AB967,51,21 21COMPENSATION TO AGENT FROM PRINCIPAL'S FUNDS
AB967,51,22 22Initials
AB967,51,2523 _____ 13. compensation. My agent may receive compensation only in an
24amount not greater than that usual for the services to be performed if expressly
25authorized in the special instructions portion of this document.
AB967,52,1
1accounting
AB967,52,2 2Initials
AB967,52,63 _____ 14. accounting. My agent shall render an accounting (monthly)
4(quarterly) (annually) (CIRCLE ONE) to me or to .... (insert name and address)
5during my lifetime and a final accounting to the personal representative of my estate,
6if any is appointed, after my death.
AB967,52,7 7Nomination of Guardian
AB967,52,8 8Initials
AB967,52,119 _____ 15. GUARDIAN: If necessary, I nominate .... (name) of .... (address) as
10guardian of my person and I nominate .... (name) of .... (address) as guardian of my
11estate.
AB967,52,12 12special instructions
AB967,52,13 13Initials
AB967,52,1414 _____ 16. SPECIAL INSTRUCTIONS:
AB967,52,1615 ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
16REGARDING THE POWERS GRANTED TO YOUR AGENT.
AB967,53,5
1TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
2ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST
3INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
4INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
5ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
AB967,53,6 6Initials
AB967,53,97 _____ This basic power of attorney for finances and property becomes effective
8when I sign it and will continue in effect as a durable power of attorney under section
9243.07, Wisconsin Statutes, if I become disabled or incapacitated.
AB967,53,1110 _____ This basic power of attorney for finances and property becomes effective
11only when both of the following apply:
AB967,53,1212 a. I have signed it; and
AB967,53,1313 b. I become disabled or incapacitated.
AB967,53,1614 _____ This basic power of attorney for finances and property becomes effective
15when I sign it but will cease to be effective if I become disabled
16or incapacitated
.
AB967,53,2117 I agree that any 3rd party who receives a copy of this document may act under
18it. Revocation of this basic power of attorney is not effective as to a 3rd party until
19the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
20resulting from claims that arise against the 3rd party because of reliance on this
21basic power of attorney.
AB967,53,2222 Signed this .... day of ...., (year)
AB967,53,2424 ....
AB967,53,2525 (Your Signature)

AB967,54,22 ....
AB967,54,33 (Your Social Security Number)
AB967,54,104 By signing as a witness, I am acknowledging the signature of the principal who
5signed in my presence and the presence of the other witness, and the fact that he or
6she has stated that this power of attorney reflects his or her wishes and is being
7executed voluntarily. I believe him or her to be of sound mind and capable of creating
8this power of attorney. I am not related to him or her by blood or marriage, and, to
9the best of my knowledge, I am not entitled to any portion of his or her estate under
10his or her will.
AB967,54,11 11Witness: .... Witness: ....
AB967,54,1212 Dated: .... Dated: ...
AB967,54,13 13By Signature: .... By Signature: ....
AB967,54,1414 Print Name: .... Print Name: ....
AB967,54,1515 Address: .... Address: ....
AB967,54,1616 State of ....
AB967,54,1717 County of ....
AB967,54,1918 This document was acknowledged before me on .... (date) by .... (name of
19principal).
AB967,54,2020 ....
AB967,54,2121 (Signature of Notarial Officer)
AB967,54,2222 (Seal, if any)
AB967,54,2323 (Title)
AB967,54,2424 [My commission is permanent or expires: .... ]
AB967,55,3
1BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
2ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
3LIABILITIES OF AN AGENT.
AB967,55,44 ....
AB967,55,55 (Name of Agent)
AB967,55,66 ....
AB967,55,77 (Signature of Agent)
AB967,55,98 This document was drafted by .... (signature of person preparing the
9document).
Note: Drafting records for 1997 Wis. Act 253 indicate that the witness portion of
this form was not properly formatted in double columns and that "Witness" was to be a
heading and was not to be followed by dot leaders. "By" is changed to "Signature" for
clarity.
AB967, s. 130 10Section 130. 251.02 (1) of the statutes, as affected by 1999 Wisconsin Act 9,
11is amended to read:
AB967,55,1912 251.02 (1) In counties with a population of less than 500,000, the county board
13shall establish a county health department that meets the requirements of this
14chapter. The county health department shall serve all areas of the county that are
15not served by a city health department that was established prior to
16January 1, 1994, by a town or village health department established under sub. (3m)
17or by a multiple municipal local health department established under sub. (3r). No
18city health department may be established after January 1, 1994, but a city-county
19health department may be established after that date.
Note: Conforms the language in this subsection with the language of s. 251.02 (3r).
