_____________, the “principal,” of ___________, _______, herewith appoints ______________ of ______________, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to do the following acts:

To conduct any and all business regarding my deposit accounts, loans, safe deposit box, or other banking business in regard to the _______________________, of ____________________. This power shall specifically include, but is not limited to the right to deposit, withdraw, sign checks or drafts, make stop payment orders, and to conduct any banking transactions necessary or possible in regard to my banking relationship with the __________________________.

To execute a deed or other instrument of conveyance conveying my interest in the following real property:
________________________________________________________________

To examine and to order copies of any and all of my educational records, including both financial and student loan and health related records, at the following college, school or other educational institution:
__________________________ of _______________ and any branches thereof.

To represent me before the Internal Revenue Service in regard to the following taxable years and returns:
Forms: ____________    Years: _____________

This power of attorney shall be in effect from _______________ to _________________.

_____________________________________________________
_____________________, As Principal

STATE OF ______________
COUNTY OF _____________

_____________ personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.

Dated: _______________________________

__________________________________________
Notary Public
My Commission Expires:

Power of Attorney, Financial Matters
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This Power of Attorney is restricted to financial matters.  Read up on the other commentary about Power of Attorney issues.  This is a serious matter.  If you have any doubts, don’t appoint the person.

1. Make multiple copies.  Give one to each interested party.  Keep a list of who has copies so you can retrieve them if you decide at a later date to revoke these powers.
2. One way to restrict a Power of Attorney is simply to put in an automatic termination date.  Then you have to renew in order to have it remain in force and makes it less likely someone can challenge a termination successfully at a later time since you anticipated it in this document.

_____________, the “principal,” of ___________, _______, herewith appoints ______________ of ______________, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to do the following acts:

To conduct any and all business regarding my deposit accounts, loans, safe deposit box, or other banking business in regard to the _______________________, of ____________________. This power shall specifically include, but is not limited to the right to deposit, withdraw, sign checks or drafts, make stop payment orders, and to conduct any banking transactions necessary or possible in regard to my banking relationship with the __________________________.

To execute a deed or other instrument of conveyance conveying my interest in the following real property:
________________________________________________________________

To examine and to order copies of any and all of my educational records, including both financial and student loan and health related records, at the following college, school or other educational institution:
__________________________ of _______________ and any branches thereof.

To represent me before the Internal Revenue Service in regard to the following taxable years and returns:
Forms: ____________    Years: _____________

This power of attorney shall be in effect from _______________ to _________________.

_____________________________________________________
_____________________, As Principal

STATE OF ______________
COUNTY OF _____________

_____________ personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.

Dated: _______________________________

__________________________________________
Notary Public
My Commission Expires:

Power of Attorney, Financial Matters
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This Power of Attorney is restricted to financial matters.  Read up on the other commentary about Power of Attorney issues.  This is a serious matter.  If you have any doubts, don’t appoint the person.

1. Make multiple copies.  Give one to each interested party.  Keep a list of who has copies so you can retrieve them if you decide at a later date to revoke these powers.
2. One way to restrict a Power of Attorney is simply to put in an automatic termination date.  Then you have to renew in order to have it remain in force and makes it less likely someone can challenge a termination successfully at a later time since you anticipated it in this document.

Taxpayer(s) name, identifying number, and address including ZIP code:
____________________________
____________________________
____________________________
____________________________

hereby appoints (names(s), CAF number(s), address (es), including ZIP code(s), and telephone numbers:
____________________________
____________________________
____________________________
____________________________
____________________________

as attorney(s)-in-fact to represent the taxpayer(s) before any office of the Internal Revenue Service for the following tax matter(s) (specify the type(s) of tax and year(s) or period(s) (date of death if estate tax):
Type of tax: _________________
Federal tax number: __________
Year(s) or period(s) _________
Date of death if estate tax: _____

The attorney(s)-in-fact (or either of them) are authorized, subject to revocation, to receive confidential information and to perform and any all acts that the principal(s) can perform with respect to the above specified tax matters (excluding the power to receive refund checks, and the power to sign the return (see regulations section 1.6012-1(a)(5), Returns made by agents), unless specifically granted below.)

Send copies of notice and other written communications addressed to the taxpayer(s) in proceedings involving the tax matters to:
the appointee first named above

Taxpayer initial here: _________________ if you are granting the power to receive, but not to endorse or cash, refund checks for the above tax matters to:
the appointee first named above

This power of attorney revokes all earlier powers of attorney and tax information authorizations on file with the Internal Revenue Service for the same tax matters and years or periods covered by this power of attorney, except the following:
__________________________________________________________________

Signature of or for taxpayer(s):
(If signed by a corporate officer, partner, or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this power of attorney on behalf of the taxpayer.)

________________________________________________
Signature

________________________________________________
Title

Date:    ___________________________

If the power of attorney is granted to a person other than an attorney, certified public accountant, enrolled agent, or enrolled actuary, the taxpayer(s) signature must be witnesses or notarized below. (The representative must complete Part II. Only representative listed there are recognized to practice before the Internal Revenue Service.

The persons signing as or for the taxpayer(s) (Check and complete one):
______ is/are known to and signed in the presence of the two disinterested witnesses whose signatures appear here:

_______________________________________________
Signature of Witness
Date:    ___________________

_______________________________________________
Signature of Witness
Date:    ___________________

__________ appeared this day before a notary public and acknowledged this power of attorney as a voluntary act and deed.

_______________________________________________
Witness (Signature of notary)

PART II
I declare that I am not currently under suspension or disbarment form practice before the Internal Revenue Service, that I am aware of Treasury Department Circular No. 230 as amended (31 C.F.R. Part 10), Regulations governing the practice of attorneys, certified public accountants, enrolled agents, enrolled actuaries, and others, and that I am one of the following:
1 a member in good standing of the bar of the highest court of the jurisdiction indicated below;
2 duly qualified to practice as a certified public accountant in the jurisdiction indicated below;
3 enrolled as an agent pursuant to the requirements of Treasury Department Circular No. 230;
4 a bona fide officer of the taxpayer organization;
5 a full-time employee of the taxpayer;
6 a member of the taxpayer’s immediate family (spouse, parent, child, brother or sister);
7 a fiduciary for the taxpayer;
8 an enrolled actuary (the authority of an enrolled actuary to practice before the Service is limited by section 10.3(d)(1) of Treasury Department Circular No. 230);
9 Commissioners special authorization (see instructions for Part II, item 9) _________________________________________;
and that I am authorized to represent the taxpayer identified in Part I for the tax matters there specified.

Designation   Jurisdiction       Signature            Date

Power of Attorney and Declaration of Representative
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This document is required for the Internal Revenue Service, should you want someone properly qualified to represent you at any meetings with them.  A qualified representative will furnish you with the latest IRS document.  This is representative of the information that must be provided.

I, __________________(“Declarant”), residing at __________________________, hereby appoint _____________________ (“Agent”) of _______________________, as my attorney-in-fact (“Agent”) to exercise the powers and discretions described below.

If the Agent is unable or unwilling to serve for any reason, I appoint ________________ (“Alternate Agent”), of _______________________________, as my alternate or successor Agent, as the case may be to serve with the same powers and discretions.

I hereby revoke any and all general powers of attorney and special powers of attorney that previously have been signed by me.  However, the preceding sentence shall not have the effect of revoking any powers of attorney that are directly related to my health care that previously have been signed by me.

My Agent shall have full power and authority to act on my behalf.  This power and authority shall authorize my Agent to manage and conduct all of my affairs and to exercise all of my legal rights and powers, including all rights and powers that I may acquire in the future.  My Agent’s powers shall include, but not be limited to, the power to:

1.  Open, maintain or close bank accounts (including, but not limited to, checking accounts, savings accounts, and certificates of deposit), brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions.

a.   Conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments with respect to any such accounts, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation or political entity.

b.   Perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities.

c.    Have access to any safe deposit box that I might own, including its contents.

2.   Sell, exchange, buy, invest, or reinvest any assets or property owned by me.  Such assets or property may include income producing or non-income producing assets and property.

3.   Purchase and/or maintain insurance and annuity contracts, including life insurance upon my life or the life of any other appropriate person.

4.   Take any and all legal steps necessary to collect any amount or debt owed to me, or to settle any claim, whether made against me or asserted on my behalf against any other person or entity.

5.    Enter into binding contracts on my behalf.

6.   Exercise all stock rights on my behalf as my proxy, including all rights with respect to stocks, bonds, debentures, commodities, options or other investments.

7.    Maintain and/or operate any business that I may own.

8.    Employ professional and business assistance, as may be appropriate, including attorneys, accountants, and real estate agents, for my personal or business affairs.

9.   Sell, convey, lease, mortgage, manage, insure, improve, repair, or perform any other act with respect to any of my property (now owned or later acquired) including, but not limited to, real estate and real estate rights (including the right to remove tenants and to recover possession).  This includes the right to sell or encumber any homestead that I now own or may own in the future.

10. Prepare, sign, and file documents with any governmental body or agency, including, but not limited to, authorization to:

a.  Prepare, sign and file income and other tax returns with federal, state, local, and other governmental bodies.

b.  Obtain information or documents from any government or its agencies, and represent me in all tax matters, including the authority to negotiate, compromise, or settle any matter with such government or agency.

c.  Prepare applications, provide information, and perform any other act reasonably requested by any government or its agencies in connection with governmental benefits (including medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my “Representative Payee” for the purpose of receiving Social Security benefits.

11.  Make gifts from my assets to members of my family and to such other persons or charitable organizations with whom I have an established pattern of giving, to file state and federal gift tax returns, and to file a tax election to split gifts with my spouse, if any.

However, my Agent shall be prohibited, except as specifically authorized in this instrument, from (a) gifting, appointing, assigning or designating any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent’s estate or creditors, or the creditors of my Agent’s estate, (b) exercising any powers of appointment I may hold in favor of my Agent, my Agent’s estate or creditors, or the creditors of my Agent’s estate, or (c) using my assets to discharge any of my Agent’s legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support.  I appoint  ___________, of ____________________, as my substitute Agent for the sole purpose of making gifts of my property to my Agent or disclaiming assets that then pass directly or indirectly to my Agent or my Agent’s estate, as either may be appropriate (unless this substitute Agent is also the Agent).

12.  Transfer any of my assets to the trustee of any revocable trust created by me, if such trust is in existence at the time of such transfer.

13.  Subject to other provisions of this document, disclaim any interest, which might otherwise be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate.  However, my Agent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent’s estate.

This Power of Attorney shall be construed broadly as a general Power of Attorney.  The listing of specific powers is not intended to limit or restrict the general powers granted in this Power of Attorney in any manner.

Any power or authority granted to my Agent under this document shall be limited to the extent necessary to prevent this Power of Attorney from causing: (i) my income to be taxable to my Agent, (ii) my assets to be subject to a general power of appointment by my Agent, or (iii) my Agent to have any incidents of ownership with respect to any life insurance policies that I may own on the life of my Agent.

My Agent shall not be liable for any loss that results from a judgment error that was made in good faith.  However, my Agent shall be liable for willful misconduct or the failure to act in good faith while acting under the authority of this Power of Attorney.  A successor Agent shall not be liable for acts of a prior Agent.

No person who relies in good faith on the authority of my Agent under this instrument shall incur any liability to my estate, my personal representative or me.  I authorize my Agent to indemnify and hold harmless any third party who accepts and acts under this document.  If any part of any provision of this instrument shall be invalid or unenforceable under applicable law, such part shall be ineffective to the extent of such invalidity only, without in any way affecting the remaining parts of such provision or the remaining provisions of this instrument.

My Agent shall be entitled to reasonable compensation for any services provided as my Agent.  My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney.

My Agent shall provide an accounting for all funds handled and all acts performed as my Agent, but only if I so request or if such a request is made by any authorized personal representative or fiduciary acting on my behalf.

This Power of Attorney shall become effective immediately, and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute.  This is a Durable Power of Attorney.  This Power of Attorney shall continue effective until my death.  This Power of Attorney may be revoked by me at any time by providing written notice to my Agent.

__________________        Date:
Declarant

_______________                    _____________________
Witness Signature:                    Witness Signature
Address:                        Address

The foregoing instrument was acknowledged before me on ______________, by Claimant, _______________, who is personally known to me or who has produced                                   _________________ as identification.

___________________________________
Signature of Notary taking acknowledgment
Date of Expiration:

Power of Attorney, General
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.   A Power of Attorney must be signed by a principal who is mentally competent and the signature should be notarized.  Notarization is strongly recommended to make it harder for a third party to challenge the validity of the signature, and allows the document to be “recorded” for use with real estate transactions, if recording becomes necessary or advisable.   Two witnesses are recommended to meet the standard of various state laws.  As usual, witnesses should be adults over 21, not be related to the Declarant, nor benefit in any way from his or her activities, assets, or anything else.

Make several copies.  Be sure to send copies to anyone having or possibly having a previous Power of Attorney in their possession.  Keep one in your home safe and give one to your lawyer, should you have one.  If there is any question of mental competence, be sure to include a physician’s statement to the effect the Declarant is fully and completely mentally competent.  Such a form is included in the Power of Attorney section.

_______________________________________________________________, the “parent”” of _____________________________________________________________, herewith appoints ______________________________ of _____________________________, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to do the following acts:

To act as the guardian of the person of my minor children:
______________________________________________________________________.

including the right to act entirely in loco parentis; including the authority to approve or to decline medical treatment of any kind for the child and including the right to review medical records or school records of the child.

This power of attorney shall be in effect from ________________ to ___________________.

_____________________________________________________
_______________________________, As Principal

STATE OF ______________________

COUNTY OF _______________________
_______________________________ personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.

Dated: _______________________________

__________________________________________
Notary Public
Commission Expires:

Power of Attorney, Simple
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.   This is a simple but powerful Power of Attorney for care of your children that has a specific time period.  An important feature of this form is the automatic termination date at the end of the period.  You can adapt this Power of Attorney to relate to many matters where you want someone to serve as your proxy.

1. Make sure to limit the time period in the document itself for your own protection.  Remember, you can always renew the Power of Attorney, should you want to do so.
2. A notary is suggested to be sure the Power of Attorney is honored in a crisis.  Authorities love the legal niceties; this gives it to them so your agent with the Power of Attorney can act promptly and effectively.

____________________, the “principal,” of ______________________, herewith appoints _____________________ of _______________________, as their attorney in fact, to act in the place and stead and with the same authority as Principal would have to transfer the following motor vehicle, and to take any other necessary steps to transfer title the following motor vehicle:
Make: ___________
Model: ______________
Year: ___________
Body: ____________
Vehicle identification number: ________________________

IMPORTANT: Federal regulations require this statement to be given to purchasers on sales of vehicles. An inaccurate or untrue statement may make you liable for damages to the buyer and there may also be civil or criminal penalties.

The odometer described above now reads ______________ miles.

Certify one of the following—please “XXX” the appropriate line before the correct statement:

___________ I (we) certify that to the best of my (our) knowledge the odometer reading as stated above reflects the actual mileage of the vehicle described below.

___________ I (we) certify that to the best of my (our) knowledge the odometer reading as stated above reflects the amount of mileage in excess of designed mechanical limits of 99,999 miles of the vehicle described below.

___________ I (we) certify that to the best of my (our) knowledge the odometer reading as stated above is NOT the actual mileage of the vehicle described below, and should not be relied upon.

Certify one of the following—please “XXX” the appropriate line before the correct statement:

__________ I (we) certify that the odometer of the vehicle described above was not altered, set back, or disconnected while in my (our) possession, and I (we) have no knowledge of anyone else doing so.

__________ I (we) certify that the odometer was altered for repair or replacement purposes while in my (our) possession, and that the mileage registered on the repaired or replaced odometer is identical to that before such service.

__________ I (we) certify that if the repaired or replacement odometer was incapable of registering the same mileage, that it was reset to zero, and that the mileage on the original odometer or the odometer before repair was __________________ miles.

The sales price of the vehicle is: $ ______ (________________________ & ____/100 dollars)

___________________________________________________
____________________ By Authorizer of Power of Attorney

STATE OF __________________
COUNTY OF __________________

____________________ personally appeared before me and acknowledged the execution of this power of attorney for the purposes set forth therein.

Dated: _______________________________

__________________________________________
Notary Public
My Commission Expires on:

Power of Attorney, Motor Vehicle only
Review List

This review list is provided to inform you about this document in question and assist you in its preparation.  This is a limited purpose Power of Attorney for your motor vehicle only.  You can adapt this document for other limited purpose reasons, related primarily to single transactions.

1. Make multiple copies.  Keep copies with your car, insurance, and other related files.  You usually need this kind of evidence to cancel insurance policies, for example, in states that require that all car owners have insurance in place.

I, __________________(“Physician”), with offices at __________________________, hereby state that _____________________ (“Individual”) of ______________________, is fully and completely mentally competent in the broadest meaning of that term, and fully capable of taking independent actions as a completely mentally competent person.

___________________                Date:
Physician

___________________
Witness

Physician’s Statement of Mental Competency
Review List

This review list is provided to inform you about the document in question and assist you in its preparation.  This document should accompany any Power of Attorney, if possible.  It helps short circuit any challenges to the Power of Attorney.

1. Make multiple copies and have them attached to the Power of Attorney statement, in your distribution of it and storing of them.