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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.
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23(5) If you are married to the principal, a legal action is
24filed with a court to end your marriage, or for your legal
25separation, unless the Special Instructions in this power of
1attorney state that such an action will not terminate your
2authority.
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3(6) if you are the principal's domestic partner and your
4domestic partnership is terminated, unless the special
5instructions in this power of attorney state that such an
6action will not terminate your authority.
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7Liability of Agent
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8The meaning of the authority granted to you is defined in
9the Uniform Power of Attorney for Finances and Property Act
10in chapter 244 of the Wisconsin statutes. If you violate the
11Uniform Power of Attorney for Finances and Property Act in
12chapter 244 of the Wisconsin statutes or act outside the
13authority granted, you may be liable for any damages caused
14by your violation.
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15If there is anything about this document or your duties
16that you do not understand, you should seek legal advice.
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OPTIONAL SIGNATURE OF AGENT
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I HAVE READ AND ACCEPT THE DUTIES AND LIABILITIES OF THE
19AGENT AS SPECIFIED IN THIS POWER OF ATTORNEY.
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Agent's signature .... Date ....
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(APPENDIX FOLLOWS)
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22244.62 Agent's certification. The following optional form may be used by an
23agent to certify facts concerning a power of attorney for finances and property:
