Wisconsin Basic Power Of Attorney For Finances And Property (Page 5 of 5) in pdf

Wisconsin Basic Power Of Attorney For Finances And Property Page 5

By signing as a witness, I am acknowledging the signature of the principal who signed in my presence and

the presence of the other witness; and the fact that he or she stated that this power of attorney reflects his or her

wishes and is being executed voluntarily. I believe him or her to be of sound mind and capable of creating this

power of attorney. I am not related to him or her by blood or marriage, and, to the best of my knowledge, I am not

entitled to any portion of his or her estate under his or her will.

Witness:

______________________________

Witness:

____________________________

Dated:

______________________________

Dated:

____________________________

By:

______________________________

By:

____________________________

Print Name:

______________________________

Print Name:

____________________________

Address:

______________________________

Address:

____________________________

State of Wisconsin

)

) ss

________________ County

)

This document was acknowledged before me this _______ day of ___________________________, _________, by

_____________________________________ (Name of Principal).

____________________________________________________

(Signature of Notary Officer)

My commission is permanent or expires: _____________________

BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE

FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND LIABILIES OF AN AGENT.

___________________________________________

(Name of Agent)

___________________________________________

(Signature of Agent)

Wisconsin Basic Power Of Attorney For Finances And Property Page 5