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YOUR AGENT IS ENTITLED TO REASONABLE COMPENSATION
10UNLESS YOU STATE OTHERWISE IN THE SPECIAL INSTRUCTIONS.
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THIS FORM PROVIDES FOR DESIGNATION OF ONE AGENT. IF YOU
12WISH TO NAME MORE THAN ONE AGENT YOU MAY NAME A COAGENT IN
13THE SPECIAL INSTRUCTIONS. COAGENTS ARE NOT REQUIRED TO ACT
14TOGETHER UNLESS YOU INCLUDE THAT REQUIREMENT IN THE SPECIAL
15INSTRUCTIONS.
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IF YOUR AGENT IS UNABLE OR UNWILLING TO ACT FOR YOU, YOUR
17POWER OF ATTORNEY WILL END UNLESS YOU HAVE NAMED A
18SUCCESSOR AGENT. YOU MAY ALSO NAME A 2ND SUCCESSOR AGENT.
SB715-SSA1,4,2319
THIS POWER OF ATTORNEY BECOMES EFFECTIVE IMMEDIATELY
20UNLESS YOU STATE OTHERWISE IN THE SPECIAL INSTRUCTIONS. THIS
21POWER OF ATTORNEY DOES NOT REVOKE ANY POWER OF ATTORNEY
22EXECUTED PREVIOUSLY UNLESS YOU SO PROVIDE IN THE SPECIAL
23INSTRUCTIONS.
SB715-SSA1,5,424
IF YOU REVOKE THIS POWER OF ATTORNEY, YOU SHOULD NOTIFY
25YOUR AGENT AND ANY OTHER PERSON TO WHOM YOU HAVE GIVEN A
1COPY. IF YOUR AGENT IS YOUR SPOUSE OR DOMESTIC PARTNER AND
2YOUR MARRIAGE IS ANNULLED OR YOU ARE DIVORCED OR LEGALLY
3SEPARATED OR THE DOMESTIC PARTNERSHIP IS TERMINATED AFTER
4SIGNING THIS DOCUMENT, THE DOCUMENT IS INVALID.
SB715-SSA1,5,75
IF YOU HAVE QUESTIONS ABOUT THE POWER OF ATTORNEY OR THE
6AUTHORITY YOU ARE GRANTING TO YOUR AGENT, YOU SHOULD SEEK
7LEGAL ADVICE BEFORE SIGNING THIS FORM.
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DESIGNATION OF AGENT
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I .... (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) (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
19successor agent:
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Name of 2nd successor agent: ....
SB715-SSA1,5,2121
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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1I grant my agent and any successor agent general authority to act for me with
2respect to the following subjects as defined in the Uniform Power of Attorney for
3Finances 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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7.... Digital 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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.... 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
21to benefit the agent or a person to whom the agent owes an obligation of support
22unless 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
SB715-SSA1,7,2
1This power of attorney is effective immediately unless I have stated otherwise
2in 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
5guardian of my person, I nominate the following person(s) for appointment:
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Name 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
13
ATTORNEY FOR FINANCES AND PROPERTY
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Any person, including my agent, may rely upon the validity of this power of
15attorney or a copy of it unless that person knows that the power of attorney has been
16terminated 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
25principal).
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1(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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AGENT'S DUTIES
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WHEN YOU ACCEPT THE AUTHORITY GRANTED UNDER THIS POWER
8OF ATTORNEY, A SPECIAL LEGAL RELATIONSHIP IS CREATED BETWEEN
9YOU AND THE PRINCIPAL. THIS RELATIONSHIP IMPOSES UPON YOU
10LEGAL DUTIES THAT CONTINUE UNTIL YOU RESIGN OR THE POWER OF
11ATTORNEY IS TERMINATED OR REVOKED. YOU MUST DO ALL OF THE
12FOLLOWING:
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(1) DO WHAT YOU KNOW THE PRINCIPAL REASONABLY EXPECTS YOU
14TO DO WITH THE PRINCIPAL'S PROPERTY OR, IF YOU DO NOT KNOW THE
15PRINCIPAL'S EXPECTATIONS, ACT IN THE PRINCIPAL'S BEST INTEREST.
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(2) ACT IN GOOD FAITH.
