The Illinois Statutory Short Form Power Of Attorney For Property (Page 4 of 8) in pdf

(NOTE: If you wish to, you may name your agent as guardian of your estate if a court decides that one

should be appointed. To do this, retain paragraph 9, and the court will appoint your agent if the court

finds that this appointment will serve your best interests and welfare. Strike out paragraph 9 if you do

not want your agent to act as guardian.)

If a guardian of my estate (my property) is to be appointed, I nominate the agent acting under this

power of attorney as such guardian, to serve without bond or security.

10.

I am fully informed as to all the contents of this form and understand the full import of this grant

of powers to my agent.

(NOTE: This form does not authorize your agent to appear in court for you as an attorney-at-law or

otherwise to engage in the practice of law unless he or she is a licensed attorney who is authorized to

practice law in Illinois.)

11.

The Notice to Agent is incorporated by reference and included as part of this form.

DATE: ___________________

__________________________________________

PRINCIPAL

(NOTE: This power of attorney will not be effective unless it is signed by at least one witness and your

signature is notarized, using the form below. The notary may not also sign as a witness.)

The undersigned witness certifies that __________________________, known to me to be the same

person whose name is subscribed as principal to the foregoing power of attorney, appeared before me and

the notary public and acknowledged signing and delivering the instrument as the free and voluntary act of

the principal, for the uses and purposes therein set forth. I believe him or her to be of sound mind and

memory. The undersigned witness also certifies that the witness is not: (a) the attending physician or

mental health service provider or a relative of the physician or provider; (b) an owner, operator, or

relative of an owner or operator of a health care facility in which the principal is a patient or resident; (c)

a parent, sibling, descendant, or any spouse of such parent, sibling, or descendant of either the principal or

any agent or successor agent under the foregoing power of attorney, whether such relationship is by

blood, marriage, or adoption; or (d) an agent or successor agent under the foregoing power of attorney.

DATE: ___________________

__________________________________________

WITNESS

(NOTE: Illinois requires only one witness, but other jurisdictions may require more than one witness. If

you wish to have a second witness, have him or her certify and sign below.)

(SECOND WITNESS) The undersigned witness certifies that _______________________, known to me

to be the same person whose name is subscribed as principal to the foregoing power of attorney, appeared

before me and the notary public and acknowledged signing and delivering the instrument as the free and

voluntary act of the principal, for the uses and purposes therein set forth. I believe him or her to be of

sound mind and memory. The undersigned witness also certifies that the witness is not: (a) the attending

physician or mental health service provider or a relative of the physician or provider; (b) an owner,

operator, or relative of an owner or operator of a health care facility in which the principal is a patient or

resident; (c) a parent, sibling, descendant, or any spouse of such parent, sibling, or descendant of either

the principal or any agent or successor agent under the foregoing power of attorney, whether such

Page 4 of 8: ILLINOIS STATUTORY SHORT FORM POWER OF ATTORNEY - PROPERTY

The Illinois Statutory Short Form Power Of Attorney For Property Page 4