AB75,1336,11 11PROFESSIONAL AND TECHNICAL ASSISTANCE
AB75,1336,12 12Initials
AB75,1336,1613 _____ 10. LEGAL ACTIONS: My agent may retain attorneys on my behalf;
14appear for me in all actions and proceedings to which I may be a party; commence
15actions and proceedings in my name; and sign in my name all documents or pleadings
16of every description.
AB75,1336,1917 _____ 11. PROFESSIONAL ASSISTANCE: My agent may hire accountants,
18attorneys, clerks, workers and others for the management, preservation and
19protection of my property and estate.
AB75,1336,20 20GENERAL AUTHORITY
AB75,1336,21 21Initials
AB75,1337,322 _____ 12. GENERAL: My agent may do any act or thing that I could do in my
23own proper person if personally present, including managing or selling tangible
24assets, disclaiming a probate or nonprobate inheritance and providing support for
25a minor child or dependent adult. The specifically enumerated powers of the basic

1power of attorney for finances and property are not a limitation of this intended
2broad general power except that my agent may not take any action prohibited by law
3and my agent under this document may not:
AB75,1337,44 a. Make medical or health care decisions for me.
AB75,1337,55 b. Make, modify or revoke a will for me.
AB75,1337,86 c. Other than a burial trust agreement under section 445.125, Wisconsin
7Statutes, enter into a trust agreement on my behalf or amend or revoke a trust
8agreement, entered into by me.
AB75,1337,129 d. Change any beneficiary designation of any life insurance policy, qualified
10retirement plan, individual retirement account or payable on death account or the
11like whether directly or by canceling and replacing the policy or rollover to another
12plan or account.
AB75,1337,1413 e. Forgive debts owed to me or disclaim or waive benefits payable to me, except
14a probate or nonprobate inheritance.
AB75,1337,1515 f. Appoint a substitute or successor agent for me.
AB75,1337,1616 g. Make gifts.
AB75,1337,18 17COMPENSATION TO AGENT FROM
18 PRINCIPAL'S FUNDS
AB75,1337,19 19Initials
AB75,1337,2220 _____ 13. compensation. My agent may receive compensation only in an
21amount not greater than that usual for the services to be performed if expressly
22authorized in the special instructions portion of this document.
AB75,1337,23 23ACCOUNTING
AB75,1337,24 24Initials
AB75,1338,4
1_____ 14. accounting. My agent shall render an accounting (monthly)
2(quarterly) (annually) (CIRCLE ONE) to me or to .... (insert name and address)
3during my lifetime and a final accounting to the personal representative of my estate,
4if any is appointed, after my death.
AB75,1338,5 5NOMINATION OF GUARDIAN
AB75,1338,6 6Initials
AB75,1338,97 _____ 15. GUARDIAN: If necessary, I nominate .... (name) of .... (address) as
8guardian of my person and I nominate .... (name) of .... (address) as guardian of my
9estate.
AB75,1338,10 10SPECIAL INSTRUCTIONS
AB75,1338,11 11Initials
AB75,1338,1212 _____ 16. SPECIAL INSTRUCTIONS:
AB75,1338,1413 ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
14REGARDING THE POWERS GRANTED TO YOUR AGENT.
AB75,1339,324 TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
25ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST

1INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
2INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
3ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
AB75,1339,4 4Initials
AB75,1339,75 _____ This basic power of attorney for finances and property becomes effective
6when I sign it and will continue in effect as a durable power of attorney under section
7243.07, Wisconsin Statutes, if I become disabled or incapacitated.
AB75,1339,98 _____ This basic power of attorney for finances and property becomes effective
9only when both of the following apply:
AB75,1339,1010 a. I have signed it; and
AB75,1339,1111 b. I become disabled or incapacitated.
AB75,1339,1412 _____ This basic power of attorney for finances and property becomes effective
13when I sign it but will cease to be effective if I become disabled
14or incapacitated
.
AB75,1339,1915 I agree that any 3rd party who receives a copy of this document may act under
16it. Revocation of this basic power of attorney is not effective as to a 3rd party until
17the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
18resulting from claims that arise against the 3rd party because of reliance on this
19basic power of attorney.
AB75,1339,2020 Signed this .... day of ...., (year)
AB75,1339,2121 ....
AB75,1339,2222 (Your Signature)
AB75,1339,2424 ....
AB75,1339,2525 (Your Social Security Number)
AB75,1340,7
1By signing as a witness, I am acknowledging the signature of the principal who
2signed in my presence and the presence of the other witness, and the fact that he or
3she has stated that this power of attorney reflects his or her wishes and is being
4executed voluntarily. I believe him or her to be of sound mind and capable of creating
5this power of attorney. I am not related to him or her by blood, marriage or adoption,
6and, to the best of my knowledge, I am not entitled to any portion of his or her estate
7under his or her will.
AB75,1340,8 8Witness Witness
AB75,1340,99 Dated: ....   Dated: ....
AB75,1340,1010 Signature: ....  Signature: ....
AB75,1340,1111 Print Name: .... Print Name: ....
AB75,1340,1212 Address: .... Address: ....
AB75,1340,1313 State of ....
AB75,1340,1414 County of ....
AB75,1340,1615 This document was acknowledged before me on .... (date) by .... (name of
16principal).
AB75,1340,1818 ....
AB75,1340,1919 (Signature of Notarial Officer)
AB75,1340,2020 (Seal, if any)
AB75,1340,2121 (Title)
AB75,1340,2222 [My commission is permanent or expires: .... ]
AB75,1340,2523 BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
24ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
25LIABILITIES OF AN AGENT.
AB75,1341,22 (Name of Agent)
AB75,1341,55 (Signature of Agent)
AB75,1341,76 This document was drafted by .... (signature of person preparing the
7document).
AB75, s. 2506 8Section 2506. 243.10 (7) (b) of the statutes is amended to read:
AB75,1341,179 243.10 (7) (b) A principal may revoke a Wisconsin basic power of attorney for
10finances and property and invalidate it at any time by destroying it, by directing
11another person to destroy it in the principal's presence or by signing a written and
12dated statement expressing the principal's intent to revoke. If the agent under the
13Wisconsin basic power of attorney for finances and property is the principal's spouse
14and the marriage is annulled, or the agent and principal are divorced, or the agent
15is the principal's domestic partner under ch. 770 and the domestic partnership is
16terminated under s. 770.12,
after signing the document, the Wisconsin basic power
17of attorney for finances and property is invalid.
AB75, s. 2507 18Section 2507. 250.10 (title) of the statutes is amended to read:
AB75,1341,19 19250.10 (title) Grant for dental Dental services.
AB75, s. 2508 20Section 2508. 250.10 (intro.) of the statutes is repealed.
AB75, s. 2509 21Section 2509. 250.10 (1) of the statutes is renumbered 250.10 (1m) (a) and
22amended to read:
AB75,1342,523 250.10 (1m) (a) The department shall provide Provide funding in each fiscal
24year to the Marquette University School of Dentistry for clinical education of
25Marquette University School of Dentistry students through the provision of dental

1services by the students and faculty of the Marquette University School of Dentistry
2in underserved areas and to underserved populations in the state, as determined by
3the department in conjunction with the Marquette University School of Dentistry;
4to inmates of correctional centers in Milwaukee County; and in clinics in the city of
5Milwaukee.
AB75, s. 2510 6Section 2510. 250.10 (1m) (intro.) of the statutes is created to read:
AB75,1342,77 250.10 (1m) (intro.) The department shall do all of the following:
AB75, s. 2511 8Section 2511. 250.10 (2) of the statutes is renumbered 250.10 (1m) (b) and
9amended to read:
AB75,1342,1310 250.10 (1m) (b) The department shall distribute Award in each fiscal year to
11qualified applicants grants totaling $25,000 for fluoride supplements, $25,000 for a
12fluoride mouth-rinse program, and $120,000 for a school-based dental sealant
13program.
AB75, s. 2512 14Section 2512. 250.15 (2) (intro.) of the statutes is created to read:
AB75,1342,1615 250.15 (2) (intro.) From the appropriation account under s. 20.435 (1) (fh), the
16department shall, in each fiscal year, award all of the following as grants:
AB75, s. 2513 17Section 2513. 250.15 (2) (a) of the statutes is amended to read:
AB75,1342,2018 250.15 (2) (a) From the appropriation under s. 20.435 (5) (fh), the department
19shall award $50,000 in each fiscal year as a grant to
To a community health center
20in a 1st class city, $50,000.
AB75, s. 2514 21Section 2514. 250.15 (2) (b) of the statutes is amended to read:
AB75,1343,522 250.15 (2) (b) From the appropriation under s. 20.435 (5) (fh), the department
23shall award grants in each fiscal year to
To community health centers that receive
24federal grants under 42 USC 254b (e), (g) or (h). Each grant shall equal the amount
25that results from multiplying the total amount available for grants under this

1paragraph in the fiscal year in which the grants are to be awarded by the quotient
2obtained by dividing the amount that the community health center received under
342 USC 254b (e), (g) or (h) in the most recently concluded federal fiscal year in which
4those grants were made by the total amount of federal grants under 42 USC 254b (e),
5(g) and (h) made in that federal fiscal year to community health centers in this state.
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