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Governing Law A Power of Attorney is normally governed by the laws of the place where the power is intended to operate (e.g. the jurisdiction in which your attorney will be excercising his or her authority). If you intend the attorney's power to operate in more than one jurisdiction, you should probably create a separate document for each jurisdiction.
Where will the document actually be used? e.g. Jane in Texas wants her son Bob in Ohio to sell Jane's condo in Florida for her. The Governing Law in this example is Florida. Where will the Power of Attorney actually be used? e.g. Jane in England wants her son Bob in Canada to sell her house in Ontario. The Governing Law in this example is Ontario.

Nation:
State:		Please select a state.
Province/Territory:		Please select a province/territory.
Country:		Please select a country.
State/Territory:		Please select a state/territory.
Note: This power of attorney allows your attorney to act on your behalf for both financial and personal matters (including health care). Note: This power of attorney allows your attorney to act on your behalf for financial matters only. It will not allow your attorney to make personal, medical or lifestyle decisions for you.

Principal

The person who gives the authority can be referred to as a donor, grantor or principal.

This is the person who wants someone else to act for him or her.

Name:
Gender:
Address:
City/Town:
Nation:
State:		Please select a state.
Province/Territory:		Please select a province/territory.
Country:		Please select a country.
State/Territory:		Please select a state/territory.

Attorney-in-fact

The Attorney-in-fact is the person that you trust to take control of your assets and manage your finances in order to take care of you and your family. Your attorney-in-fact does NOT need to be a lawyer, but does need to be of the age of majority and have capacity. It is best if it is someone that knows your wishes. A spouse is a good choice for attorney-in-fact as long as your spouse would be able to deal with the powers you are providing them. The attorney-in-fact should not be an undischarged bankrupt, convicted of a criminal offence, or a person whose business is to provide attorney-in-fact services for a fee.

This is the person who will act on the principal's behalf.

Number of Attorneys-in-fact

One attorney-in-fact is normally sufficient. If you have two attorneys-in-fact, you must decide what decision making power they have. :

One

Two

Three

Name:
Address:
City/Town:
Nation:
State:
Province/Territory:
Country:
State/Territory:

Type of Power of Attorney:

Ordinary

Durable

An ordinary Power of Attorney is only valid as long as the Principal is capable of managing his or her own affairs. It becomes invalid when the Principal loses capacity (loses the ability to make important decisions). A "durable" Power of Attorney, if created before the Principal loses capacity, will remain valid even after capacity is lost. If you want your Attorney-in-fact to make decisions for you after you have lost the ability to make decisions for yourself, then you should choose "durable".

Type of Durable Power of Attorney		Here you can decide what type of Power of Attorney you wish to have. It can be either immediate (starting right away), springing (starting at a later happening such as mental incapacity), or a combination of the two.
Type:

How will Mental Incapacity be defined?
Two licensed physicians declare that you are incapable of managing your affairs
One licensed physician declares that you are incapable of managing your affairs

Complete this sentence: "____________ will be conclusive proof of my infirmity or mental incapacity."

Attorney-in-fact Powers

You may not use this form to transfer custody of your children. You may not give your attorney-in-fact the power to make medical or other health care decisions for yourself or your children.

Which specific powers do you want your attorney to have?

Do you wish to put restrictions on your attorney-in-fact

Use this feature if you wish to put certain restrictions on your attorney-in-fact, such as which properties they are allowed to sell.

Yes

What restrictions would you like put on your Attorney-in-fact:
	I wish to live independently as long as possible and would like my money to be spent for that purpose.
	I restrict the types of investments my Attorney-in-fact can make with my money to only government issued savings bonds.

You can also add up to three additional restrictions:
E.g., "My Attorney-in-fact is restricted to $X that they can spend on ____ item."
E.g., "My Attorney-in-fact is restricted from selling ____ property located at 111 - 2nd Street."
1.
2.
3.

Other Attorney-in-fact Issues

Attorney-in-fact compensated for their work? Yes Only out of pocket expenses

How Much? As set by Attorney-in-fact As set by you

Describe how your Attorney-in-fact will be compensated:

(e.g. My Attorney-in-fact will be paid $1000 dollars per month for his or her work.)

Attorney-in-fact required to prepare financial statements? Yes No

How often should reports be prepared? Every 6 months Yearly

Name and address of where reports will be sent:

Termination of the Power of Attorney

Do you wish to set a specific end time or event to the power of attorney?

Yes

When would you like the power of attorney to end?

Example:
This power of attorney will end at 11:59 pm, eastern standard time, January 5, 2004

Signing Details You MUST have your witness(es) present and watching you while you sign your Power of Attorney. Each Witness must sign in your presence and in the presence of any other witnesses. 'In your presence' means actually watching them. You and the witness(es) should then initial the bottom right hand corner of each page of the document (except the page signed by all of you). Witnesses should NOT be: *The spouse (married or common-law) or other close family member of either the Principal or the Attorney-in-fact. * The owner or operator of a nursing home or other long term care facility in which the Principal resides.

Agreement to be signed?

Other certificates you may need to have:

Check each certificate you want printed.

Location where document will be signed:
City/Town:
Nation:
State:		Please select a state.
Province/Territory:		Please select a province/territory.
Country:		Please select a country.
State/Territory:		Please select a state/territory.

NOTE: In North Carolina a durable power of attorney must be recorded with the Register of Deeds for the document to be valid past the principal's incapacity.

NOTE: In South Carolina a durable power of attorney must be recorded with the Register of Deeds for the document to be valid past the principal's incapacity.

County Requirements for Recording Document

How wide should the top margin width be?

The blank space required for the filing stamp varies between counties. While for many it is just one inch, others require three or more. If you will need to have your power of attorney recorded it is recommended that you confirm necessary spacing with your local county land or deeds registration office.

Do you want your attorney's authority to continue if you become mentally incapable of managing your own affairs?
Yes (Enduring)	No (Ordinary)
Click here to view the Public Guardianship Office's information booklet.

This is a power of attorney that gives the Attorney authority over property and finances. It may be either "continuing" or "ordinary".
Do you want your attorney's authority to continue if you become mentally incapable of managing your own affairs?
Yes	No
Select "Yes" if you want to create a Continuing Power of Attorney.

	To buy, sell, exchange, or otherwise deal with chattels and goods (tangible personal property).
	To control bank and financial interests.
	To control or direct personal business or business interests.
	To control any insurance or annuity policy.
	To act for me in estate, trust, and other beneficiary transactions.
	To act for me by managing assets transferred to any living trust I may have.
	To act for me in all claims and litigation matters.
	To act for me in securing all governmental benefits owed to me.
	To act for me in all matters affecting my retirement plans and benefits.

	Any expenditures required, such as home renovation, to stay at home as long as possible.
	Any expenditures for maintenance, education, medical care of yourself and family.
	To take any action required to fulfill tax obligations.
	The power to provide gifts to family on special occasions.
	The power to continue providing gifts to charities as you have in the past.
	The power to retain and reinvest assets and investments.
	The power to employ any professionals for the care of you or your family.
	To do any act or thing that you could do in your own person if personally present.
	The power to vote as proxy and manage all shares, bonds, and other instruments.

Limitations:

Common Options

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Help

Second Attorney-in-fact
Name:
Address:
City/Town:
Nation:
State:
Province/Territory:
Country:
State/Territory:

Third Attorney-in-fact
Name:
Address:
City/Town:
Nation:
State:
Province/Territory:
Country:
State/Territory:

Second Alternate Attorney-in-fact
Name:
Address:
City/Town:
Nation:
State:
Province/Territory:
Country:
State/Territory:

Add up to three powers that you wish to start immediately:
E.g., "To pay all expenses incurred by me for homecare pursuant to my self-managed homecare service, from my bank account maintained at __________ Bank with account number __________."

	A certificate for witnesses to fill out acknowledging signing and the capacity of the principal.	A certificate for witnesses to fill out acknowledging signing and the capacity of the donor/grantor.
Note: An affidavit of Execution or Witness Certificate is evidence that the Principal freely signed the document. A Witness Certificate is signed by the witness(es), An Affidavit of Execution must be sworn by the witness(es) in front of a Notary Public.