AB75,1338,97 _____ 15. GUARDIAN: If necessary, I nominate .... (name) of .... (address) as
8guardian of my person and I nominate .... (name) of .... (address) as guardian of my
9estate.
AB75,1338,10 10SPECIAL INSTRUCTIONS
AB75,1338,11 11Initials
AB75,1338,1212 _____ 16. SPECIAL INSTRUCTIONS:
AB75,1338,1413 ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS
14REGARDING THE POWERS GRANTED TO YOUR AGENT.
AB75,1339,324 TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
25ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST

1INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
2INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
3ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
AB75,1339,4 4Initials
AB75,1339,75 _____ This basic power of attorney for finances and property becomes effective
6when I sign it and will continue in effect as a durable power of attorney under section
7243.07, Wisconsin Statutes, if I become disabled or incapacitated.
AB75,1339,98 _____ This basic power of attorney for finances and property becomes effective
9only when both of the following apply:
AB75,1339,1010 a. I have signed it; and
AB75,1339,1111 b. I become disabled or incapacitated.
AB75,1339,1412 _____ This basic power of attorney for finances and property becomes effective
13when I sign it but will cease to be effective if I become disabled
14or incapacitated
.
AB75,1339,1915 I agree that any 3rd party who receives a copy of this document may act under
16it. Revocation of this basic power of attorney is not effective as to a 3rd party until
17the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
18resulting from claims that arise against the 3rd party because of reliance on this
19basic power of attorney.
AB75,1339,2020 Signed this .... day of ...., (year)
AB75,1339,2121 ....
AB75,1339,2222 (Your Signature)
AB75,1339,2424 ....
AB75,1339,2525 (Your Social Security Number)
AB75,1340,7
1By signing as a witness, I am acknowledging the signature of the principal who
2signed in my presence and the presence of the other witness, and the fact that he or
3she has stated that this power of attorney reflects his or her wishes and is being
4executed voluntarily. I believe him or her to be of sound mind and capable of creating
5this power of attorney. I am not related to him or her by blood, marriage or adoption,
6and, to the best of my knowledge, I am not entitled to any portion of his or her estate
7under his or her will.
AB75,1340,8 8Witness Witness
AB75,1340,99 Dated: ....   Dated: ....
AB75,1340,1010 Signature: ....  Signature: ....
AB75,1340,1111 Print Name: .... Print Name: ....
AB75,1340,1212 Address: .... Address: ....
AB75,1340,1313 State of ....
AB75,1340,1414 County of ....
AB75,1340,1615 This document was acknowledged before me on .... (date) by .... (name of
16principal).
AB75,1340,1818 ....
AB75,1340,1919 (Signature of Notarial Officer)
AB75,1340,2020 (Seal, if any)
AB75,1340,2121 (Title)
AB75,1340,2222 [My commission is permanent or expires: .... ]
AB75,1340,2523 BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
24ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
25LIABILITIES OF AN AGENT.
AB75,1341,22 (Name of Agent)
AB75,1341,55 (Signature of Agent)
AB75,1341,76 This document was drafted by .... (signature of person preparing the
7document).
AB75, s. 2506 8Section 2506. 243.10 (7) (b) of the statutes is amended to read:
AB75,1341,179 243.10 (7) (b) A principal may revoke a Wisconsin basic power of attorney for
10finances and property and invalidate it at any time by destroying it, by directing
11another person to destroy it in the principal's presence or by signing a written and
12dated statement expressing the principal's intent to revoke. If the agent under the
13Wisconsin basic power of attorney for finances and property is the principal's spouse
14and the marriage is annulled, or the agent and principal are divorced, or the agent
15is the principal's domestic partner under ch. 770 and the domestic partnership is
16terminated under s. 770.12,
after signing the document, the Wisconsin basic power
17of attorney for finances and property is invalid.
AB75, s. 2507 18Section 2507. 250.10 (title) of the statutes is amended to read:
AB75,1341,19 19250.10 (title) Grant for dental Dental services.
AB75, s. 2508 20Section 2508. 250.10 (intro.) of the statutes is repealed.
AB75, s. 2509 21Section 2509. 250.10 (1) of the statutes is renumbered 250.10 (1m) (a) and
22amended to read:
AB75,1342,523 250.10 (1m) (a) The department shall provide Provide funding in each fiscal
24year to the Marquette University School of Dentistry for clinical education of
25Marquette University School of Dentistry students through the provision of dental

1services by the students and faculty of the Marquette University School of Dentistry
2in underserved areas and to underserved populations in the state, as determined by
3the department in conjunction with the Marquette University School of Dentistry;
4to inmates of correctional centers in Milwaukee County; and in clinics in the city of
5Milwaukee.
AB75, s. 2510 6Section 2510. 250.10 (1m) (intro.) of the statutes is created to read:
AB75,1342,77 250.10 (1m) (intro.) The department shall do all of the following:
AB75, s. 2511 8Section 2511. 250.10 (2) of the statutes is renumbered 250.10 (1m) (b) and
9amended to read:
AB75,1342,1310 250.10 (1m) (b) The department shall distribute Award in each fiscal year to
11qualified applicants grants totaling $25,000 for fluoride supplements, $25,000 for a
12fluoride mouth-rinse program, and $120,000 for a school-based dental sealant
13program.
AB75, s. 2512 14Section 2512. 250.15 (2) (intro.) of the statutes is created to read:
AB75,1342,1615 250.15 (2) (intro.) From the appropriation account under s. 20.435 (1) (fh), the
16department shall, in each fiscal year, award all of the following as grants:
AB75, s. 2513 17Section 2513. 250.15 (2) (a) of the statutes is amended to read:
AB75,1342,2018 250.15 (2) (a) From the appropriation under s. 20.435 (5) (fh), the department
19shall award $50,000 in each fiscal year as a grant to
To a community health center
20in a 1st class city, $50,000.
AB75, s. 2514 21Section 2514. 250.15 (2) (b) of the statutes is amended to read:
AB75,1343,522 250.15 (2) (b) From the appropriation under s. 20.435 (5) (fh), the department
23shall award grants in each fiscal year to
To community health centers that receive
24federal grants under 42 USC 254b (e), (g) or (h). Each grant shall equal the amount
25that results from multiplying the total amount available for grants under this

1paragraph in the fiscal year in which the grants are to be awarded by the quotient
2obtained by dividing the amount that the community health center received under
342 USC 254b (e), (g) or (h) in the most recently concluded federal fiscal year in which
4those grants were made by the total amount of federal grants under 42 USC 254b (e),
5(g) and (h) made in that federal fiscal year to community health centers in this state.
AB75, s. 2515 6Section 2515. 250.15 (2) (c) of the statutes is amended to read:
AB75,1343,97 250.15 (2) (c) From the appropriation under s. 20.435 (5) (fh), the department
8shall award $50,000 in each fiscal year as a grant to
To HealthNet of Janesville, Inc.,
9$50,000
.
AB75, s. 2516 10Section 2516. 250.16 (1) of the statutes is amended to read:
AB75,1343,1711 250.16 (1) The From the appropriation account under s. 20.435 (1) (gi), the
12department shall enter into an agreement with the Wisconsin Women's Health
13Foundation, Inc., to
make payments from the appropriation under s. 20.435 (5) (fi)
14to the Wisconsin Women's Health Foundation, Inc., to be used by the Wisconsin
15Women's Health Foundation, Inc., to fund its efforts to
provide women's health
16outreach and education programs and support for women's health research that
17improves the quality of life for women and families in this state.
