SB254-SSA1,10,87 _____ This basic power of attorney for finances and property becomes effective only
8when both of the following apply:
SB254-SSA1,10,99 a. I have signed it; and
SB254-SSA1,10,1010 b. I become disabled or incapacitated.
SB254-SSA1,10,1311 _____ This basic power of attorney for finances and property becomes effective when
12I sign it but will cease to be effective if I become disabled or
13incapacitated
.
SB254-SSA1,10,1814 I agree that any 3rd party who receives a copy of this document may act under
15it. Revocation of this basic power of attorney is not effective as to a 3rd party until
16the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
17resulting from claims that arise against the 3rd party because of reliance on this
18basic power of attorney.
SB254-SSA1,10,1919 Signed this .... day of ...., (year)
SB254-SSA1,10,2121 (Your Signature)
SB254-SSA1,10,2323 (Your Social Security Number)
SB254-SSA1,11,524 By signing as a witness, I am acknowledging the signature of the principal who
25signed in may presence and the presence of the other witness, and the fact that he

1or she has stated that this power of attorney reflects his or her wishes and is being
2executed voluntarily. I believe him or her to be of sound mind and capable of creating
3this power of attorney. I am not related to him or her by blood or marriage, and, to
4the best of my knowledge, I am not entitled to any portion of his or her estate under
5his or her will.
SB254-SSA1,11,66 Witness: ....
SB254-SSA1,11,77 Dated: ....
SB254-SSA1,11,88 By: ....
SB254-SSA1,11,99 Print Name: ....
SB254-SSA1,11,1010 Address: ....
SB254-SSA1,11,1111 Witness: ....
SB254-SSA1,11,1212 Dated: ....
SB254-SSA1,11,1313 By: ....
SB254-SSA1,11,1414 Print Name: ....
SB254-SSA1,11,1515 Address: ....
SB254-SSA1,11,1616 State of ....
SB254-SSA1,11,1717 County of ....
SB254-SSA1,11,1918 This document was acknowledged before me on .... (date) by .... (name of
19principal).
SB254-SSA1,11,2121 (Signature of Notarial Officer)
SB254-SSA1,11,2222 (Seal, if any)
SB254-SSA1,11,2323 (Title)
SB254-SSA1,11,2424 [My commission is permanent or expires: ....]
SB254-SSA1,12,3
1BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
2ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
3LIABILITIES OF AN AGENT.
SB254-SSA1,12,55 (Name of Agent)
SB254-SSA1,12,77 (Signature of Agent)
SB254-SSA1,12,88 This document was drafted by .... (signature of person preparing the document).
SB254-SSA1,12,12 9(2) Requirements. A Wisconsin basic power of attorney for finances and
10property is legally sufficient under this section if the wording of the form complies
11substantially with sub. (1), the form is properly completed, the signature of the
12principal is acknowledged and the signature of the agent is obtained.
SB254-SSA1,12,14 13(3) Copies. A copy of a completed Wisconsin basic power of attorney for finances
14and property form has the same force and effect as the original.
SB254-SSA1,12,20 15(4) Durable power of attorney. A Wisconsin basic power of attorney for
16finances and property that is legally sufficient under this section is durable to the
17extent that durable powers are permitted under s. 243.07 and the basic power of
18attorney for finances and property contains language provided under s. 243.07 (1) (a)
19showing the intent of the principal that the power granted may be exercised
20notwithstanding later disability or incapacity.
SB254-SSA1,13,2 21(5) Distribution of forms. The department of health and family services shall
22prepare and provide copies of the Wisconsin basic power of attorney for finances and
23property form under sub. (1) for distribution in quantities to financial institutions,
24health care professionals, hospitals, nursing homes, multipurpose senior centers,
25county clerks and local bar associations and individually to private persons. The

1department of health and family services may charge a reasonable fee for the cost
2of preparation and distribution of the forms.
SB254-SSA1,13,6 3(6) Relation to power of attorney for health care. The execution of a
4Wisconsin basic power of attorney for finances and property under this section does
5not confer on the agent any of the powers or duties conferred on a health care agent
6by the power of attorney for health care under ch. 155.
SB254-SSA1,13,10 7(7) Amendment, revocation and invalidation of basic power of attorney for
8finances and property.
(a) A principal may amend a Wisconsin basic power of
9attorney for finances and property only by revoking that power of attorney and
10completing a new basic power of attorney for finances and property.
SB254-SSA1,13,1711 (b) A principal may revoke a Wisconsin basic power of attorney for finances and
12property and invalidate it at any time by destroying it, by directing another person
13to destroy it in the principal's presence or by signing a written and dated statement
14expressing the principal's intent to revoke. If the agent under the Wisconsin basic
15power of attorney for finances and property is the principal's spouse and the
16marriage is annulled, or the agent and principal are divorced, after signing the
17document, the Wisconsin basic power of attorney for finances and property is invalid.
SB254-SSA1,13,25 18(8) Review of agent's performance. (a) An interested party may petition the
19court assigned to exercise probate jurisdiction for the county where a principal is
20present or the county of the principal's legal residence to review whether the agent
21is performing his or her duties in accordance with the terms of the Wisconsin basic
22power of attorney for finances and property executed by the principal. If the court
23finds after a hearing that the agent has not been performing in accordance with the
24terms of the Wisconsin basic power of attorney for finances and property, the court
25may do any of the following:
SB254-SSA1,14,2
11. Direct the agent to act in accordance with the terms of the principal's
2Wisconsin basic power of attorney for finances and property.
SB254-SSA1,14,43 2. Require the agent to report to the court concerning performance of the
4agent's duties at periods of time established by the court.
SB254-SSA1,14,65 3. Rescind all powers of the agent to act under the power of attorney for finances
6and property.
SB254-SSA1,14,97 (b) If the principal has designated an alternate agent and if the powers of the
8first-designated agent are rescinded under par. (a) 3., the alternate agent is the
9agent and is subject to par. (a).
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