Power of Attorney

Who is this Power of Attorney being created for?

* Indicates required field

Name *

First

Last

Address *

City *

State *

Zip Code *

Email *

Where will this Power of Attorney be Signed

City *

County *

State *

Who will be appointed as Agent to act on your behalf

You can select a sole Agent or Co-Agents who will act on your behalf. A "Co-Agent" means you select two agents to serve. If you select Co-Agents, you'll be asked later whether they can act independently of each other or whether they must act jointly. *

A Sole Agent Co-Agents

Who are you appointing as your Co-Agent to act on your behalf?

Name *

First

Last

Address *

City *

State *

Zip Code *

Phone Number *

If you selected Co-Agent, put Agent #2 Information Below

Name (Agent #2) *

First

Last

Address *

City *

State *

Zip Code *

Phone Number *

Do you want this Power of Attorney to replace any prior Power of Attorney documents you've used in the past? Replacing a prior Power of Attorney will "revoke" or cancel the terms of any prior Power of Attorney document. *

Yes No

Will any prior healthcare Power of Attorney documents remain in effect? *

Yes No

Would you like your Agent to act on your behalf in all situations or only in specific situations? *

All Situations Specific Situations

Do you want your Agent to have access to your medical records? *

Yes No

Will your Agent be authorized to hire business professionals to help with Agent's duties? *

Yes No

Will your Agent have access to your bank accounts? *

Yes No

What bank accounts will your Agent have authority over? *

All Bank Accountns Specific Bank Accounts

Which of the following powers will your Agent be granted? *

Handle treasury securities Begin or defend lawsuits Access Safe Deposit Boxes

Will your Agent be authorized to remove items from your safe deposit boxes or only take inventory? *

The Agent may remove items The Agent may only inventory the items

Will your Agent be allowed to sell real estate that you own? *

Yes No

Who will be appointed as substitute Agent to handle your real estate?

In case your spouse is restricted from selling your residence, name a substitute Agent for that purpose.

Name *

First

Last

City *

State *

Will your Agent be allowed to mortgage your real estate? *

Yes, and this document will be signed in an attorney's office Yes, and this document will be signed in a title company's office No

Will your Agent be allowed to sell your personal property? *

Any Property Only Specific Property

Will your Agent be authorized to obtain credit or borrow money on your behalf? *

Yes No

Will your Agent be authorized to manage any business that you own? *

Yes No

Will your Agent be authorized to handle governmental matters for you? *

Yes No

If Yes, What governmental matters will your Agent be authorized to handle? *

Prepare and file tax returns Negotiate matters with governmental agencies Handle issues in connection with governmental benefits

Will your Agent be authorized to handle any financial matters for you? *

Yes No

Select the financial matters your Agent will be authorized to manage.

What financial matters do you want your Agent to manage? *

Will your Agent have the power to change the beneficiaries on your accounts? *

Yes No

Are you currently a fiduciary or trustee? *

Yes No

Will your Agent be allowed to make gifts on your behalf? *

Yes No

Will your Agent have the authority to use your assets to provide for any person to whom you have an obligation to support? *

Yes No

Will your Agent be allowed to transfer assets into your revocable trust? *

Yes No

Will your Agent be allowed to manage a trust on your behalf? *

Yes No

Will your Agent be allowed to refuse any inheritance you might receive? *

Yes No

Will your Agent be entitled to receive compensation for services performed in connection with this Power of Attorney? *

Yes No

Will your Agent be entitled reimbursement for reasonable expenses? *

Yes No

If you have Co-Agents, May the Co-Agents act independently of each other? *

Each Agent may act independently, without the consent of the other AgentOption 1 Both Agents must act jointly, with the consent of the other Agent

Would you like to appoint an agent (Digital Agent) to manage your digital assets? *

Yes No

If Yes, What are the digital Assets?

Provide identifying information regarding your digital asset, such as website or account name, etc. Provide any relevant information your Digital Agent may need to access your digital asset. For example: Gmail account, www.gmail.com, username: kathleenjparker, password: kjparker, save all my emails and close email account. Enter each digital asset separately. You will be able to enter as many as you need.

Name of Asset, Where to Access, Username, Password *

You can select a sole Digital Agent, Co-Digital Agents, or the same Agent who handles your other affairs to act on your behalf.

Who will be appointed as Digital Agent to manage your digital assets on your behalf? *

The same Agent(s) appointed in this Power of Attorney to handle my other affairs Sole Digital Agent Co- Digital Agents

Do you want to make this document a Durable Power of Attorney? *

Yes No

When will would this Power of Attorney become effective? *

Immediately (upon signing) On specific date Upon certification by a physician that you are disabled or lack mental competence (a "springing" Power of Attorney)

When will this Power of Attorney terminate? *

Upon your death On specific date

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