Limited Power of Attorney for Finances

Use this simple form to give someone you trust authority to act on your behalf. You can use it for any specific, clearly defined task involving your finances.

Do not use this form if you live in Louisiana or New York, or if you want to create a durable power of attorney.

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See below the form for a full product description.

 

Grant of Authority

I, , (principal) of , appoint  (attorney-in-fact or agent) to act in my place for the purposes of: .

I grant my attorney-in-fact full authority to act in any manner both proper and necessary to the exercise of the foregoing powers, and I ratify every act that my attorney-in-fact may lawfully perform in exercising those powers.

Effective Date and Term

This power of attorney takes effect on  and shall continue until I terminate it in writing or until , whichever comes first. This power of attorney shall terminate immediately if I die or become incapacitated.

Reliance by Third Parties

I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney.

 

Signature: ________________________________, Principal

Date: ____________________________________
State of __________________, County of ___________________

Multiple Selection
Label Contract Text

witnesses will sign

Alternate Selection
Label Contract Text
one witness
Witness
On the date written above, the principal declared to me that this instrument is his or her financial power of attorney and that he or she willingly executed it as a free and voluntary act. The principal signed this instrument in my presence.

Signature: ________________________________
Print Name: ______________________________
Address: _________________________________

two witnesses

Witnesses
On the date written above, the principal declared to us that this instrument is his or her financial power of attorney and that he or she willingly executed it as a free and voluntary act. The principal signed this instrument in our presence.

Signature: ________________________________
Print Name: ______________________________
Address: _________________________________

Signature: ________________________________
Print Name: ______________________________
Address: _________________________________

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Certificate of Acknowledgment of Notary Public

State of _____________________________________________    )

                                                                                                            )           ss

County of ___________________________________________     )

 

On _______________ before me, _________________________________________ (here insert name and title of the officer) personally appeared _______________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of ___________ that the foregoing paragraph is true and correct.

                                                            WITNESS my hand and official seal.

                                                            _____________________________________

                                                            Notary Public for the State of ______________

                                                            My commission expires __________________

[NOTARY SEAL]

 

Multiple Selection
Label Contract Text
attorney-in-fact will sign
Alternate Selection
Label Contract Text
Vermont acknowledgment 

Acknowledgment of Vermont Agent

I accept appointment as agent. I understand my duties under this power of attorney and under the law. I understand that I have a duty to act if expressly required to do so in the power of attorney consistent with subsection 3506(c) of Title 14 of the Vermont Statutes. I understand that I am expected to use my special skills or expertise on behalf of the principal, if the expectation that I do so is expressly provided for in the power of attorney consistent with subdivision 3505(a) of Title 14 of the Vermont Statutes.

Signature: ___________________________________
Agent: 
Date: _______________________________________

acknowledgment for all other states

Acknowledgment of Attorney-in-Fact

By accepting or acting under the appointment, I assume the fiduciary and other legal responsibilities and liabilities of an agent. I understand that I owe a duty of loyalty and good faith to the principal and must use the powers granted to me only for the benefit of the principal. I acknowledge that my authority to act on behalf of the principal ceases at the death of the principal.

Signature: ___________________________________
Attorney-in-Fact: 
Date: _______________________________________

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