Durable Power of Attorney Form

This Durable Power of Attorney is made and entered into on Month Day, Year, by and between the Principal and the Attorney-in-Fact listed below, granting authority as specified within this document.

Principal Information

Name

    Address

      Attorney-in-Fact Information

      Name

        Address

          Powers Granted to Attorney-in-Fact

            • Manage bank accounts

            • Handle real estate transactions

            • Make healthcare decisions

            • File and pay taxes

            • Manage business interests

            • Make investment decisions

            Effective Date

              • Immediately upon signing

              • Upon the Principal's incapacitation

              Duration of Power

              This Power of Attorney shall remain in effect until:

                • Revoked by the Principal

                Signatures

                IN WITNESS WHEREOF, the undersigned have executed this Durable Power of Attorney on the date first above written.

                Principal

                Name:

                Date:

                Attorney-in-Fact

                Name:

                Date:

                Witness 1

                Name:

                Date:

                Witness 2

                Name:

                Date:

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