Power Of Attorney Worksheet Page 3

ADVERTISEMENT

6.
INSURANCE
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
Item(s) to be Insured: ______________________________ Insurance Company: __________________________________
7.
MAIL
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
8.
MILITARY HOUSING
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
Please choose the power(s) you wish to grant to your agent with respect to military housing:
Accept Quarters
Vacate Quarters
Location to Accept Quarters:
_________ Location to Vacate Quarters:
9.
PERSONAL PROPERTY (INCLUDES AUTOMOBILE)
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
Please choose the powers with respect to personal property that you give to your agent:
Use/Maintain Auto
Register Auto in State of: ____
Purchase Auto (for no more than): ________
Sell Auto (for no less than): _______
Provide applicable auto info: Year: _______ Make: ___________ Model: ______________ License Plate #: _______________
VIN#: ____________________________________________ Registration State: _______ Insurance Co/Policy#:______________________________
)
Use/Maintain Personal Property
Purchase Personal Property (for no more than: $________
Sell Personal Property (for no less than: $_______
Make Claim for Damage/Loss
Mail (Rec/Fwd) Describe Personal Property to be Purchased or Sold: ____________________________________
_____________________________________________________________________________________________________________________
10.
PET CARE
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
Pet Information: Name: ________________ Species/Breed: _____________ Gender: _________ Max $ Amount for Vet: _______ Vet Name: ___________________
Vet Address _____________________Vet Phone # _________________ Emergency Vet Clinic Allowed (Y/N)? (if Emergency Vet differs from Regular Vet have, contact info) __
11.
REAL ESTATE (***NOTE: CUSTOMER MUST REVIEW SPOA REAL ESTATE PRIMER BEFORE RECEIVING SPOA***)
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
Type of Property:
House/Condo/or other Structure
Land Only
Please choose the power(s) you wish to grant to your agent with respect to real estate.
Buy (for not more than):
Purchase County: ______
Sell (for no less than):
Manage/Lease ($______/month for ___months)/Settle Claims
NOTE: If you are choosing one of the powers listed in this box, you MUST see an attorney before executing your POA
Refinance
Loan Modification
Bankruptcy
Short Sale
Deed-in-Lieu of Foreclosure
Address of Real Estate:
If applicable: Max Interest Rate for Loan:
Fixed or Variable Interest Rate:
Type of Loan (VA, FHA, etc.):
Loan #: ____________
12.
CUSTOM POA (
Provide description of a required POA not listed above):
Person receiving POA (Last, First, Middle): _________________________________________________________
Address: _______________________________________________________________ Desired expiration date for POA (
): ______________
Limited to one year
Your Signature ___________________________________________________ Date: ___________
Revised Nov 2014
OJAG Code 16
Mandatory Use
3

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Power Of Attorney Worksheet Power Of Attorney Worksheet Legal
Power Of Attorney Worksheet Power Of Attorney Worksheet Legal
Power Of Attorney New York Statutory Short Form/power Of Attorney New York Statutory Major Gifts Rider Authorization To Make Major Gifts Or Other Transfers Form Power Of Attorney New York Statutory Short Form/power Of Attorney New York Statutory Major Gifts Rider Authorization To Make Major Gifts Or Other Transfers Form Legal
Power Of Attorney - General With Durable Power Of Attorney Form Power Of Attorney - General With Durable Power Of Attorney Form Legal
Power Of Attorney Guidelines And Special Power Template Power Of Attorney Guidelines And Special Power Template Legal
Power Of Attorney Delegating Parent's Power Over Minor Child Power Of Attorney Delegating Parent's Power Over Minor Child Legal
Power Of Attorney Delegating Parental Power Power Of Attorney Delegating Parental Power Legal
Power Of Attorney Delegating Parental Powers - Ada County Power Of Attorney Delegating Parental Powers - Ada County Legal
Power Of Attorney Form Delegating Parental Powers Power Of Attorney Form Delegating Parental Powers Legal
Power Of Attorney And Declaration Of Representative Form - Employment Security Commission Of North Carolina Power Of Attorney And Declaration Of Representative Form - Employment Security Commission Of North Carolina Legal

Related Categories

Parent category: Legal
Download
Go
Page of 4