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I .... (insert your name and address) appoint .... (insert the name and address
11of the person appointed) as my agent to act for me in any lawful way with respect to
12the powers initialed below. If the person appointed is unable or unwilling to act as
13my agent, I appoint .... (insert name and address of alternate person appointed) to
14act for me in any lawful way with respect to the powers initialed below.
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TO GRANT ONE OR MORE OF THE FOLLOWING POWERS, INITIAL THE
16LINE IN FRONT OF EACH POWER YOU ARE GRANTING.
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TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT.
18YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD.
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handling my money and property
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_____ 1.
PAYMENTS OF BILLS: My agent may make payments that are necessary
22or appropriate in connection with the administration of my affairs.
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_____ 2.
BANKING: My agent may conduct business with financial institutions,
24including endorsing all checks and drafts made payable to my order and collecting
25the proceeds; signing in my name checks or orders on all accounts in my name or for
1my benefit; withdrawing funds from accounts in my name; opening accounts in my
2name; 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
4necessary or appropriate, settle and adjust insurance claims and borrow from
5insurers and 3rd parties using insurance policies as collateral.
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_____ 4.
ACCOUNTS: My agent may ask for, collect and receive money, dividends,
7interest, legacies and property due or that may become due and owing to me and give
8receipt for those payments.
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_____ 5.
REAL ESTATE: My agent may manage real property; sell, convey and
10mortgage realty for prices and on terms as considered advisable; foreclose mortgages
11and take title to property in my name; and execute deeds, mortgages, releases,
12satisfactions and other instruments relating to realty.
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_____ 6.
BORROWING: My agent may borrow money and encumber my assets for
14loans as considered necessary.
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_____ 7.
SECURITIES: My agent may buy, sell, pledge and exchange securities of
16all kinds in my name; sign and deliver in my name transfers and assignments of
17securities; and consent in my name to reorganizations, mergers or exchange of
18securities for new securities.
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_____ 8.
INCOME TAXES: My agent may make and sign tax returns; represent me
20in all income tax matters before any federal, state, or local tax collecting agency; and
21receive confidential information and perform any acts that I may perform, including
22receiving 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
24trust that has been established by me before the execution of this document.
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1Because of the significant and potentially serious consequences of the authority
2to make gifts, this provision should be read carefully and all blanks must be
3completed if the gift authority is granted.
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_____ 10.
GIFTS: My agent may make gifts to persons or entities that may not
6exceed the following limits:
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a. [$....] in one year for any one person or entity.
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b. [$....] in one year to all persons or entities.
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My agent may make a gift to himself or herself only as expressly stated in the special
10instructions portion of this document.
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11(My agent may not make a gift unless both this line is
12initialed and maximum gift amounts are specified in both lines
13a. and b.)
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Professional and Technical Assistance
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_____ 11.
LEGAL ACTIONS: My agent may retain attorneys on my behalf; appear
17for me in all actions and proceedings to which I may be a party; commence actions
18and proceedings in my name; and sign in my name all documents or pleadings of
19every description.
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_____ 12.
PROFESSIONAL ASSISTANCE: My agent may hire accountants,
21attorneys, clerks, workers and others for the management, preservation and
22protection of my property and estate.
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General Authority
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1_____ 13.
GENERAL: My agent may do any act or thing that I could do in my own
2proper person if personally present. The specifically enumerated powers of the basic
3power of attorney for finances and property are not a limitation of this intended
4broad general power except that 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
8Statutes, enter into a trust agreement on my behalf or amend or revoke a trust
9agreement, entered into by me.
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COMPENSATION
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_____ 14.
compensation. My agent may receive compensation only in an
13amount not greater than that usual for the services to be performed if expressly
14authorized in the special instructions portion of this document.
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_____ 15.
accounting. My agent may render an accounting (monthly)
18(quarterly) (annually) (CIRCLE ONE) to me or to .... (insert name and address)
19during my lifetime and a final accounting to the personal representative of my estate,
20if any is appointed, after my death.
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Nomination of Guardian
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_____ 16.
GUARDIAN: If necessary, I nominate .... (name)
of .... (address) as
24guardian of my person and I nominate .... (name) of .... (address) as guardian of my
25estate.
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1special instructions
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_____ 17.
SPECIAL INSTRUCTIONS:
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ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
5REGARDING THE POWERS GRANTED TO YOUR AGENT.
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TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
16ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST
17INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
18INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
19ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
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_____ This basic power of attorney for finances and property becomes effective when
22I sign it and will continue in effect as a durable power of attorney under section
23243.07, Wisconsin Statutes, if I become disabled or incapacitated.
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_____ This basic power of attorney for finances and property becomes effective only
25when both of the following apply:
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1a. 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
4I sign it
but will cease to be effective if I become disabled or
5incapacitated.
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I agree that any 3rd party who receives a copy of this document may act under
7it. Revocation of this basic power of attorney is not effective as to a 3rd party until
8the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
9resulting from claims that arise against the 3rd party because of reliance on this
10basic 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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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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8(2) Requirements. A Wisconsin basic power of attorney for finances and
9property is legally sufficient under this section if the wording of the form complies
10substantially with sub. (1), the form is properly completed, the signature of the
11principal is acknowledged and the signature of the agent is obtained.
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12(3) Copies. A copy of a completed Wisconsin basic power of attorney for finances
13and property form has the same force and effect as the original.
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14(4) Durable power of attorney. A Wisconsin basic power of attorney for
15finances and property that is legally sufficient under this section is durable to the
16extent that durable powers are permitted under s. 243.07 and the basic power of
17attorney for finances and property contains language provided under s. 243.07 (1) (a)
18showing the intent of the principal that the power granted may be exercised
19notwithstanding later disability or incapacity.
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20(5) Distribution of forms. The department of health and family services shall
21prepare and provide copies of the Wisconsin basic power of attorney for finances and
22property form under sub. (1) for distribution in quantities to financial institutions,
23health care professionals, hospitals, nursing homes, multipurpose senior centers,
24county 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) Revocation and invalidation of basic power of attorney for finances and
8property. A principal may revoke a Wisconsin basic power of attorney for finances
9and property and invalidate it at any time by destroying it, by directing another
10person to destroy it in the principal's presence or by signing a written and dated
11statement expressing the principal's intent to revoke. If the agent under the
12Wisconsin basic power of attorney for finances and property is the principal's spouse
13and the marriage is annulled, or the agent and principal are divorced, after signing
14the document, the Wisconsin basic power of attorney for finances and property is
15invalid.
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16(8) Review of agent's performance. (a) An interested party may petition the
17court assigned to exercise probate jurisdiction for the county where a principal is
18present or the county of the principal's legal residence to review whether the agent
19is performing his or her duties in accordance with the terms of the Wisconsin basic
20power of attorney for finances and property executed by the principal. If the court
21finds after a hearing that the agent has not been performing in accordance with the
22terms of the Wisconsin basic power of attorney for finances and property, the court
23may do any of the following:
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1. Direct the agent to act in accordance with the terms of the principal's
25Wisconsin basic power of attorney for finances and property.