DURABLE FINANCIAL POWER OF ATTORNEY

I, [PRINCIPAL NAME], the Principal (hereinafter “Principal”), of [PRINCIPAL ADDRESS], hereby designate [AGENT NAME], of [AGENT ADDRESS], my Attorney-in-Fact (hereinafter “Attorney-in-Fact”), to act as initialed below, in my name, in my stead and for my benefit, hereby revoking any and all financial powers of attorney I may have executed in the past.

1. EFFECTIVE DATE. I grant my Attorney-in-Fact the powers set forth herein: (initial one)

[INITIALS] – Immediately upon the execution of this document. These powers shall not be affected by any subsequent disability or incapacity I may experience.
[INITIALS] – Only when it has been determined in writing, by my attending physician, that I cannot handle my financial affairs properly.

2. POWERS. My Attorney-in-Fact shall have the following powers: (initial all that apply)

[INITIALS] – Power to Make Payments or Collect Monies Owed
[INITIALS] – Power to Acquire, Lease, and Sell Personal Property
[INITIALS] – Power to Acquire, Lease, and Sell Real Property
[INITIALS] – Banking Powers
[INITIALS] – Motor Vehicle Transaction Powers
[INITIALS] – Tax Powers
[INITIALS] – Gift Making Powers
[INITIALS] – Lending and Borrowing Powers
[INITIALS] – Other: [DESCRIBE OTHER POWERS OR SPECIAL INSTRUCTIONS].

3. AUTHORITY. Any party dealing with my Attorney-in-Fact may rely fully on the authority granted in this document and is not required to verify how proceeds are used or question the Attorney-in-Fact’s actions. Anyone acting in good faith based on this authority shall not be held liable to me or my estate. I ratify all lawful acts taken under this power, and my Attorney-in-Fact may seek court enforcement to ensure its full effect.

4. LIABILITY. My Attorney-in-Fact shall not incur any liability to me under this power of attorney except for a breach of fiduciary duty.

5. AMENDMENT AND REVOCATION. I can amend or revoke this power of attorney through a writing delivered to my Attorney-in-Fact. Any amendment or revocation is ineffective as to a third party until such third party has notice of such revocation or amendment.

6. STATE LAW. This power of attorney is governed by the laws of the State of [STATE].

IN WITNESS WHEREOF, I have executed this power of attorney on [DATE].

Principal Signature: _____________________________

ACCEPTANCE OF APPOINTMENT

I, [AGENT NAME], the Attorney-in-Fact named above, hereby accept appointment as attorney-in-fact in accordance with the foregoing instrument.

Attorney-in-Fact Signature: _____________________________

WITNESS

We, the witnesses, each do hereby declare in the presence of the Principal that the Principal signed and executed this instrument in the presence of each of us, that the Principal signed it willingly, that each of us hereby signs this power of attorney as witness at the request of the Principal and in the Principal’s presence, and that, to the best of our knowledge, the Principal is eighteen years of age or over, of sound mind, and under no constraint or undue influence.

Witness Signature: _____________________________
Print Name: [WITNESS NAME]    Address: [WITNESS ADDRESS]

Witness Signature: _____________________________
Print Name: [WITNESS NAME]    Address: [WITNESS ADDRESS]

STATE OF [NOTARY: STATE]
COUNTY OF [NOTARY: COUNTY]

On [DATE], before me appeared [PRINCIPAL NAME], as Principal of this Power of Attorney who proved to me through government-issued photo identification to be the above-named person, in my presence executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed.

Notary Signature: _____________________________
Print Name: [NOTARY NAME]
My Commission Expires: [DATE]                                                 (seal)