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Sample durable power of attorney form
Any legal document should be prepared and reviewed by an attorney whenever possible. In real life that doesn't always happen. This sample language of a health care advocate form is provided for such occasions when attorney preparation is not possible.
The usual disclaimers apply as you might expect. This is not legal advice; I am not an attorney; no representation is made as to suitability of this language. This document is not intended to replace the need for a will, living will, durable power of attorney other estate planning documents. The language is also available in a downloadable Word document format. The language on the downloaded form may be slightly different than the Web page.
Durable Power of Attorney
By this Durable Power of Attorney, I appoint ____________________ as my attorney in fact to manage my affairs, hereby revoking any and all Durable Powers of Attorney heretofore made by me. In the event _______________________ is unable, unwilling, or unavailable to handle my affairs, I appoint as alternate attorney-in-fact, _______________________________________, to manage my affairs.
This Durable Power of Attorney shall not be affected by any physical or mental disability that I may suffer, except as provided by statute, and it shall be exercisable from this date. All acts done pursuant to this power by my attorney-in-fact shall bind me, my heirs, devisees, and personal representatives. This power of attorney is non-delegable.
All of my property and interest is subject to this Durable Power of Attorney.
Without limiting the broad powers by the preceding provisions, I authorize my attorney‑in‑fact to;
(1) Collect all sums of money and other property that may be payable or belonging to me and execute receipts, releases, cancellations or discharges.
(2) Settle any accounts in which I have any interest and pay or receive the balance of that account.
(3) Borrow money on such terms and with such security as my attorney‑f n‑fact thinks fit and execute all notes, mortgages, and other instruments that my attorney‑in-fact finds necessary or desirable.
(4) Draw, accept, endorse, or otherwise deal with any checks or other commercial instruments, specifically including the right to make withdrawals from any checking or savings account.
(5) Redeem bonds issued by the United States Government or any of its agencies, any other bonds, any certificates of deposit, or other similar assets belonging to me.
(6) Sell any of my assets including but not limited to real estate, bonds, shares of stock, warrants or debentures; execute all assignments and deeds or other instruments necessary or proper for transferring them to the purchaser or purchasers; and give good receipts and discharges for all money payable with regard to them.
(7) Invest the proceeds of any redemptions or sales and any other money in bonds, shares of stock and other securities, or real estate, as my attorney‑in‑fact thinks fit.
(8) Vote at all meetings of stockholders of any company and otherwise act as my proxy with respect to my shares of stock or other securities or investments that now or thereafter belong to me and appoint substitutes or proxies with respect to any of those shares of stock.
(9) Execute on my behalf any tax return and act for me in any examination, audit hearing, conference, or litigation relating to taxes, including the authority to file and prosecute refund claims and enter into any settlements.
(10) Prosecute, defend, and settle all actions or other legal proceedings with regard to any of my assets in any manner.
(11) Purchase bonds issued by the United States, commonly known as Flower Bonds that can be applied at face or maturity value on account of estate tax liabilities.
(12) Transfer any of my assets to the trustee of any living trust of which I am or may become grantor.
(13) Do anything regarding my estate, property, and affairs that I could do myself, if competent.
(14) Make gifts of any of my property in connection with estate and income tax planning procedures for me.
(15) Exercise any power of revocation or amendment retained by me over any living Trust of which I am or may become grantor.
(16) Arrange for and consent to any medical, therapeutic, and/or surgical procedures for me, including the administration of drugs.
(17) Enter any safe deposit box held in my name (alone or jointly) and remove any or all contents.
(18) Collect and receive all sums of money and other property that may be payable to me by reason of my participation in a qualified retirement plan, by reason of my being the beneficiary of a participant in a qualified retirement plan, or that may be payable to me, as owner or beneficiary, from an Individual Retirement Account.
(19) Make on my behalf any elections of choices available to me and give on my behalf any consents required, by reason of either my participation in or my being beneficiary of a participant in a qualified retirement plan, and make any elections or choices available to me and give on my behalf any consents required under any Individual Retirement Account of which I am the owner or beneficiary.
(20) Establish for my benefit one or more Individual Retirement Accounts with any trustee or custodian.
(21) Transfer any of my assets to the trustee or custodian of an Individual Retirement Account established for my benefit.
The powers conferred upon my attorney‑in‑fact extend to all of my right, title, and interest in property in which I may have an interest jointly with any other person, whether in an estate by the entireties, joint tenancy, or tenancy in common.
This instrument is executed by me in the State of ______________, but it is my intention that this power of attorney shall be exercisable in any other State or jurisdiction where I may have any property or interest in property.
Xerographic copies of this instrument shall have the same force
and effect as the original.
I HEREBY CONFIRM all acts of my attorney‑in‑fact pursuant to this power.
Any act that is done under this power between the revocation of this instrument and notice of that revocation of my attorney in fact shall be valid unless the person claiming the benefit of the act had notice of that revocation.
IN WITNESS WHEREOF, I have set my hand and seal this ____ day of _____________,2012,
SIGNED, SEALED, AND DELIVERED
IN THE PRESENCE OF:
__________________________________
(Signature)
Witness
_______________________________
(Signature)
Witness
_______________________________
(Signature)