STATUTORY FORM POWER OF ATTORNEY
This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the Uniform Power of Attorney Act.
This power of attorney does not authorize the agent to make health-care decisions for you.
You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent's authority will continue until you die or revoke the power of attorney or the agent resigns or is unable to act for you.
Your agent is entitled to reasonable compensation unless you state otherwise in the Special Instructions.
This form provides for designation of one agent. If you wish to name more than one agent, you may name a co-agent in the Special Instructions. Co-agents are not required to act together unless you include that requirement in the Special Instructions.
If your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent.
This power of attorney becomes effective immediately, unless you state otherwise in the Special Instructions.
If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.
DESIGNATION OF AGENT
I, _________, with permanent residence address at _________, telephone number _________, and email address _________, name the following person as my agent:
Name of Agent: _________
Agent's Address: _________
Agent's Telephone Number: _________
Agent's Email Address: _________
DURABLE POWER OF ATTORNEY
GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in the Uniform Power of Attorney Act:
- Real Property Transactions, in accordance with section 30-5-5-2 of the Indiana Code.
- Tangible Personal Property Transactions, in accordance with section 30-5-5-3 of the Indiana Code.
- Bond, shares and commodity transactions, in accordance with section 30-5-5-4 of the Indiana Code.
- Retirement plans, in accordance with section 30-5-5-4.5 of the Indiana Code.
- Banking transactions, in accordance with section 30-5-5-5 of the Indiana Code.
- Business operation transactions, in accordance with section 30-5-5-6 of the Indiana Code.
- Insurance Transactions, in accordance with section 30-5-5-7 of the Indiana Code.
- Transfer on Death Transfers, in accordance with section 30-5-5-7.5 of the Indiana Code.
- Beneficiary Transactions, in accordance with section 30-5-5-8 of the Indiana Code.
- Gift Transactions, in accordance with section 30-5-5-9 of the Indiana Code.
- Fiduciary Transactions, in accordance with section 30-5-5-10 of the Indiana Code.
- Claims and Litigation, in accordance with section 30-5-5-11 of the Indiana Code.
- Family Maintenance, in accordance with section 30-5-5-12 of the Indiana Code.
- Benefits From Military Service, in accordance with section 30-5-5-13 of the Indiana Code.
- Records, Reports and Statements, in accordance with section 30-5-5-14 of the Indiana Code.
- Electronic Records, Reports and Statements, in accordance with section 30-5-5-14.5 of the Indiana Code.
- Estate Transactions, in accordance with section 30-5-5-15 of the Indiana Code.
- Health Care Powers; Religious Tenets; Funeral Planning Declaration, in accordance with section 30-5-5-16 of the Indiana Code.
- Consent to or Refusal of Health Care, in accordance with section 30-5-5-17 of the Indiana Code.
- Delegation of Authority, in accordance with section 30-5-5-18 of the Indiana Code.
- All other matters, in accordance with section 30-5-5-19 of the Indiana Code.
LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the Special Instructions.
My Agent is entitled to reasonable compensation for services rendered as my Agent.
My Agent is entitled to reimbursement for reasonable expenses incurred in acting under this Power of Attorney.
This power of attorney shall be effective immediately and will continue to be effective until my death, even if I became incapacitated, except as may be provided otherwise by an applicable state statute.
This Power of Attorney may be revoked or terminated by me at any time by providing written notice to the my Agent.
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows it has terminated or is invalid.
Dated ____________________, _____, at _________, Indiana.
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___________________________________ | _______________ |
_________ | Date |
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Address: _________
Telephone Number: _________
Email Address: _________
___________________________________ | _______________ |
_________ | Date |
We, _________ and _________, the witnesses, sign our name to the foregoing power of attorney being first duly sworn and do declare to the undersigned authority that the principal signs and executes this instrument as the principal's power of attorney and that the principal signs it willingly, or willingly directs another to sign for the principal, and that We, in the presence and hearing of each other, sign this power of attorney as witnesses to the principal's signing and that to the best of our knowledge the principal is eighteen years of age or older, of sound mind and under no constraint or undue influence.
_________________________________
_________
_________________________________
_________
IN WITNESS WHEREOF, I hereunto set my hand and seal at the City of _________ in the State of Indiana, this _______________ (date).
SIGNED, SEALED, AND DELIVERED in the presence of:
_________________________________ Witness Signature Witness Name: _________ Witness Address: _________ Witness Telephone Number: _________ _________________________________ Witness Signature Witness Name: _________ Witness Address: _________ Witness Telephone Number: _________ | | | _________________________________ _________ |
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State of Indiana
_________ County
Before me, a Notary Public for _________ County, State of Indiana, personally appeared _________ and acknowledged the execution of this instrument this _______________ (Date).
__________________________________
Notary Public
__________________________________
(print name)
My commission expires: _______________________________
IMPORTANT INFORMATION FOR AGENT
Agent's Duties
When you accept the authority granted under this power of attorney, a special legal relationship is created between you and the principal. This relationship imposes upon you legal duties that continue until you resign or the power of attorney is terminated or revoked. You must:
(1) Act for the benefit of the principal;
(2) Exercise all powers granted under the power of attorney in a fiduciary capacity;
(3) Keep complete records of all transactions entered into by the attorney in fact on behalf of the principal for six (6) years after the date of the transaction or until the records are delivered to the successor attorney in fact; and
(4) Render a written accounting if an accounting is ordered by a court or requested by the principal, a guardian appointed for the principal, a child of the principal, unless a court finds that such a rendering is not in the best interests of the principal, a person who jointly owns an account with the principal, or upon the death of the principal, the personal representative of the principal's estate or an heir or legatee of the principal.
Unless the Special Instructions in this power of attorney state otherwise, you must also:
(1) Avoid conflicts that would impair your ability to act in the principal's best interest;
(2) Act with care, competence, and diligence;
(3) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;
(4) Cooperate with any person that has authority to make health-care decisions for the principal to do what you know the principal reasonably expects or, if you do not know the principal's expectations, to act in the principal's best interest; and
(5) Attempt to preserve the principal's estate plan if you know the plan and preserving the plan is consistent with the principal's best interest.
Termination of Agent's Authority
You must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include:
(1) Death of the principal;
(2) The principal's revocation of the power of attorney or your authority;
(3) The occurrence of a termination event stated in the power of attorney;
(4) The purpose of the power of attorney is fully accomplished; or
(5) If you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal separation, unless the Special Instructions in this power of attorney state that such an action will not terminate your authority.
The meaning of the authority granted to you is defined in the Uniform Power of Attorney Act. If you violate the Uniform Power of Attorney Act or act outside the authority granted, you may be liable for any damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you should seek legal advice.