AB695,25,2222 Agent's signature....
AB695,25,2323 Address....
AB695,25,2424 Alternate's signature....
AB695,25,2525 Address....
AB695,26,3
1Failure to execute a power of attorney for health care document under chapter
2155 of the Wisconsin Statutes creates no presumption about the intent of any
3individual with regard to his or her health care decisions.
AB695,26,54 This power of attorney for health care is executed as provided in chapter 155
5of the Wisconsin Statutes.
AB695,26,66 ANATOMICAL GIFTS (optional)
AB695,26,77 Upon my death:
AB695,26,98 .... I wish to donate only the following organs or parts: .... (specify the organs or
9parts).
AB695,26,1010 .... I wish to donate any needed organ or part.
AB695,26,1111 .... I wish to donate my body for anatomical study if needed.
AB695,26,1412 .... I refuse to make an anatomical gift. (If this revokes a prior commitment that
13I have made to make an anatomical gift to a designated donee, I will attempt to notify
14the donee to which or to whom I agreed to donate.)
AB695,26,1615 Failing to check any of the lines immediately above creates no presumption
16about my desire to make or refuse to make an anatomical gift.
AB695,26,1717 Signature....     Date....
AB695,5 18Section 5. 244.41 (1) (i) of the statutes is created to read:
AB695,26,2019 244.41 (1) (i) Access the content of an electronic communication, as defined in
20s. 112.12 (2) (f), sent or received by the principal.
AB695,6 21Section 6. 244.43 (9m) of the statutes is created to read:
AB695,26,2522 244.43 (9m) Access a catalogue of electronic communications, as defined in s.
23112.12 (2) (d), sent or received by the principal, and the principal's digital assets, as
24defined in s. 112.12 (2) (j), other than the content of electronic communications, as
25defined in s. 112.12 (2) (f).
AB695,7
1Section 7. 244.61 (form) of the statutes is amended to read:
AB695,27,2 2244.61 (form)
AB695,27,5 3WISCONSIN STATUTORY FORM
4 POWER OF ATTORNEY
5 FOR FINANCES AND PROPERTY
AB695,27,66 IMPORTANT INFORMATION
AB695,27,147 THIS POWER OF ATTORNEY AUTHORIZES ANOTHER PERSON (YOUR
8AGENT) TO MAKE DECISIONS CONCERNING YOUR PROPERTY FOR YOU
9(THE PRINCIPAL). YOUR AGENT WILL BE ABLE TO MAKE DECISIONS AND
10ACT WITH RESPECT TO YOUR PROPERTY (INCLUDING YOUR MONEY)
11WHETHER OR NOT YOU ARE ABLE TO ACT FOR YOURSELF. THE MEANING
12OF AUTHORITY OVER SUBJECTS LISTED ON THIS FORM IS EXPLAINED IN
13THE UNIFORM POWER OF ATTORNEY FOR FINANCES AND PROPERTY ACT
14IN CHAPTER 244 OF THE WISCONSIN STATUTES.
AB695,27,1615 THIS POWER OF ATTORNEY DOES NOT AUTHORIZE THE AGENT TO
16MAKE HEALTH-CARE DECISIONS FOR YOU.
AB695,27,2017 YOU SHOULD SELECT SOMEONE YOU TRUST TO SERVE AS YOUR
18AGENT. UNLESS YOU SPECIFY OTHERWISE, GENERALLY THE AGENT'S
19AUTHORITY WILL CONTINUE UNTIL YOU DIE OR REVOKE THE POWER OF
20ATTORNEY OR THE AGENT RESIGNS OR IS UNABLE TO ACT FOR YOU.
AB695,27,2221 YOUR AGENT IS ENTITLED TO REASONABLE COMPENSATION
22UNLESS YOU STATE OTHERWISE IN THE SPECIAL INSTRUCTIONS.
AB695,28,223 THIS FORM PROVIDES FOR DESIGNATION OF ONE AGENT. IF YOU
24WISH TO NAME MORE THAN ONE AGENT YOU MAY NAME A COAGENT IN
25THE SPECIAL INSTRUCTIONS. COAGENTS ARE NOT REQUIRED TO ACT

1TOGETHER UNLESS YOU INCLUDE THAT REQUIREMENT IN THE SPECIAL
2INSTRUCTIONS.
AB695,28,53 IF YOUR AGENT IS UNABLE OR UNWILLING TO ACT FOR YOU, YOUR
4POWER OF ATTORNEY WILL END UNLESS YOU HAVE NAMED A
5SUCCESSOR AGENT. YOU MAY ALSO NAME A 2ND SUCCESSOR AGENT.
AB695,28,106 THIS POWER OF ATTORNEY BECOMES EFFECTIVE IMMEDIATELY
7UNLESS YOU STATE OTHERWISE IN THE SPECIAL INSTRUCTIONS. THIS
8POWER OF ATTORNEY DOES NOT REVOKE ANY POWER OF ATTORNEY
9EXECUTED PREVIOUSLY UNLESS YOU SO PROVIDE IN THE SPECIAL
10INSTRUCTIONS.
