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23 Agent's address: ....
24 Agent's telephone number: ....
25 DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
1If my agent is unable or unwilling to act for me, I name as my successor agent:
2 Name of successor agent: ....
3 Successor agent's address: ....
4 Successor agent's telephone number: ....
5 If my successor agent is unable or unwilling to act for me, I name as my 2nd
6successor agent:
7 Name of 2nd successor agent: ....
8 Second successor agent's address: ....
9 Second successor agent's telephone number: ....
10 GRANT OF GENERAL AUTHORITY
11 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:
14 INITIAL each subject you want to include in the agent's general authority.
15 .... Real property
16 .... Tangible personal property
17 .... Stocks and bonds
18 .... Commodities and options
19 .... Banks and other financial institutions
20 .... Operation of entity or business
21 .... Insurance and annuities
22 .... Estates, trusts, and other beneficial interests
23 .... Claims and litigation
24 .... Personal and family maintenance
25 .... Benefits from governmental programs or civil or military service
1.... Retirement plans
2 .... Taxes
3 LIMITATION ON AGENT'S AUTHORITY
4 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.
7ACCESS TO DIGITAL ASSETS
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.
11Access to content of electronic communications — Yes.... No....
12If I have not checked either "Yes" or "No" immediately above, my agent may not
13access the content of electronic communications on my behalf.
14 SPECIAL INSTRUCTIONS (OPTIONAL)
15 You may give special instructions in the following space ....
16 EFFECTIVE DATE
17 This power of attorney is effective immediately unless I have stated otherwise
18in the special instructions.
19 NOMINATION OF GUARDIAN (OPTIONAL)
20 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:
22 Name of nominee for guardian of my estate: ....
23 Nominee's address: ....
24 Nominee's telephone number: ....
25 Name of nominee for guardian of my person: ....
1Nominee's address: ....
2 Nominee's telephone number: ....
3 RELIANCE ON THIS POWER OF
4 ATTORNEY FOR FINANCES AND PROPERTY
5 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.
8 SIGNATURE AND ACKNOWLEDGMENT
9 Your signature ....   Date ....
10 Your name printed ....
11 Your address ....
12 Your telephone number ....
13 State of ....
14 County of ....
15 This document was acknowledged before me on .... (date), by .... (name of
16principal).
17 (Seal, if any)
18 Signature of notary ....
19 My commission expires: ....
20 This document prepared by: ....
21 IMPORTANT INFORMATION FOR AGENT
22 AGENT'S DUTIES
23 WHEN YOU ACCEPT THE AUTHORITY GRANTED UNDER THIS POWER
24OF ATTORNEY, A SPECIAL LEGAL RELATIONSHIP IS CREATED BETWEEN
25YOU AND THE PRINCIPAL. THIS RELATIONSHIP IMPOSES UPON YOU
1LEGAL DUTIES THAT CONTINUE UNTIL YOU RESIGN OR THE POWER OF
2ATTORNEY IS TERMINATED OR REVOKED. YOU MUST DO ALL OF THE
3FOLLOWING:
4 (1) DO WHAT YOU KNOW THE PRINCIPAL REASONABLY EXPECTS YOU
5TO DO WITH THE PRINCIPAL'S PROPERTY OR, IF YOU DO NOT KNOW THE
6PRINCIPAL'S EXPECTATIONS, ACT IN THE PRINCIPAL'S BEST INTEREST.
7 (2) ACT IN GOOD FAITH.
8 (3) DO NOTHING BEYOND THE AUTHORITY GRANTED IN THIS POWER
9OF ATTORNEY.
10 (4) DISCLOSE YOUR IDENTITY AS AN AGENT WHENEVER YOU ACT
11FOR THE PRINCIPAL BY WRITING OR PRINTING THE NAME OF THE
12PRINCIPAL AND SIGNING YOUR OWN NAME AS "AGENT" IN THE
13FOLLOWING MANNER:
14 .... (principal's name) by .... (your signature) as agent
15 UNLESS THE SPECIAL INSTRUCTIONS IN THIS POWER OF ATTORNEY
16STATE OTHERWISE, YOU MUST ALSO DO ALL OF THE FOLLOWING:
17 (1) ACT LOYALLY FOR THE PRINCIPAL'S BENEFIT.
18 (2) AVOID CONFLICTS THAT WOULD IMPAIR YOUR ABILITY TO ACT IN
19THE PRINCIPAL'S BEST INTEREST.
20 (3) ACT WITH CARE, COMPETENCE, AND DILIGENCE.
21 (4) KEEP A RECORD OF ALL RECEIPTS, DISBURSEMENTS, AND
22TRANSACTIONS MADE ON BEHALF OF THE PRINCIPAL.
23 (5) COOPERATE WITH ANY PERSON THAT HAS AUTHORITY TO MAKE
24HEALTH-CARE DECISIONS FOR THE PRINCIPAL TO DO WHAT YOU KNOW
1THE PRINCIPAL REASONABLY EXPECTS OR, IF YOU DO NOT KNOW THE
2PRINCIPAL'S EXPECTATIONS, TO ACT IN THE PRINCIPAL'S BEST INTEREST.
3 (6) ATTEMPT TO PRESERVE THE PRINCIPAL'S ESTATE PLAN IF YOU
4KNOW THE PLAN AND PRESERVING THE PLAN IS CONSISTENT WITH THE
5PRINCIPAL'S BEST INTEREST.
6 TERMINATION OF AGENT'S AUTHORITY
7 YOU MUST STOP ACTING ON BEHALF OF THE PRINCIPAL IF YOU
8LEARN OF ANY EVENT THAT TERMINATES THIS POWER OF ATTORNEY OR
9YOUR AUTHORITY UNDER THIS POWER OF ATTORNEY. EVENTS THAT
10TERMINATE A POWER OF ATTORNEY OR YOUR AUTHORITY TO ACT UNDER
11A POWER OF ATTORNEY INCLUDE ALL OF THE FOLLOWING:
12 (1) DEATH OF THE PRINCIPAL.
13 (2) THE PRINCIPAL'S REVOCATION OF THE POWER OF ATTORNEY OR
14YOUR AUTHORITY.
15 (3) THE OCCURRENCE OF A TERMINATION EVENT STATED IN THE
16POWER OF ATTORNEY.
17 (4) THE PURPOSE OF THE POWER OF ATTORNEY IS FULLY
18ACCOMPLISHED.
19 (5) IF YOU ARE MARRIED TO THE PRINCIPAL, A LEGAL ACTION IS
20FILED WITH A COURT TO END YOUR MARRIAGE, OR FOR YOUR LEGAL
21SEPARATION, UNLESS THE SPECIAL INSTRUCTIONS IN THIS POWER OF
22ATTORNEY STATE THAT SUCH AN ACTION WILL NOT TERMINATE YOUR
23AUTHORITY.
24 (6) IF YOU ARE THE PRINCIPAL'S DOMESTIC PARTNER AND YOUR
25DOMESTIC PARTNERSHIP IS TERMINATED, UNLESS THE SPECIAL
1INSTRUCTIONS IN THIS POWER OF ATTORNEY STATE THAT SUCH AN
2ACTION WILL NOT TERMINATE YOUR AUTHORITY.
3 LIABILITY OF AGENT
4 THE MEANING OF THE AUTHORITY GRANTED TO YOU IS DEFINED IN
5THE UNIFORM POWER OF ATTORNEY FOR FINANCES AND PROPERTY ACT
6IN CHAPTER 244 OF THE WISCONSIN STATUTES. IF YOU VIOLATE THE
7UNIFORM POWER OF ATTORNEY FOR FINANCES AND PROPERTY ACT IN
8CHAPTER 244 OF THE WISCONSIN STATUTES OR ACT OUTSIDE THE
9AUTHORITY GRANTED, YOU MAY BE LIABLE FOR ANY DAMAGES CAUSED
10BY YOUR VIOLATION.
11 IF THERE IS ANYTHING ABOUT THIS DOCUMENT OR YOUR DUTIES
12THAT YOU DO NOT UNDERSTAND, YOU SHOULD SEEK LEGAL ADVICE.
13 OPTIONAL SIGNATURE OF AGENT
14 I HAVE READ AND ACCEPT THE DUTIES AND LIABILITIES OF THE
15AGENT AS SPECIFIED IN THIS POWER OF ATTORNEY.
16 Agent's signature ....   Date ....
17 (APPENDIX FOLLOWS)
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