AB967,49,1611 _____ 2. BANKING: My agent may conduct business with financial
12institutions, including endorsing all checks and drafts made payable to my order and
13collecting the proceeds; signing in my name checks or orders on all accounts in my
14name or for my benefit; withdrawing funds from accounts in my name; opening
15accounts in my name; and entering into and removing articles from my safe deposit
16box.
AB967,49,1917 _____ 3. INSURANCE: My agent may obtain insurance of all types, as
18considered necessary or appropriate, settle and adjust insurance claims and borrow
19from insurers and 3rd parties using insurance policies as collateral.
AB967,49,2220 _____ 4. ACCOUNTS: My agent may ask for, collect and receive money,
21dividends, interest, legacies and property due or that may become due and owing to
22me and give receipt for those payments.
AB967,50,223 _____ 5. REAL ESTATE: My agent may manage real property; sell, convey and
24mortgage realty for prices and on terms as considered advisable; foreclose mortgages

1and take title to property in my name; and execute deeds, mortgages, releases,
2satisfactions and other instruments relating to realty.
AB967,50,43 _____ 6. BORROWING: My agent may borrow money and encumber my assets
4for loans as considered necessary.
AB967,50,85 _____ 7. SECURITIES: My agent may buy, sell, pledge and exchange securities
6of all kinds in my name; sign and deliver in my name transfers and assignments of
7securities; and consent in my name to reorganizations, mergers or exchange of
8securities for new securities.
AB967,50,129 _____ 8. INCOME TAXES: My agent may make and sign tax returns; represent
10me in all income tax matters before any federal, state, or local tax collecting agency;
11and receive confidential information and perform any acts that I may perform,
12including receiving refund checks and the signing of returns.
AB967,50,1413 _____ 9. TRUSTS: My agent may transfer at any time any of my property to
14a living trust that has been established by me before the execution of this document.
AB967,50,15 15Professional and Technical Assistance
AB967,50,16 16Initials
AB967,50,2017 _____ 10. LEGAL ACTIONS: My agent may retain attorneys on my behalf;
18appear for me in all actions and proceedings to which I may be a party; commence
19actions and proceedings in my name; and sign in my name all documents or pleadings
20of every description.
AB967,50,2321 _____ 11. PROFESSIONAL ASSISTANCE: My agent may hire accountants,
22attorneys, clerks, workers and others for the management, preservation and
23protection of my property and estate.
AB967,50,24 24General Authority
AB967,50,25 25Initials
AB967,51,7
1_____ 12. GENERAL: My agent may do any act or thing that I could do in my
2own proper person if personally present, including managing or selling tangible
3assets, disclaiming a probate or nonprobate inheritance and providing support for
4a minor child or dependent adult. The specifically enumerated powers of the basic
5power of attorney for finances and property are not a limitation of this intended
6broad general power except that my agent may not take any action prohibited by law
7and my agent under this document may not:
AB967,51,88 a. Make medical or health care decisions for me.
AB967,51,99 b. Make, modify or revoke a will for me.
AB967,51,1210 c. Other than a burial trust agreement under section 445.125, Wisconsin
11Statutes, enter into a trust agreement on my behalf or amend or revoke a trust
12agreement, entered into by me.
AB967,51,1613 d. Change any beneficiary designation of any life insurance policy, qualified
14retirement plan, individual retirement account or payable on death account or the
15like whether directly or by canceling and replacing the policy or rollover to another
16plan or account.
AB967,51,1817 e. Forgive debts owed to me or disclaim or waive benefits payable to me, except
18a probate or nonprobate inheritance.
AB967,51,1919 f. Appoint a substitute or successor agent for me.
AB967,51,2020 g. Make gifts.
AB967,51,21 21COMPENSATION TO AGENT FROM PRINCIPAL'S FUNDS
AB967,51,22 22Initials
AB967,51,2523 _____ 13. compensation. My agent may receive compensation only in an
24amount not greater than that usual for the services to be performed if expressly
25authorized in the special instructions portion of this document.
AB967,52,1
1accounting
AB967,52,2 2Initials
AB967,52,63 _____ 14. accounting. My agent shall render an accounting (monthly)
4(quarterly) (annually) (CIRCLE ONE) to me or to .... (insert name and address)
5during my lifetime and a final accounting to the personal representative of my estate,
6if any is appointed, after my death.
AB967,52,7 7Nomination of Guardian
AB967,52,8 8Initials
AB967,52,119 _____ 15. GUARDIAN: If necessary, I nominate .... (name) of .... (address) as
10guardian of my person and I nominate .... (name) of .... (address) as guardian of my
11estate.
AB967,52,12 12special instructions
AB967,52,13 13Initials
AB967,52,1414 _____ 16. SPECIAL INSTRUCTIONS:
AB967,52,1615 ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
16REGARDING THE POWERS GRANTED TO YOUR AGENT.
AB967,53,5
1TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
2ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST
3INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
4INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
5ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
AB967,53,6 6Initials
AB967,53,97 _____ This basic power of attorney for finances and property becomes effective
8when I sign it and will continue in effect as a durable power of attorney under section
9243.07, Wisconsin Statutes, if I become disabled or incapacitated.
AB967,53,1110 _____ This basic power of attorney for finances and property becomes effective
11only when both of the following apply:
AB967,53,1212 a. I have signed it; and
AB967,53,1313 b. I become disabled or incapacitated.
AB967,53,1614 _____ This basic power of attorney for finances and property becomes effective
15when I sign it but will cease to be effective if I become disabled
16or incapacitated
.
AB967,53,2117 I agree that any 3rd party who receives a copy of this document may act under
18it. Revocation of this basic power of attorney is not effective as to a 3rd party until
19the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
20resulting from claims that arise against the 3rd party because of reliance on this
21basic power of attorney.
AB967,53,2222 Signed this .... day of ...., (year)
AB967,53,2424 ....
AB967,53,2525 (Your Signature)

AB967,54,22 ....
AB967,54,33 (Your Social Security Number)
AB967,54,104 By signing as a witness, I am acknowledging the signature of the principal who
5signed in my presence and the presence of the other witness, and the fact that he or
6she has stated that this power of attorney reflects his or her wishes and is being
7executed voluntarily. I believe him or her to be of sound mind and capable of creating
8this power of attorney. I am not related to him or her by blood or marriage, and, to
9the best of my knowledge, I am not entitled to any portion of his or her estate under
10his or her will.
AB967,54,11 11Witness: .... Witness: ....
AB967,54,1212 Dated: .... Dated: ...
AB967,54,13 13By Signature: .... By Signature: ....
AB967,54,1414 Print Name: .... Print Name: ....
AB967,54,1515 Address: .... Address: ....
AB967,54,1616 State of ....
AB967,54,1717 County of ....
AB967,54,1918 This document was acknowledged before me on .... (date) by .... (name of
19principal).
AB967,54,2020 ....
AB967,54,2121 (Signature of Notarial Officer)
AB967,54,2222 (Seal, if any)
AB967,54,2323 (Title)
AB967,54,2424 [My commission is permanent or expires: .... ]
AB967,55,3
1BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
2ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
3LIABILITIES OF AN AGENT.
AB967,55,44 ....
AB967,55,55 (Name of Agent)
AB967,55,66 ....
AB967,55,77 (Signature of Agent)
AB967,55,98 This document was drafted by .... (signature of person preparing the
9document).
Note: Drafting records for 1997 Wis. Act 253 indicate that the witness portion of
this form was not properly formatted in double columns and that "Witness" was to be a
heading and was not to be followed by dot leaders. "By" is changed to "Signature" for
clarity.
AB967, s. 130 10Section 130. 251.02 (1) of the statutes, as affected by 1999 Wisconsin Act 9,
11is amended to read:
AB967,55,1912 251.02 (1) In counties with a population of less than 500,000, the county board
13shall establish a county health department that meets the requirements of this
14chapter. The county health department shall serve all areas of the county that are
15not served by a city health department that was established prior to
16January 1, 1994, by a town or village health department established under sub. (3m)
17or by a multiple municipal local health department established under sub. (3r). No
18city health department may be established after January 1, 1994, but a city-county
19health department may be established after that date.
Note: Conforms the language in this subsection with the language of s. 251.02 (3r).
AB967, s. 131 20Section 131. 251.04 (1) of the statutes, as affected by 1999 Wisconsin Act 9,
21is amended to read:
AB967,56,8
1251.04 (1) A city or county board of health shall govern each local health
2department other than a local health department as authorized in s. 251.02 (3m) and
3(3r) and a city or county board of health or a board of health for a local health
4department as authorized in s. 251.02 (3m) and (3r) shall assure the enforcement of
5state public health statutes and public health rules of the department as prescribed
6for a Level I local health department. A local board of health may contract or
7subcontract to provide public health services. The contractor's staff shall meet the
8appropriate qualifications for positions in a Level I local health department.
Note: 1999 Wis. Act 9 inserted the underscored language without showing it as
underscored. The change was intended.
AB967, s. 132 9Section 132. 251.125 of the statutes, as affected by 1999 Wisconsin Act 9, is
10amended to read:
AB967,56,15 11251.125 Village health department, how financed. If a village health
12department is established under s. 251.02 (2) or (3m) or if a multiple municipal local
13health department is established under s. 251.01 251.02 (3r) by the governing body
14of a village in concert with the governing body of another village or a city or town, the
15village board shall appropriate funds for the operation of the department.
Note: Corrects cross-reference. There is no s. 251.01 (3r). Section 251.02 (3r)
relates to the establishment of local health departments.
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