Simple (1-Page) Power of Attorney Form

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A power of attorney form is a one-page legal document used to give a person the ability to choose someone else to carry out tasks on their behalf. The appointer, known as the principal, can be any legal citizen eighteen or older. The appointee is called the attorney-in-fact (or agent) and can be anyone the principal knows and trusts (such as a close friend).

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Simple (1-Page) Power of Attorney Form

Last updated September 11th, 2025

A power of attorney form is a one-page legal document used to give a person the ability to choose someone else to carry out tasks on their behalf. The appointer, known as the principal, can be any legal citizen eighteen or older. The appointee is called the attorney-in-fact (or agent) and can be anyone the principal knows and trusts (such as a close friend).

Document Features

  • Length – Prioritizes brevity and simplicity to allow the principal to draft a simple yet effective power of attorney.
  • Powers – Enables the principal to grant clearly defined powers and authority to the attorney-in-fact.
  • Revocation – Establishes whether the attorney-in-fact’s authority ends on a specific date, upon performing certain acts, or upon another circumstance.
  • Legality – Includes witness and notary public acknowledgment, which gives the document legal validity.
Note: For brevity, the form waives many clauses that are typically found in more comprehensive power of attorney forms, such as the durable and general POAs.

Sample

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POWER OF ATTORNEY

BE IT ACKNOWLEDGED that I, [PRINCIPAL NAME], the “Principal”, do hereby grant a limited and specific power of attorney to [ATTORNEY-IN-FACT NAME], of [ATTORNEY-IN-FACT ADDRESS], as my “Attorney-in-Fact”.

Powers. Said Attorney-in-Fact shall have full power and authority to undertake and perform only the following acts on my behalf:

[LIST POWER(S)].

The authority herein shall include such incidental acts as are reasonably required to carry out and perform the specific authorities granted herein. My Attorney-in-Fact agrees to accept this appointment subject to its terms and agrees to act and perform in said fiduciary capacity consistent with my best interests. This Power of Attorney is effective upon execution.

Revocation. This Power of Attorney shall automatically revoke upon my death or incapacitation and shall revoke upon any of the following circumstances: (initial and check all that apply)

[INITIAL] ☐ – When the act(s) designated above have been completed.
[INITIAL] ☐ – On [MM/DD/YYYY].
[INITIAL] ☐ – Other: [OTHER].

State Law. This Power of Attorney is governed by the laws of the State of [STATE NAME].

Principal’s Signature: ___________________ Signing Date: [MM/DD/YYYY]

 

WITNESS ACKNOWLEDGMENT

Witness 1 Signature: ___________________ Signing Date: [MM/DD/YYYY]

Witness 2 Signature: ___________________ Signing Date: [MM/DD/YYYY]

 

NOTARY ACKNOWLEDGMENT

STATE OF [STATE]
COUNTY OF [COUNTY]

On [MM/DD/YYYY], 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 executed the same as his free act and deed.
___________________
Notary Public

My commission expires: [MM/DD/YYYY]