AB75-SSA1,1340,55 (Your Signature)
AB75-SSA1,1340,6
AB75-SSA1,1340,77 ....
AB75-SSA1,1340,88 (Your Social Security Number)
AB75-SSA1,1340,159 By signing as a witness, I am acknowledging the signature of the principal who
10signed in my presence and the presence of the other witness, and the fact that he or
11she has stated that this power of attorney reflects his or her wishes and is being
12executed voluntarily. I believe him or her to be of sound mind and capable of creating
13this power of attorney. I am not related to him or her by blood, marriage or adoption,
14and, to the best of my knowledge, I am not entitled to any portion of his or her estate
15under his or her will.
AB75-SSA1,1340,16 16Witness Witness
AB75-SSA1,1340,1717 Dated: ....   Dated: ....
AB75-SSA1,1340,1818 Signature: ....  Signature: ....
AB75-SSA1,1340,1919 Print Name: .... Print Name: ....
AB75-SSA1,1340,2020 Address: .... Address: ....
AB75-SSA1,1340,2121 State of ....
AB75-SSA1,1340,2222 County of ....
AB75-SSA1,1340,2423 This document was acknowledged before me on .... (date) by .... (name of
24principal).
AB75-SSA1,1340,25
AB75-SSA1,1340,26
1....
AB75-SSA1,1341,22 (Signature of Notarial Officer)
AB75-SSA1,1341,33 (Seal, if any)
AB75-SSA1,1341,44 (Title)
AB75-SSA1,1341,55 [My commission is permanent or expires: .... ]
AB75-SSA1,1341,86 BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT
7ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND
8LIABILITIES OF AN AGENT.
AB75-SSA1,1341,99 ....
AB75-SSA1,1341,1010 (Name of Agent)
AB75-SSA1,1341,11
AB75-SSA1,1341,1212 ....
AB75-SSA1,1341,1313 (Signature of Agent)
AB75-SSA1,1341,1514 This document was drafted by .... (signature of person preparing the
15document).
AB75-SSA1, s. 2506 16Section 2506. 243.10 (7) (b) of the statutes is amended to read:
AB75-SSA1,1341,2517 243.10 (7) (b) A principal may revoke a Wisconsin basic power of attorney for
18finances and property and invalidate it at any time by destroying it, by directing
19another person to destroy it in the principal's presence or by signing a written and
20dated statement expressing the principal's intent to revoke. If the agent under the
21Wisconsin basic power of attorney for finances and property is the principal's spouse
22and the marriage is annulled, or the agent and principal are divorced, or the agent
23is the principal's domestic partner under ch. 770 and the domestic partnership is
24terminated under s. 770.12,
after signing the document, the Wisconsin basic power
25of attorney for finances and property is invalid.
AB75-SSA1, s. 2506r
1Section 2506r. 250.03 (3) (b) of the statutes is amended to read: