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_____ 1.
PAYMENTS OF BILLS: My agent may make payments that are necessary
8or appropriate in connection with the administration of my affairs.
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_____ 2.
BANKING: My agent may conduct business with financial institutions,
10including endorsing all checks and drafts made payable to my order and collecting
11the proceeds; signing in my name checks or orders on all accounts in my name or for
12my benefit; withdrawing funds from accounts in my name; opening accounts in my
13name; and entering into and removing articles from my safe deposit box.
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_____ 3.
INSURANCE: My agent may obtain insurance of all types, as considered
15necessary or appropriate, settle and adjust insurance claims and borrow from
16insurers and 3rd parties using insurance policies as collateral.
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_____ 4.
ACCOUNTS: My agent may ask for, collect and receive money, dividends,
18interest, legacies and property due or that may become due and owing to me and give
19receipt for those payments.
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_____ 5.
REAL ESTATE: My agent may manage real property; sell, convey and
21mortgage realty for prices and on terms as considered advisable; foreclose mortgages
22and take title to property in my name; and execute deeds, mortgages, releases,
23satisfactions and other instruments relating to realty.
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_____ 6.
BORROWING: My agent may borrow money and encumber my assets for
25loans as considered necessary.
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1_____ 7.
SECURITIES: My agent may buy, sell, pledge and exchange securities of
2all kinds in my name; sign and deliver in my name transfers and assignments of
3securities; and consent in my name to reorganizations, mergers or exchange of
4securities for new securities.
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_____ 8.
INCOME TAXES: My agent may make and sign tax returns; represent me
6in all income tax matters before any federal, state, or local tax collecting agency; and
7receive confidential information and perform any acts that I may perform, including
8receiving refund checks and the signing of returns.
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_____ 9.
TRUSTS: My agent may transfer at any time any of my property to a living
10trust that has been established by me before the execution of this document.
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Professional and Technical Assistance
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_____ 10.
LEGAL ACTIONS: My agent may retain attorneys on my behalf; appear
14for me in all actions and proceedings to which I may be a party; commence actions
15and proceedings in my name; and sign in my name all documents or pleadings of
16every description.
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_____ 11.
PROFESSIONAL ASSISTANCE: My agent may hire accountants,
18attorneys, clerks, workers and others for the management, preservation and
19protection of my property and estate.
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General Authority
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_____ 12.
GENERAL: My agent may do any act or thing that I could do in my own
23proper person if personally present. The specifically enumerated powers of the basic
24power of attorney for finances and property are not a limitation of this intended
1broad general power except that my agent may not take any action prohibited by law
2and my agent under this document may not:
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a. Make medical or health care decisions for me.
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b. Make, modify or revoke a will for me.
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c. Other than a burial trust agreement under section 445.125, Wisconsin
6Statutes, enter into a trust agreement on my behalf or amend or revoke a trust
7agreement, entered into by me.
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d. Change any beneficiary designation of any life insurance policy, qualified
9retirement plan, individual retirement account or payable on death account or the
10like whether directly or by canceling and replacing the policy or rollover to another
11plan or account.
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e. Forgive debts owed to me or disclaim or waive benefits payable to me.
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f. Appoint a substitute or successor agent for me.
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g. Make gifts.
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COMPENSATION TO AGENT
16
FROM PRINCIPAL'S FUNDS
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_____ 13.
compensation. My agent may receive compensation only in an
19amount not greater than that usual for the services to be performed if expressly
20authorized in the special instructions portion of this document.
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_____ 14.
accounting. My agent shall render an accounting (monthly)
24(quarterly) (annually) (CIRCLE ONE) to me or to .... (insert name and address)
1during my lifetime and a final accounting to the personal representative of my estate,
2if any is appointed, after my death.
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Nomination of Guardian
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_____ 15.
GUARDIAN: If necessary, I nominate .... (name)
of .... (address) as
6guardian of my person and I nominate .... (name) of .... (address) as guardian of my
7estate.
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special instructions
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_____ 16.
SPECIAL INSTRUCTIONS:
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ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
12REGARDING THE POWERS GRANTED TO YOUR AGENT.
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TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
23ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST
24INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
1INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
2ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
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_____ This basic power of attorney for finances and property becomes effective when
5I sign it and will continue in effect as a durable power of attorney under section
6243.07, Wisconsin Statutes, if I become disabled or incapacitated.
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_____ This basic power of attorney for finances and property becomes effective only
8when both of the following apply:
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a. I have signed it; and
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b. I become disabled or incapacitated.
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_____ 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.
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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.
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Signed this .... day of ...., (year)
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(Your Signature)
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(Your Social Security Number)
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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.
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Witness: ....
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Print Name: ....
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Address: ....
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Witness: ....
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Print Name: ....
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Address: ....
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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
19principal).
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(Signature of Notarial Officer)
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(Seal, if any)
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[My commission is permanent or expires: ....]
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1BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
2ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
3LIABILITIES OF AN AGENT.
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(Name of Agent)
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(Signature of Agent)
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This document was drafted by .... (signature of person preparing the document).
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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.
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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.
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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.
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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.
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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.
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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.
