Parent With Dementia Power of Attorney
Parent With Dementia Power of Attorney
I. Appointment of Agent
I, [YOUR NAME], residing at [YOUR COMPANY ADDRESS], hereby appoint [AGENT'S NAME], residing at [AGENT'S ADDRESS], as my attorney-in-fact (hereinafter referred to as "Agent") to act on my behalf in all matters related to my finances, healthcare, and legal affairs, should I become incapacitated due to dementia.
II. Powers Granted to the Agent
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Financial Management: The Agent shall have full authority to manage, invest, and make decisions regarding all of my financial assets, including but not limited to bank accounts, investments, real estate properties, and retirement accounts. This includes the authority to pay bills, collect debts, and file taxes on my behalf.
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Healthcare Decisions: The Agent is authorized to make decisions regarding my healthcare and medical treatment, including consenting to or refusing medical procedures, treatments, and surgeries, by my wishes as expressed in any advance directives or healthcare instructions.
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Legal Matters: The Agent is empowered to initiate, defend, settle, or compromise any legal actions or proceedings on my behalf, including but not limited to contracts, lawsuits, or disputes, ensuring that my interests are represented appropriately.
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Access to Information: The Agent shall have access to all of my medical records, financial statements, legal documents, and any other information necessary to fulfill their duties under this Power of Attorney.
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Property Management: If it becomes necessary, the Agent is authorized to manage and maintain any real property owned by me, including but not limited to renting, leasing, selling, or otherwise disposing of such property.
III. Remedy or Penalty Clause
If any third party refuses to honor this Power of Attorney, I hereby authorize my Agent to take any legal action necessary to enforce the powers granted herein, including seeking injunctive relief and recovering attorney's fees and costs incurred in such enforcement.
IV. Duration of Power of Attorney
This Power of Attorney shall remain in effect indefinitely unless revoked by me in writing or upon my death.
V. Signature Section
In Witness whereof, I have hereunto set my hand and seal this [DATE].
[YOUR NAME]
[SEAL]
[AGENT'S NAME]
VI. Witness Acknowledgement
We, the undersigned witnesses, certify that the foregoing Power of Attorney was signed and sealed by [YOUR NAME] in our presence and that [YOUR NAME] appeared to execute this Power of Attorney willingly and voluntarily.
Witness 1:
[WITNESS 1'S NAME]
[DATE]
Witness 2:
[WITNESS 2'S NAME]
[DATE]
Notary Acknowledgement
State of [STATE], County of [COUNTY],
On this [DATE], before me, a Notary Public in and for said County and State, personally appeared [YOUR NAME], known to me to be the person described in and who executed the foregoing instrument, and acknowledged to me that [he/she/they] executed the same as [his/her/their] free and voluntary act and deed for the purposes therein expressed.
Witness my hand and official seal.
[NOTARY PUBLIC'S NAME]
[SEAL]
My Commission Expires: [EXPIRATION DATE OF COMMISSION]