AB695,28,1611 IF YOU REVOKE THIS POWER OF ATTORNEY, YOU SHOULD NOTIFY
12YOUR AGENT AND ANY OTHER PERSON TO WHOM YOU HAVE GIVEN A
13COPY. IF YOUR AGENT IS YOUR SPOUSE OR DOMESTIC PARTNER AND
14YOUR MARRIAGE IS ANNULLED OR YOU ARE DIVORCED OR LEGALLY
15SEPARATED OR THE DOMESTIC PARTNERSHIP IS TERMINATED AFTER
16SIGNING THIS DOCUMENT, THE DOCUMENT IS INVALID.
AB695,28,1917 IF YOU HAVE QUESTIONS ABOUT THE POWER OF ATTORNEY OR THE
18AUTHORITY YOU ARE GRANTING TO YOUR AGENT, YOU SHOULD SEEK
19LEGAL ADVICE BEFORE SIGNING THIS FORM.
AB695,28,2020 DESIGNATION OF AGENT
AB695,28,2121 I .... (name of principal) name the following person as my agent:
AB695,28,2222 Name of agent: ....
AB695,28,2323 Agent's address: ....
AB695,28,2424 Agent's telephone number: ....
AB695,28,2525 DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
AB695,29,1
1If my agent is unable or unwilling to act for me, I name as my successor agent:
AB695,29,22 Name of successor agent: ....
AB695,29,33 Successor agent's address: ....
AB695,29,44 Successor agent's telephone number: ....
AB695,29,65 If my successor agent is unable or unwilling to act for me, I name as my 2nd
6successor agent:
AB695,29,77 Name of 2nd successor agent: ....
AB695,29,88 Second successor agent's address: ....
AB695,29,99 Second successor agent's telephone number: ....
AB695,29,1010 GRANT OF GENERAL AUTHORITY
AB695,29,1311 I grant my agent and any successor agent general authority to act for me with
12respect to the following subjects as defined in the Uniform Power of Attorney for
13Finances and Property Act in chapter 244 of the Wisconsin statutes:
AB695,29,1414 INITIAL each subject you want to include in the agent's general authority.
AB695,29,1515 .... Real property
AB695,29,1616 .... Tangible personal property
AB695,29,1717 .... Stocks and bonds
AB695,29,1818 .... Commodities and options
AB695,29,1919 .... Banks and other financial institutions
AB695,29,2020 .... Operation of entity or business
AB695,29,2121 .... Insurance and annuities
AB695,29,2222 .... Estates, trusts, and other beneficial interests
AB695,29,2323 .... Claims and litigation
AB695,29,2424 .... Personal and family maintenance
AB695,29,2525 .... Benefits from governmental programs or civil or military service
AB695,30,1
1.... Retirement plans
AB695,30,22 .... Taxes
AB695,30,33 LIMITATION ON AGENT'S AUTHORITY
AB695,30,64 An agent who is not my spouse or domestic partner MAY NOT use my property
5to benefit the agent or a person to whom the agent owes an obligation of support
6unless I have included that authority in the special instructions.
AB695,30,7 7ACCESS TO DIGITAL ASSETS
AB695,30,10 8If I have checked "Yes" to the following, my agent may access the content of
9electronic communications on my behalf. If I have checked "No" to the following, my
10agent may not access the content of electronic communications on my behalf.
AB695,30,11 11Access to content of electronic communications — Yes.... No....
AB695,30,13 12If I have not checked either "Yes" or "No" immediately above, my agent may not
13access the content of electronic communications on my behalf.
AB695,30,1414 SPECIAL INSTRUCTIONS (OPTIONAL)
AB695,30,1515 You may give special instructions in the following space ....
AB695,30,1616 EFFECTIVE DATE
AB695,30,1817 This power of attorney is effective immediately unless I have stated otherwise
18in the special instructions.
AB695,30,1919 NOMINATION OF GUARDIAN (OPTIONAL)
AB695,30,2120 If it becomes necessary for a court to appoint a guardian of my estate or
21guardian of my person, I nominate the following person(s) for appointment:
AB695,30,2222 Name of nominee for guardian of my estate: ....
AB695,30,2323 Nominee's address: ....
AB695,30,2424 Nominee's telephone number: ....
AB695,30,2525 Name of nominee for guardian of my person: ....
AB695,31,1
1Nominee's address: ....
AB695,31,22 Nominee's telephone number: ....
AB695,31,43 RELIANCE ON THIS POWER OF
4 ATTORNEY FOR FINANCES AND PROPERTY
AB695,31,75 Any person, including my agent, may rely upon the validity of this power of
6attorney or a copy of it unless that person knows that the power of attorney has been
7terminated or is invalid.
AB695,31,88 SIGNATURE AND ACKNOWLEDGMENT
AB695,31,99 Your signature ....   Date ....
AB695,31,1010 Your name printed ....
AB695,31,1111 Your address ....
AB695,31,1212 Your telephone number ....
AB695,31,1313 State of ....
AB695,31,1414 County of ....
AB695,31,1615 This document was acknowledged before me on .... (date), by .... (name of
16principal).
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