Power Of Attorney Form - Indiana printable pdf download

Power Of Attorney Form - Indiana

Indiana Power of Attorney

I ___________________________________________________________(name and address)

appoint:

____________________________________________________________(name and address)

As my agent (attorney-in-fact) to act for me in any lawful way with respect to the following

initialed subjects:

[____] Real Estate Transactions

[____] Stock and Bond Transactions

[____] Commodity and Option Transactions

[____] Tangible Personal Property Transactions

[____] Banking and Other Financial Institution Transactions

[____] Business Operating Transactions

[____] Insurance and Annuity Transactions

[____] Estate, Trust and Other Beneficiary Transactions

[____] Claims and Litigation

[____] Personal and Family Maintenance

[____] Benefits from Social Security, Medicare, Medicaid or Other Government Programs

[____] Retirement Plan Transactions

[____] Tax Matters, including any transactions with the Internal Revenue Service

[____] Decisions Regarding Lifesaving and Life Prolonging Medical Treatment.

[____] Decisions Relating to Medical Treatment, Surgical Treatment, Nursing Care, Medication,

Hospitalization, Institutionalization in a nursing home or other facility and home health care.

[____] Transfer of Property or Income as a Gift to the Principal’s Spouse for the purpose of

qualifying the principal for governmental medical assistance.

[____] All OF THE ABOVE POWERS, INCLUDING FINANCIAL AND HEALTH CARE DECISIONS.

Go to for more free business forms

Power Of Attorney Form - Indiana