Official Durable Power Of Attorney Form Page 2
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9V. PRINCIPAL - I,
, residing at
Name of Principal
Street Address of Principal
City of
, State of
, appoint
City of Principal
State of Principal
the following as my Attorney-in-Fact, whom I trust with any and all my
financial decision making power immediately upon the authorization of this
form, and in the event that I should become incapacitated:
VI. ATTORNEY-IN-FACT -
, residing at
Name of Attorney-in-Fact
Street Address of Attorney-in-Fact
City of
, State of
grant
City of Attorney-in-Fact
State of Attorney-in-Fact
the Attorney-in-Fact the legal authority to act on my behalf for any power legal
under law in regard to my financial decisions under the State of
.
State
VII. SUCCESSOR ATTORNEY-IN-FACT (Optional) – If the Attorney-in-Fact named
above cannot or is unwilling to serve, then I appoint
,
Name of Successor Attorney-in-Fact
residing at
Street Address of Successor Attorney-in-Fact
City of
, State of
grant
City of Successor Attorney-in-Fact
State of Successor Attorney-in-Fact
the Attorney-in-Fact the legal authority to act on my behalf for any power legal
under law in regard to my financial decisions under the State of
.
State
VIII. TERMS & CONDITIONS – Upon authorization by all parties, the Attorney-in-
Fact accepts their designation to act in the Principal’s best interests for all
financial decisions legal under law.
TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS,
INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING.TO WITHHOLD
A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT
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