AB75, s. 2517 18Section 2517. 250.17 (1) of the statutes is amended to read:
AB75,1344,219 250.17 (1) The From the appropriation account under s. 20.435 (1) (g), the
20department shall enter into an agreement with Donate Life Wisconsin to make
21payments from the appropriation under s. 20.435 (5) (g) to Donate Life Wisconsin,
22to be used to fund its efforts to encourage organ and tissue donation by providing
23educational programs, promoting or advancing research and patient services, and,
24at its the discretion of Donate Life Wisconsin, distributing portions of these
25payments to any other organ and tissue procurement and donation organization in

1this state that is exempt from taxation under section 501 (a) of the Internal Revenue
2Code, to be used for these same purposes.
AB75, s. 2518 3Section 2518. 250.20 (3) of the statutes is amended to read:
AB75,1344,124 250.20 (3) From the appropriation account under s. 20.435 (5) (1) (kb), the
5department shall annually award grants for activities to improve the health status
6of economically disadvantaged minority group members. A person may apply, in the
7manner specified by the department, for a grant of up to $50,000 in each fiscal year
8to conduct these activities. An awardee of a grant under this subsection shall
9provide, for at least 50% of the grant amount, matching funds that may consist of
10funding or an in-kind contribution. An applicant that is not a federally qualified
11health center, as defined under 42 CFR 405.2401 (b) shall receive priority for grants
12awarded under this subsection.
AB75, s. 2519 13Section 2519. 250.20 (4) of the statutes is amended to read:
AB75,1344,1714 250.20 (4) From the appropriation account under s. 20.435 (5) (1) (kb), the
15department shall award a grant of up to $50,000 in each fiscal year to a private
16nonprofit corporation that applies, in the manner specified by the department, to
17conduct a public information campaign on minority health.
AB75, s. 2520 18Section 2520. 250.20 (5) (intro.) of the statutes is amended to read:
AB75,1344,2519 250.20 (5) American Indian health project grants. (intro.) From the
20appropriation under s. 20.435 (5) (1) (ke), the department shall award grants for
21American Indian health projects in order to address specific problem areas in the
22field of American Indian health. A tribe, tribal agency, or inter-tribal organization
23may apply, in the manner specified by the department, for a grant of up to $10,000
24to conduct an American Indian health project that is designed to do any of the
25following:
AB75, s. 2521
1Section 2521. 252.04 (11) of the statutes is repealed.
AB75, s. 2522 2Section 2522. 252.06 (10) (b) 4. of the statutes is repealed.
AB75, s. 2523 3Section 2523. 252.07 (10) of the statutes is amended to read:
AB75,1345,104 252.07 (10) Inpatient care for isolated pulmonary tuberculosis patients, and
5inpatient care exceeding 30 days for other pulmonary tuberculosis patients, who are
6not eligible for federal medicare benefits, or for medical assistance under subch. IV
7of ch. 49 or for health care services funded by a relief block grant under subch. II of
8ch. 49
may be reimbursed if provided by a facility contracted by the department. If
9the patient has private health insurance, the state shall pay the difference between
10health insurance payments and total charges.
AB75, s. 2524 11Section 2524. 252.10 (6) (g) of the statutes is amended to read:
AB75,1345,1412 252.10 (6) (g) The reimbursement by the state under pars. (a) and (b) shall
13apply only to funds that the department allocates for the reimbursement under the
14appropriation account under s. 20.435 (5) (1) (e).
AB75, s. 2525 15Section 2525. 252.10 (7) of the statutes is amended to read:
AB75,1345,1916 252.10 (7) Drugs necessary for the treatment of mycobacterium tuberculosis
17shall be purchased by the department from the appropriation account under s.
1820.435 (5) (1) (e) and dispensed to patients through the public health dispensaries,
19local health departments, physicians or advanced practice nurse prescribers.
AB75, s. 2526 20Section 2526. 252.12 (2) (a) (intro.) of the statutes is amended to read:
AB75,1345,2421 252.12 (2) (a) HIV and related infections, including hepatitis C virus infections;
22services.
(intro.) From the appropriations appropriation accounts under s. 20.435
23(1) (a) and (5) (am), the department shall distribute funds for the provision of services
24to individuals with or at risk of contracting HIV infection, as follows:
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