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(3) DO NOTHING BEYOND THE AUTHORITY GRANTED IN THIS POWER
18OF ATTORNEY.
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(4) DISCLOSE YOUR IDENTITY AS AN AGENT WHENEVER YOU ACT
20FOR THE PRINCIPAL BY WRITING OR PRINTING THE NAME OF THE
21PRINCIPAL AND SIGNING YOUR OWN NAME AS "AGENT" IN THE
22FOLLOWING MANNER:
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.... (principal's name) by .... (your signature) as agent
SB715-SSA1,8,2524
UNLESS THE SPECIAL INSTRUCTIONS IN THIS POWER OF ATTORNEY
25STATE OTHERWISE, YOU MUST ALSO DO ALL OF THE FOLLOWING:
SB715-SSA1,9,1
1(1) ACT LOYALLY FOR THE PRINCIPAL'S BENEFIT.
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(2) AVOID CONFLICTS THAT WOULD IMPAIR YOUR ABILITY TO ACT IN
3THE PRINCIPAL'S BEST INTEREST.
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(3) ACT WITH CARE, COMPETENCE, AND DILIGENCE.
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(4) KEEP A RECORD OF ALL RECEIPTS, DISBURSEMENTS, AND
6TRANSACTIONS MADE ON BEHALF OF THE PRINCIPAL.
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(5) COOPERATE WITH ANY PERSON THAT HAS AUTHORITY TO MAKE
8HEALTH-CARE DECISIONS FOR THE PRINCIPAL TO DO WHAT YOU KNOW
9THE PRINCIPAL REASONABLY EXPECTS OR, IF YOU DO NOT KNOW THE
10PRINCIPAL'S EXPECTATIONS, TO ACT IN THE PRINCIPAL'S BEST INTEREST.
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(6) ATTEMPT TO PRESERVE THE PRINCIPAL'S ESTATE PLAN IF YOU
12KNOW THE PLAN AND PRESERVING THE PLAN IS CONSISTENT WITH THE
13PRINCIPAL'S BEST INTEREST.
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TERMINATION OF AGENT'S AUTHORITY
SB715-SSA1,9,1915
YOU MUST STOP ACTING ON BEHALF OF THE PRINCIPAL IF YOU
16LEARN OF ANY EVENT THAT TERMINATES THIS POWER OF ATTORNEY OR
17YOUR AUTHORITY UNDER THIS POWER OF ATTORNEY. EVENTS THAT
18TERMINATE A POWER OF ATTORNEY OR YOUR AUTHORITY TO ACT UNDER
19A POWER OF ATTORNEY INCLUDE ALL OF THE FOLLOWING:
SB715-SSA1,9,2020
(1) DEATH OF THE PRINCIPAL.
SB715-SSA1,9,2221
(2) THE PRINCIPAL'S REVOCATION OF THE POWER OF ATTORNEY OR
22YOUR AUTHORITY.
SB715-SSA1,9,2423
(3) THE OCCURRENCE OF A TERMINATION EVENT STATED IN THE
24POWER OF ATTORNEY.
SB715-SSA1,10,2
1(4) THE PURPOSE OF THE POWER OF ATTORNEY IS FULLY
2ACCOMPLISHED.
SB715-SSA1,10,73
(5) IF YOU ARE MARRIED TO THE PRINCIPAL, A LEGAL ACTION IS
4FILED WITH A COURT TO END YOUR MARRIAGE, OR FOR YOUR LEGAL
5SEPARATION, UNLESS THE SPECIAL INSTRUCTIONS IN THIS POWER OF
6ATTORNEY STATE THAT SUCH AN ACTION WILL NOT TERMINATE YOUR
7AUTHORITY.
SB715-SSA1,10,118
(6) IF YOU ARE THE PRINCIPAL'S DOMESTIC PARTNER AND YOUR
9DOMESTIC PARTNERSHIP IS TERMINATED, UNLESS THE SPECIAL
10INSTRUCTIONS IN THIS POWER OF ATTORNEY STATE THAT SUCH AN
11ACTION WILL NOT TERMINATE YOUR AUTHORITY.
SB715-SSA1,10,1212
LIABILITY OF AGENT