Enduring Power of Attorney Form

Enduring Power of Attorney Form

Please fill out this form to designate someone to make financial and legal decisions on your behalf, both now and in the event that you become incapacitated.

Principal Information

Name

    Address

      Phone Number

        Email

          Authorized Agent Information

          Name

            Address

              Phone Number

                Email

                  Powers Granted

                  The Attorney-in-Fact (Agent) is authorized to act on behalf of the Principal in the following matters:

                    • Financial Management (Banking, Investments, etc.)

                    • Property Management (Buying, Selling, Renting, etc.)

                    • Legal Decisions (Lawsuits, Contracts, etc.)

                    • Healthcare Decisions

                    Effective Date

                      Termination Date

                      This power of attorney will remain in effect until:

                        Principal's Signature

                        Name:

                        Date:

                        Agent’s Signature

                        Name:

                        Date:

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