Power of Attorney Sample

A power of attorney allows your agent to handle your important affairs for you.

This document is also known as Letter of Attorney.

A POA is a written document in which a person (grantor, principal, or donor) authorizes another person (the agent, attorney-in-fact, or donee) to represent or act on his or her behalf in business issues, private affairs, or other legal matter.

This document is also known as Letter of Attorney.

TYPES OF POA: Blank, General, Specific or Limited, Durable or Enduring, Springing, Financial, Medical, Real Estate.

Not all states require the P.O.A. to be notarized. A notary's seal and signature is used to attest to the fact that the person named in the document is the same person who has signed it. In the US a notary stamp is accepted anywhere, no matter which state the notarization has taken place. Notaries can be found at any courthouse, lawyers offices, car lots, and public offices with notary services.

The power or letter of attorney form below (POA) is just an example. It is not intended to cover all or any legal requirements of one's jurisdiction or legal issues. It is crucial that you consult an attorney to obtain the proper legal advice, assistance and directions on filing legal forms for your specific case correctly, and in order for the document to be legally suitable and effective.

Creating a power of attorney (POA) form involves careful consideration of your specific needs and local legal requirements. Below is a general template for a durable power of attorney form, but it is essential to consult with a legal professional to ensure it complies with your jurisdiction's laws.


I. Principal Information: Full Legal Name of Principal: ______________________________________
Address: ______________________________________________________
City, State, ZIP: ________________________________________________
Contact Number: _______________________________________________
II. Agent Information: Full Legal Name of Agent: ________________________________________
Address: ______________________________________________________
City, State, ZIP: _______________________________________________
Contact Number: ______________________________________________
III. Powers Granted: A. Financial Powers: - Manage bank accounts, investments, and financial transactions. - Buy, sell, or manage real estate. - Handle tax matters. - Operate businesses on behalf of the principal. B. Healthcare Powers: - Make medical decisions, including treatment options and procedures. - Access medical records. - Decide on admission to or discharge from medical facilities. C. Additional Powers (Specify):
IV. Special Instructions or Limitations: [Include any specific instructions or limitations on the powers granted, if applicable.] V. Duration and Termination: This power of attorney is effective from [Start Date] and shall remain effective notwithstanding the principal's subsequent incapacity. The principal reserves the right to revoke or amend this power of attorney in writing. VI. Witnesses: Principal's Signature: _____________________________
Date: ___/___/______
Witness 1: Full Name: ________________________________________________
Signature: ________________________________________________
Date: ___/___/______
Witness 2: Full Name: ________________________________________________
Signature: ________________________________________________
Date: ___/___/______

POA with Notary:


Made this _________day of ____________________ (month) of ____________ (year)


I,_______________________________________ (insert name and address of principal)

hereby appoint:

_________________________________________ (insert name and address of person appointed)

as my true and lawful agent (attorney-in-fact) to have full power and authority to act on my behalf in any lawful way with respect to the following:

________________________________________________________ ________________________________________________________ (Personal and Family Issues, Real State Transactions, Stocks and Bonds Transactions, Banking and Other Financial Institutions, Business Transactions, Tax Matters, Insurance and Annuity, Claims and Litigations, State, Trust and Other Beneficiary, Retirement Plan, Social security, Medicaid, Medicare, Governament programs or Military Services Benefits)

And all matter pertaining to: ________________________________________________________ ________________________________________________________

I aknowledge and agree that my attorney in fact binds me to all terms, obligations and conditions associated with this form, including repayment obligations.

I understand that my attorney-in-fact may act for me until this power of attorney is revoked or terminated.

I confirm tha both my attorney-in-fact and I are at least 18 years of age.

The agent (attorney-in-fact) IS/IS NOT entitled to compensation for acting persuant to this power of attorney in the amount of $____________ Month/Year.

IN WITNESS WHEREOF, I have hereunto set my hand and seal this _______ day of _______________________, 20____.

Signed, sealed and delivered in the presence of:

______________________________ ___________________________
Witness - 1

______________________________ ___________________________
Witness - 2

State of _____________ )
) ss.
County of ____________ )

The foregoing instrument was acknowledged by me this ______ day of _____________, 20 ____ by:_______________________________ who is/are personally known by me or who has/have produced:_____ ______________________ as identification and who did not take an oath.

________________________________ Notary Public State of ___________________ My Commission Expires: ___/___/___

Notary Seal:

Although POA's can be oral, a written form is required by some Jurisdictions Courts, The Internal Revenue Services, Hospitals and Banks, in order to keep a copy of the original document for their records.

Please note that this template is a general guide, and the language and requirements may vary depending on your jurisdiction. It is crucial to seek legal advice to ensure that the power of attorney form is valid and complies with local laws.

Alabama, Arkansas, Alaska, Arizona, California, Colorado, Delaware, Connecticut, Florida, Georgia, Hawaii, Indiana, Illinois, Iowa, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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