AB75-ASA1,1339,117
TO ESTABLISH WHEN, AND FOR HOW LONG, THE BASIC POWER OF
8ATTORNEY FOR FINANCES AND PROPERTY IS IN EFFECT, YOU MUST
9INITIAL ONLY ONE OF THE FOLLOWING 3 OPTIONS. IF YOU DO NOT
10INITIAL ONE, OR IF YOU INITIAL MORE THAN ONE, THIS BASIC POWER OF
11ATTORNEY FOR FINANCES AND PROPERTY WILL NOT TAKE EFFECT.
AB75-ASA1,1339,1513
_____ This basic power of attorney for finances and property becomes effective
14when I sign it and will continue in effect as a durable power of attorney under section
15243.07, Wisconsin Statutes, if I become disabled or incapacitated.
AB75-ASA1,1339,1716
_____ This basic power of attorney for finances and property becomes effective
17only when both of the following apply:
AB75-ASA1,1339,1919
b. I become disabled or incapacitated.
AB75-ASA1,1339,2220
_____ This basic power of attorney for finances and property becomes effective
21when I sign it
but will cease to be effective if I become disabled
22or incapacitated.
AB75-ASA1,1340,223
I agree that any 3rd party who receives a copy of this document may act under
24it. Revocation of this basic power of attorney is not effective as to a 3rd party until
25the 3rd party learns of the revocation. I agree to reimburse the 3rd party for any loss
1resulting from claims that arise against the 3rd party because of reliance on this
2basic power of attorney.
AB75-ASA1,1340,33
Signed this .... day of ...., (year)
AB75-ASA1,1340,88
(Your Social Security Number)
AB75-ASA1,1340,159
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-ASA1,1340,1818
Signature: .... Signature: ....
AB75-ASA1,1340,1919
Print Name: .... Print Name: ....
AB75-ASA1,1340,2020
Address: .... Address: ....
AB75-ASA1,1340,2423
This document was acknowledged before me on .... (date) by .... (name of
24principal).