SB421,49,214 IF YOU WISH TO CHANGE YOUR BASIC POWER OF ATTORNEY FOR
15FINANCES AND PROPERTY, YOU MUST COMPLETE A NEW DOCUMENT
16AND REVOKE THIS ONE. YOU MAY REVOKE THIS DOCUMENT AT ANY TIME
17BY DESTROYING IT, BY DIRECTING ANOTHER PERSON TO DESTROY IT IN
18YOUR PRESENCE OR BY SIGNING A WRITTEN AND DATED STATEMENT
19EXPRESSING YOUR INTENT TO REVOKE THIS DOCUMENT. IF YOU
20REVOKE THIS DOCUMENT, YOU SHOULD NOTIFY YOUR AGENT AND ANY
21OTHER PERSON TO WHOM YOU HAVE GIVEN A COPY OF THE FORM. YOU
22ALSO SHOULD NOTIFY ALL PARTIES HAVING CUSTODY OF YOUR ASSETS.
23THESE PARTIES HAVE NO RESPONSIBILITY TO YOU UNLESS YOU
24ACTUALLY NOTIFY THEM OF THE REVOCATION. IF YOUR AGENT IS YOUR

1SPOUSE AND YOUR MARRIAGE IS ANNULLED, OR YOU ARE DIVORCED
2AFTER SIGNING THIS DOCUMENT, THIS DOCUMENT IS INVALID.
SB421,49,63 SINCE SOME 3RD PARTIES OR SOME TRANSACTIONS MAY NOT
4PERMIT USE OF THIS DOCUMENT, IT IS ADVISABLE TO CHECK IN
5ADVANCE, IF POSSIBLE, FOR ANY SPECIAL REQUIREMENTS THAT MAY BE
6IMPOSED.
SB421,49,87 YOU SHOULD SIGN THIS FORM ONLY IF THE AGENT YOU NAME IS
8RELIABLE, TRUSTWORTHY AND COMPETENT TO MANAGE YOUR AFFAIRS.
SB421,49,139 I .... (insert your name and address) appoint .... (insert the name and address
10of the person appointed) as my agent to act for me in any lawful way with respect to
11the powers initialed below. If the person appointed is unable or unwilling to act as
12my agent, I appoint .... (insert name and address of alternate person appointed) to
13act for me in any lawful way with respect to the powers initialed below.
SB421,49,1514 TO GRANT ONE OR MORE OF THE FOLLOWING POWERS, INITIAL THE
15LINE IN FRONT OF EACH POWER YOU ARE GRANTING.
SB421,49,1716 TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT.
17YOU MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD.
SB421,49,18 18handling my money and property
SB421,49,19 19Initials
SB421,49,2120 _____ 1. PAYMENTS OF BILLS: My agent may make payments that are
21necessary or appropriate in connection with the administration of my affairs.
SB421,50,222 _____ 2. BANKING: My agent may conduct business with financial
23institutions, including endorsing all checks and drafts made payable to my order and
24collecting the proceeds; signing in my name checks or orders on all accounts in my
25name or for my benefit; withdrawing funds from accounts in my name; opening

1accounts in my name; and entering into and removing articles from my safe deposit
2box.
SB421,50,53 _____ 3. INSURANCE: My agent may obtain insurance of all types, as
4considered necessary or appropriate, settle and adjust insurance claims and borrow
5from insurers and 3rd parties using insurance policies as collateral.
SB421,50,86 _____ 4. ACCOUNTS: My agent may ask for, collect and receive money,
7dividends, interest, legacies and property due or that may become due and owing to
8me and give receipt for those payments.
SB421,50,129 _____ 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.
SB421,50,1413 _____ 6. BORROWING: My agent may borrow money and encumber my assets
14for loans as considered necessary.
SB421,50,1815 _____ 7. SECURITIES: My agent may buy, sell, pledge and exchange securities
16of all 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.
SB421,50,2219 _____ 8. INCOME TAXES: My agent may make and sign tax returns; represent
20me in all income tax matters before any federal, state, or local tax collecting agency;
21and receive confidential information and perform any acts that I may perform,
22including receiving refund checks and the signing of returns.
SB421,50,2423 _____ 9. TRUSTS: My agent may transfer at any time any of my property to
24a living trust that has been established by me before the execution of this document.
SB421,50,25 25Professional and Technical Assistance
SB421,51,1
1Initials
SB421,51,52 _____ 10. LEGAL ACTIONS: My agent may retain attorneys on my behalf;
3appear for me in all actions and proceedings to which I may be a party; commence
4actions and proceedings in my name; and sign in my name all documents or pleadings
5of every description.
SB421,51,86 _____ 11. PROFESSIONAL ASSISTANCE: My agent may hire accountants,
7attorneys, clerks, workers and others for the management, preservation and
8protection of my property and estate.
SB421,51,9 9General Authority
SB421,51,10 10Initials
SB421,51,1711 _____ 12. GENERAL: My agent may do any act or thing that I could do in my
12own proper person if personally present, including managing or selling tangible
13assets, disclaiming a probate or nonprobate inheritance and providing support for
14a minor child or dependent adult. The specifically enumerated powers of the basic
15power of attorney for finances and property are not a limitation of this intended
16broad general power except that my agent may not take any action prohibited by law
17and my agent under this document may not:
SB421,51,1818 a. Make medical or health care decisions for me.
SB421,51,1919 b. Make, modify or revoke a will for me.
SB421,51,2220 c. Other than a burial trust agreement under section 445.125, Wisconsin
21Statutes, enter into a trust agreement on my behalf or amend or revoke a trust
22agreement, entered into by me.
SB421,52,223 d. Change any beneficiary designation of any life insurance policy, qualified
24retirement plan, individual retirement account or payable on death account or the

1like whether directly or by canceling and replacing the policy or rollover to another
2plan or account.
SB421,52,43 e. Forgive debts owed to me or disclaim or waive benefits payable to me, except
4a probate or nonprobate inheritance.
SB421,52,55 f. Appoint a substitute or successor agent for me.
SB421,52,66 g. Make gifts.
SB421,52,7 7COMPENSATION TO AGENT FROM PRINCIPAL'S FUNDS
SB421,52,8 8Initials
SB421,52,119 _____ 13. compensation. My agent may receive compensation only in an
10amount not greater than that usual for the services to be performed if expressly
11authorized in the special instructions portion of this document.
SB421,52,1212 accounting
SB421,52,13 13Initials
SB421,52,1714 _____ 14. accounting. My agent shall render an accounting (monthly)
15(quarterly) (annually) (CIRCLE ONE) to me or to .... (insert name and address)
16during my lifetime and a final accounting to the personal representative of my estate,
17if any is appointed, after my death.
SB421,52,18 18Nomination of Guardian
SB421,52,19 19Initials
SB421,52,2220 _____ 15. GUARDIAN: If necessary, I nominate .... (name) of .... (address) as
21guardian of my person and I nominate .... (name) of .... (address) as guardian of my
22estate.
SB421,52,23 23special instructions
SB421,52,24 24Initials
SB421,52,2525 _____ 16. SPECIAL INSTRUCTIONS:
SB421,53,2
1ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
2REGARDING THE POWERS GRANTED TO YOUR AGENT.
SB421,53,1612 TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
13ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST
14INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
15INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
16ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
SB421,53,17 17Initials
SB421,53,2018 _____ This basic power of attorney for finances and property becomes effective
19when I sign it and will continue in effect as a durable power of attorney under section
20243.07, Wisconsin Statutes, if I become disabled or incapacitated.
SB421,53,2221 _____ This basic power of attorney for finances and property becomes effective
22only when both of the following apply:
SB421,53,2323 a. I have signed it; and
SB421,53,2424 b. I become disabled or incapacitated.
SB421,54,3
1_____ This basic power of attorney for finances and property becomes effective
2when I sign it but will cease to be effective if I become disabled
3or incapacitated
.
SB421,54,84 I agree that any 3rd party who receives a copy of this document may act under
5it. Revocation of this basic power of attorney is not effective as to a 3rd party until
6the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
7resulting from claims that arise against the 3rd party because of reliance on this
8basic power of attorney.
SB421,54,99 Signed this .... day of ...., (year)
SB421,54,1111 ....
SB421,54,1212 (Your Signature)
SB421,54,1414 ....
SB421,54,1515 (Your Social Security Number)
SB421,54,2216 By signing as a witness, I am acknowledging the signature of the principal who
17signed in my presence and the presence of the other witness, and the fact that he or
18she has stated that this power of attorney reflects his or her wishes and is being
19executed voluntarily. I believe him or her to be of sound mind and capable of creating
20this power of attorney. I am not related to him or her by blood or marriage, and, to
21the best of my knowledge, I am not entitled to any portion of his or her estate under
22his or her will.
SB421,54,23 23Witness: .... Witness: ....
SB421,54,2424 Dated: .... Dated: ...
SB421,54,25 25By Signature: .... By Signature: ....
SB421,55,1
1Print Name: .... Print Name: ....
SB421,55,22 Address: .... Address: ....
SB421,55,33 State of ....
SB421,55,44 County of ....
SB421,55,65 This document was acknowledged before me on .... (date) by .... (name of
6principal).
SB421,55,77 ....
SB421,55,88 (Signature of Notarial Officer)
SB421,55,99 (Seal, if any)
SB421,55,1010 (Title)
SB421,55,1111 [My commission is permanent or expires: .... ]
SB421,55,1412 BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
13ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
14LIABILITIES OF AN AGENT.
SB421,55,1515 ....
SB421,55,1616 (Name of Agent)
SB421,55,1717 ....
SB421,55,1818 (Signature of Agent)
SB421,55,2019 This document was drafted by .... (signature of person preparing the
20document).
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.
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