Power of Attorney With Dementia
Power of Attorney With Dementia
I. Appointment of Agent
I, [YOUR NAME] of [YOUR ADDRESS] (hereafter also referred to as the "Principal"), do herewith appoint: [AGENT NAME] of[AGENT ADDRESS], to act as my lawful agent (hereafter "Agent") concerning the following powers, if I become incapable of making rational decisions about my health affairs and financial matters due to dementia.
II. Purpose
This Power of Attorney is established to ensure that my healthcare and financial affairs are managed effectively if I am diagnosed with dementia or any cognitive impairment that renders me unable to make sound decisions for myself.
III. Roles and Responsibilities of the Agent:
-
Healthcare Decisions: My agent shall have the authority to make decisions regarding my medical treatment, including but not limited to consenting to or refusing medical procedures, surgeries, medications, and other forms of healthcare interventions. This authority extends to the selection of healthcare providers and the admission or discharge from medical facilities.
-
Financial Management: My agent shall have the authority to manage my financial affairs, including but not limited to accessing bank accounts, paying bills, managing investments, filing taxes, and engaging in any other financial transactions necessary for my well-being.
-
Property Management: My agent shall have the authority to manage my real and personal property, including but not limited to buying, selling, leasing, or otherwise dealing with any property owned by me. This authority includes the power to sign documents and enter into contracts on my behalf.
-
Legal Representation: My agent shall have the authority to represent me in all legal matters, including initiating or defending lawsuits, settling disputes, signing legal documents, and engaging legal counsel as deemed necessary for my interests.
-
Personal Care Decisions: My agent shall have the authority to make decisions regarding my care and welfare, including but not limited to determining where I will reside, arranging for caregivers or assisted living facilities, and making decisions related to my daily activities and lifestyle.
IV. Validity of the POA
This POA is subject to all the laws of the state of[STATE] and will be in effect as soon as it is signed and witnessed according to the laws of the state of [STATE]. It will stay in effect until my passing or it is revoked by a court of law.
V. Signature Section:
IN WITNESS WHEREOF, I have executed this Parental Power of Attorney on [DATE].
[YOUR NAME] (Principal)
ACCEPTANCE OF THE AGENT
I, [AGENT NAME], acknowledge that I have read and understood the terms and responsibilities outlined in this Power of Attorney document. I accept the appointment as Agent and agree to act under the instructions and limitations provided herein.
[AGENT'S NAME] (Agent)
WITNESS ACKNOWLEDGEMENT
We, the undersigned witnesses, hereby acknowledge that the above-named Principal has signed this Power of Attorney in our presence on the date stated above.
Witness 1:
[Witness 1 Full Name]
[Date]
Witness 2:
[Witness 2 Full 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], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.
Witness my hand and official seal.
[NOTARY PUBLIC'S NAME]
My Commission Expires:
