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3This form provides for designation of one agent. If you
4wish to name more than one agent you may name a coagent in
5the special instructions. Coagents are not required to act
6together unless you include that requirement in the special
7instructions.
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8If your agent is unable or unwilling to act for you, your
9power of attorney will end unless you have named a
10successor agent. You may also name a 2nd successor agent.
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11This power of attorney becomes effective immediately
12unless you state otherwise in the special instructions. This
13power of attorney does not revoke any power of attorney
14executed previously unless you so provide in the special
15instructions.
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16if you revoke this power of attorney, you should notify
17your agent and any other person to whom you have given a
18copy. If your agent is your spouse or domestic partner and
19your marriage in annulled or you are divorced or legally
20separated or the domestic partnership is terminated after
21signing this document, the document is invalid.
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22If you have questions about the power of attorney or the
23authority you are granting to your agent, you should seek
24legal advice before signing this form.
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DESIGNATION OF AGENT
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1I .... (name of principal) name the following person as my agent:
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Name of agent: ....
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Agent's address: ....
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Agent's telephone number: ....
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DESIGNATION OF SUCCESSOR AGENT(S)
6(OPTIONAL)
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If my agent is unable or unwilling to act for me, I name as my successor agent:
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Name of successor agent: ....
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Successor agent's address: ....
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Successor agent's telephone number: ....
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If my successor agent is unable or unwilling to act for me, I name as my 2nd
12successor agent:
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Name of 2nd successor agent: ....
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Second successor agent's address: ....
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Second successor agent's telephone number: ....
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GRANT OF GENERAL AUTHORITY
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I grant my agent and any successor agent general authority to act for me with
18respect to the following subjects as defined in the Uniform Power of Attorney for
19Finances and Property Act in chapter 244 of the Wisconsin statutes:
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INITIAL each subject you want to include in the agent's general authority.
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.... Real property
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.... Tangible personal property
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.... Stocks and bonds
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.... Commodities and options
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.... Banks and other financial institutions
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1.... Operation of entity or business
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.... Insurance and annuities
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.... Estates, trusts, and other beneficial interests
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.... Claims and litigation
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.... Personal and family maintenance
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.... Benefits from governmental programs or civil or military service
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.... Retirement plans
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LIMITATION ON AGENT'S AUTHORITY
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An agent who is not my spouse or domestic partner MAY NOT use my property
11to benefit the agent or a person to whom the agent owes an obligation of support
12unless I have included that authority in the special instructions.
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SPECIAL INSTRUCTIONS (OPTIONAL)
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You may give special instructions in the following space ....
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EFFECTIVE DATE
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This power of attorney is effective immediately unless I have stated otherwise
22in the special instructions.
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NOMINATION OF GUARDIAN (OPTIONAL)
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If it becomes necessary for a court to appoint a guardian of my estate or
25guardian of my person, I nominate the following person(s) for appointment:
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1Name of nominee for guardian of my estate: ....
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Nominee's address: ....
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Nominee's telephone number: ....
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Name of nominee for guardian of my person: ....
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Nominee's address: ....
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Nominee's telephone number: ....
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RELIANCE ON THIS POWER OF
8
ATTORNEY FOR FINANCES AND PROPERTY
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Any person, including my agent, may rely upon the validity of this power of
10attorney or a copy of it unless that person knows that the power of attorney has been
11terminated or is invalid.
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SIGNATURE AND ACKNOWLEDGMENT
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Your signature .... Date ....
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Your name printed ....
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Your address ....
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Your telephone number ....
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State of ....
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County of ....
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This document was acknowledged before me on .... (date), by .... (name of
20principal).
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(Seal, if any)
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Signature of notary ....
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My commission expires: ....
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This document prepared by: ....
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IMPORTANT INFORMATION FOR AGENT
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1AGENT'S DUTIES
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2When you accept the authority granted under this power
3of attorney, a special legal relationship is created between
4you and the principal. This relationship imposes upon you
5legal duties that continue until you resign or the power of
6attorney is terminated or revoked. You must do all of the
7following:
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8(1) Do what you know the principal reasonably expects you
9to do with the principal's property or, if you do not know the
10principal's expectations, act in the principal's best interest.
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11(2) Act in good faith.
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12(3) Do nothing beyond the authority granted in this power
13of attorney.
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14(4) Disclose your identity as an agent whenever you act
15for the principal by writing or printing the name of the
16principal and signing your own name as "agent" in the
17following manner:
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.... (principal's name) by .... (your signature) as agent
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19Unless the special instructions in this power of attorney
20state otherwise, you must also do all of the following:
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21(1) Act loyally for the principal's benefit.
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22(2) Avoid conflicts that would impair your ability to act in
23the principal's best interest.
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24(3) Act with care, competence, and diligence.
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1(4) Keep a record of all receipts, disbursements, and
2transactions made on behalf of the principal.
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3(5) Cooperate with any person that has authority to make
4health-care decisions for the principal to do what you know
5the principal reasonably expects or, if you do not know the
6principal's expectations, to act in the principal's best interest.
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7(6) Attempt to preserve the principal's estate plan if you
8know the plan and preserving the plan is consistent with the
9principal's best interest.
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10Termination of Agent's Authority
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11You must stop acting on behalf of the principal if you
12learn of any event that terminates this power of attorney or
13your authority under this power of attorney. Events that
14terminate a power of attorney or your authority to act under
15a power of attorney include all of the following:
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16(1) Death of the principal.
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17(2) The principal's revocation of the power of attorney or
18your authority.
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19(3) The occurrence of a termination event stated in the
20power of attorney.
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21(4) The purpose of the power of attorney is fully
22accomplished.
