Free Dementia Power of Attorney Template
Dementia Power of Attorney
This Dementia Power of Attorney ("Power of Attorney") is made and executed on [Effective Date] by [Your Name], henceforth referred to as the Principal, of [Your Company Name], and [Agent's Name], henceforth referred to as the Agent, of [Agent's Address].
I. Scope Authority
The Principal hereby grants the Agent the authority to act on their behalf in managing their affairs as outlined herein, specifically relating to financial, healthcare, legal, and personal matters.
II. Effective Date and Duration
This Power of Attorney shall become effective immediately upon execution and shall remain in full force and effect until revoked by the Principal or upon the death of the Principal.
III. Revocation Clause
The Principal reserves the right to revoke this Power of Attorney at any time, provided they are deemed mentally competent to do so. Any such revocation must be made in writing and delivered to the Agent.
IV. Specific Powers
The Agent is hereby granted the following specific powers:
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Financial Management: The Agent is authorized to manage the Principal's financial affairs, including but not limited to banking transactions, bill payments, investments, and property transactions.
Healthcare Decisions: The Agent is authorized to make healthcare decisions on behalf of the Principal, including consenting to medical treatments, selecting healthcare providers, and making decisions regarding long-term care management.
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Legal Matters: The Agent shall represent the Principal in legal matters, including signing legal documents, initiating or defending legal actions, and managing legal proceedings related to the Principal's affairs.
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Personal Care: The Agent may make decisions regarding the Principal's care and well-being, including living arrangements, dietary needs, and recreational activities, ensuring the Principal's comfort and safety.
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End-of-Life Decisions: In the event of terminal illness or incapacitation, the Agent shall have the authority to make decisions regarding end-of-life care and treatment, following any instructions or preferences expressed by the Principal.
V. Incapacity Provisions
If the Principal becomes incapacitated and unable to make decisions for themselves, this Power of Attorney shall remain valid and in effect.
VI. Governing Law
This Power of Attorney shall be governed by and construed by the laws of [State/Country].
IN WITNESS WHEREOF, the undersigned Principal and Agent have executed this Power of Attorney on [DATE].
Principal:
[Your Name]
Agent:
[Agent's Name]
WITNESS ACKNOWLEDGEMENT
We, the undersigned witnesses, certify that the foregoing Dementia Power of Attorney was signed by the Principal and Agent in our presence.
Witness 1:
[WITNESS 1 NAME]
[DATE]
Witness 2:
[WITNESS 2 NAME]
[DATE]
NOTARY ACKNOWLEDGEMENT
On this day of in the year , before me, a Notary Public in and for said County and State, personally appeared [Your Name] and [Agent's Name], known to me to be the persons whose names are subscribed to the foregoing instrument, and acknowledged to me that they executed the same for the purposes therein contained.
Witness my hand and official seal.
[NOTARY PUBLIC'S NAME]
My Commission Expires:
