorized to handle any financial matters for you?
- Yes
- No
What financial matters do you want your authorized Power of Attorney Agent to manage?
- Select All
- Stocks & Bonds
- Contracts
- Insurance and Annuities
- Retirement Plans
- Other Financial Matters
Will your Agent have the power to change the beneficiaries on your accounts
- First Choice
- Second Choice
- Third Choice
Will your Agent have the power to change the benificiaries on your accounts?
- Yes
- No
If you select "No," your Agent will be able to manage your accounts but will not be allowed to alter any beneficiary designations you have previously made.
Will your Agent have be allowed to use your assets to fund any trust that was not created by you?
- Yes
- No
Will your Agent be allowed to make gifts on your behalf?
- Yes
- No

Are you currently a fiduciary or trustee?
- Yes
- No
Will your Agent be allowed to transfer assets into your revocable trust?
- Yes
- No
Will your Agent have the authority to use your assets to provide for any person to whom you have an obligation to support?
- Yes
- No
Will your Agent have be allowed to manage a trust on your behalf?
- Yes
- No
Will your Agent be allowed to refuse any inheritance you might receive?
- Yes
- No
Will your Agent be authorized to protect any third party who accepts and acts under this document?
- Yes
- No

Will your Agent be entitled to receive compensation for services performed in connection with this Power of Attorney?
- Yes
- No
Will your Agent be entitled to reimbursement for reasonable expenses?
- Yes
- No
Would you like to include digital assets in your power of attorney?
- Yes
- No
Digital Assets can include online accounts, files or media saved on computers or online, and any kind of digital device.
Digital Assets Memorandum for Power of Attorney
Max. file size: 512 MB.
Securely add any digital assets to the Power of Attorney documentation.

When will this Power of Attorney become effective?
- Immediately (upon signing)
- On the Specific Date
- Upon certification by a physician that you are disabled or lack mental competence (a "springing" Power of Attorney"
When will this Power of Attorney become effective?
- Immediately (upon signing)
- On the Specific Date
- Upon certification by a physician that you are disabled or lack mental competence (a "springing" Power of Attorney"
Do you want to make this document a "Durable Power of Attorney"?
- Yes
- No
A "Durable Power of Attorney" remains effective even if you become disabled or lack the mental competence to understand and handle your financial and personal affairs.
Do you want to make this document a "Durable Power of Attorney"?
- Yes
- No
When will this Power of Attorney terminate?
- Upon your Death
- On the specific Date Below
When will this Power of Attorney terminate?
MM slash DD slash YYYY

Please include a specific date in time.
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Questions?

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A Durable Power of Attorney allows you to assign someone (an agent) to manage your finances if you become incapable or otherwise unable to do it yourself. This is the most common type of Power of Attorney document and is simple to make.

Use a Durable Power of Attorney if:

You want to appoint someone to manage your finances if you become incapacitated.
You want to assign an agent to act on your behalf if you become legally incompetent.
You want to assign an agent to care for your financial matters now and when/if you become incapacitated.

After carefully choosing your agent or co-agents, you can make and print your Power of Attorney documents easily. To make it valid you will need to have it signed and notarized. Some states may also require witness signatures.

Other names for a Durable Power of Attorney:

Durable POA, Power of Attorney, Power of Attorney with Durable Provisions, Enduring Power of Attorney

What is a Durable Power of Attorney?

A Durable Power of Attorney is a document used to assign someone (an agent) to act on your behalf regarding financial matters. Durable POAs are specifically active when you dictate them to be so, which may be while you are well and/or if you become incapacitated. You can decide exactly what financial matters you want your agent to be responsible for which may be everything or limited to specific financial obligations.