AB967, s. 131 20Section 131. 251.04 (1) of the statutes, as affected by 1999 Wisconsin Act 9,
21is amended to read:
AB967,56,8
1251.04 (1) A city or county board of health shall govern each local health
2department other than a local health department as authorized in s. 251.02 (3m) and
3(3r) and a city or county board of health or a board of health for a local health
4department as authorized in s. 251.02 (3m) and (3r) shall assure the enforcement of
5state public health statutes and public health rules of the department as prescribed
6for a Level I local health department. A local board of health may contract or
7subcontract to provide public health services. The contractor's staff shall meet the
8appropriate qualifications for positions in a Level I local health department.
Note: 1999 Wis. Act 9 inserted the underscored language without showing it as
underscored. The change was intended.
AB967, s. 132 9Section 132. 251.125 of the statutes, as affected by 1999 Wisconsin Act 9, is
10amended to read:
AB967,56,15 11251.125 Village health department, how financed. If a village health
12department is established under s. 251.02 (2) or (3m) or if a multiple municipal local
13health department is established under s. 251.01 251.02 (3r) by the governing body
14of a village in concert with the governing body of another village or a city or town, the
15village board shall appropriate funds for the operation of the department.
Note: Corrects cross-reference. There is no s. 251.01 (3r). Section 251.02 (3r)
relates to the establishment of local health departments.
AB967, s. 133 16Section 133. 252.08 (title) of the statutes is repealed.
Note: The remainder of s. 252.08 was renumbered or repealed by 1999 Wis. Act 9.
AB967, s. 134 17Section 134. 253.115 (1) (a) of the statutes, as created by 1999 Wisconsin Act
189
, is amended to read:
AB967,56,2119 253.115 (1) (a) "Hearing loss" means an inability in one or both ears to detect
20sounds at 30 decibels hearing level or greater in the frequency region of 500 to 4,000
21hertz, which that affects speech recognition and auditory comprehension.
Note: Replaces ", which" with "that" to correct grammar.
AB967, s. 135
1Section 135. 254.916 (3) (a) (intro.) of the statutes, as created by 1999
2Wisconsin Act 9
, is renumbered 254.916 (3) (intro.).
Note: Corrects numbering.
AB967, s. 136 3Section 136. 254.916 (11) of the statutes, as created by 1999 Wisconsin Act 9,
4is amended to read:
AB967,57,105 254.916 (11) The department shall hold a hearing under ch. 227 if any
6interested person, in lieu of proceeding under ch. 68, appeals to the department
7alleging that the person making an investigation of the appellant has a financial
8interest in a regulated cigarette and tobacco product retailer, tobacco vending
9machine operator, tobacco vending machine premises or tobacco vending machine
10which that may interfere with his or her ability to properly take that action.
Note: Replaces "which" with "that" to correct grammar.
AB967, s. 137 11Section 137. 281.68 (1r) (a) of the statutes, as affected by 1999 Wisconsin Act
129
, is amended to read:
AB967,57,1413 281.68 (1r) (a) Prevent pollution from entering into lakes or into natural lake
14ecosystems.
Note: 1999 Wis. Act 9 inserted "or" without showing it as underscored. The change
was intended.
AB967, s. 138 15Section 138. 281.69 (6) of the statutes, as affected by 1999 Wisconsin Act 9,
16is amended to read:
AB967,57,2117 281.69 (6) Lake classification technical assistance contracts. A nonprofit
18corporation receiving a lake classification technical assistance contract shall use the
19grant money provided under the contract to provide educational and technical
20assistance to local units of government and lake management organizations that will
21participate in a lake classification project.
Note: 1999 Wisconsin Act 9 amended this section by replacing "technical
assistance grant" with "technical assistance contract" but did not make the corresponding

change to the later use of the term "grant". Act 9 also omitted the phrase "use the grant
to" without showing it as stricken. This bill restores the unintentionally omitted
language and amends the subsection to reflect the term change.
AB967, s. 139 1Section 139. 289.645 (4) (c) of the statutes, as created by 1999 Wisconsin Act
29
, is amended to read:
AB967,58,53 289.645 (4) (c) Waste generated by an organization described in par. (b) which
4that is commingled with waste generated by a person other than an organization
5described in par. (b) is subject to the fee.
Note: Replaces "which" with "that" to correct grammar.
AB967, s. 140 6Section 140. 292.15 (2) (at) 3. of the statutes, as created by 1999 Wisconsin Act
79
, is amended to read:
AB967,58,138 292.15 (2) (at) 3. The voluntary party obtains and maintains insurance to cover
9the costs of complying with s. 292.11 (3) with respect to a hazardous substance
10discharges that occurred before the investigation under subd. 1. is completed and
11that are discovered in the course of conducting a cleanup of the property, the
12insurance complies with rules promulgated by the department and the insurance
13names the voluntary party and this state as insureds.
Note: Deletes unnecessary "a."
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