Form F-00036 - Designation Of Agent

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State of Wisconsin
Department of Health Services
This Power of Attorney for Finances form allows you to plan for future financial decision-making even if you
1
are unable to make your own decisions. More information is available to assist you in filling out this form
.
This form is not the answer for everyone. Only select someone you trust to be your agent. You may wish
to consult with an attorney to explore other financial planning tools such as a Power of Attorney for
Finances drafted by an attorney, or special accounts or trusts.
This is an important legal document. Do not sign it until you, and your chosen agent, understand the
powers being granted. By signing this document, you are not giving up any powers or rights to control your
finances or property. Instead, you are giving your agent, in addition to yourself, the authority to handle your
finances and property. While it is not required that you sign this document in the presence of a notary,
acknowledged signatures create a lawful presumption of genuineness and will be more easily accepted by
businesses and financial institutions.
This document is effective immediately when executed unless you state a future date or occurrence that will
activate the powers expressed in this form.
This Power of Attorney for Finances is “durable” (does not terminate upon the principal’s incapacity) unless
you specifically state that it terminates if you become incapacitated.
If you name your spouse or domestic partner as your agent and the marriage or domestic partnership is
terminated (annulment or divorce), this document becomes invalid unless the special instructions in this
document state that such an action will not terminate the authority given to the agent.
If you used a former state Power of Attorney for Finances form, that form is still valid. Executing a new
Power of Attorney for Finances does not, automatically, revoke a prior document.
If you wish to change this Power of Attorney for Finances in the future, you must complete a new document
and revoke this one. You may revoke this document at any time; a suggested method is a written and
dated statement expressing your intent to revoke this document. If you revoke this document, you should
notify your agent and any other persons or entities that have a copy.
In general, an agent who is not the principal’s spouse or domestic partner may not use the principal’s
property for the benefit of the agent or a person to whom the agent owes an obligation of support. Gifting to
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others is also generally not allowed
.
Your agent is entitled to reasonable compensation unless you state otherwise in the special instructions.
This document does not give your agent the power to make medical, long-term care or other health care
decisions for you.
Once your Power of Attorney for Finances form is completed and signed, send a copy of this document to
your financial contacts (e.g. your bank, stockbroker, mortgage company, insurance agent, etc.) Give a copy
to your agent and alternate agents as well as to trustworthy family members and/or to your attorney. Finally
place a copy in a safe place in your home along with a list of who has a copy of the document.
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Coalition of Wisconsin Aging Groups: Guardianship Support Center ( )
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For more information on gifting, see Wis. Stats. §244.57
Wisconsin.gov

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