Free Durable Power of Attorney Form

A Durable Power of Attorney form is a legal form used to appoint another person to take care of your financial affairs or medical needs if you are unable to do so yourself. Fill out and print a free Durable Power of Attorney form in just minutes online.

With a Durable Power of Attorney form, a person – called the Principal in the Durable Power of Attorney – appoints another person – called the Agent in the Durable Power of Attorney – with the authority or power to take care of the Principal’s affairs in the event that the Principal is unable to do so on his or her own.

Our Free Durable Power of Attorney Forms

Free Durable Power of Attorney Form

To start your free Durable Power of Attorney, begin by filling out the full name and address of the Principal and then, fill in the full name and address of the Agent. After each of the personal information is entered, all the powers that you are granting must be listed on the Durable Power of Attorney form. You can be as detailed as you prefer in this space.

Next, the Agent and Principal sign and date the Durable Power of Attorney form along with each of the witnesses. The Principal will then sign and date the Durable Power of Attorney form in the presence of a Notary Public. The Notary will then sign and seal your free Durable Power of Attorney form to execute the document.
Free Durable Power of Attorney Form

Sample Free Durable Power of Attorney Form

This sample free Durable Power of Attorney form is an example of the information needed to fill out a Durable Power of Attorney form. This is a cut and paste free Durable Power of Attorney form. Feel free to tailor the information to the form as needed to fit your needs. We strongly suggest that if you have any questions about filling out a Durable Power of Attorney form, you should consult a lawyer.

Free Durable Power of Attorney Form

______________________________________________________________
Principal

1. Agent. I choose______________________________as my Agent with full authority to
manage my finances.

2. Alternate. If ______________________________is unable or unwilling to act, I choose
_____________________________ as my Agent with full authority to manage my finances.

3. My Rights. I keep the right to make financial decisions for myself as long as I am capable.

4. Durable. My Agent can use this power of attorney document to manage my finances
even if I become sick or injured and cannot make decisions for myself. This power of attorney
document shall not be affected by my disability.

5. Start Date. This power of attorney document is effective.

Check one:

_____Immediately.

_____Only if my medical provider signs a letter saying I cannot make decisions for myself.

6. End Date. This power of attorney document will end if I revoke it or when I die.
If my spouse or domestic partner is my Agent, this power of attorney document will
end if either of us files for divorce in court.

7. Revocation. I revoke any power of attorney for finances documents I have signed in
the past. I understand that I may revoke this power of attorney document at any time
by giving written notice of revocation to my Agent.

8. Powers. My Agent shall have full power and authority to do anything as fully and
effectively as I could do myself, including,but not limited to, the power to make deposits
to, and payments from, any account in my name in any financial institution, to open and
remove items from any safe deposit box in my name, to sell, exchange or transfer
title to stocks, bonds or other securities, and to sell, convey or encumber any real or
personal property. My agent shall also have the following special powers.

Check all that apply:

_____Manage my financial and business affairs
_____Create, amend, revoke, or terminate a living trust
_____Make gifts of my money or property
_____Create or change my rights of survivorship
_____Create or change my beneficiary designation
_____Delegate some authority granted in this document to someone else
_____Waive my right to be the beneficiary of an annuity or retirement plan
_____Create, amend, revoke, or terminate my community property agreement
_____Tell a trustee to make distributions from a trust just as I could

List any additional powers to grant:

9. No Power to Agree to Binding Pre-Dispute Arbitration. I recognize that some long-term
care providers will ask me or my Agent to sign a binding pre-dispute arbitration
agreement. These agreements limit my right to sue the provider before any injury or
dispute occurs. I think these agreements are unfair and unacceptable. Therefore, my agent
does not have the power to agree to pre-dispute binding arbitration or any other process
involving my person or property that limits my right to a jury, to sue for money, or to join
a class action.

10. Accounting. My Agent shall keep accurate records of my finances and show these
records to me at my request.

11. Nomination of Guardian. I nominate my Agent as the guardian of my estate for
consideration by the court if guardianship proceedings become necessary.

12. HIPAA Release. I authorize my healthcare providers to release all information governed
by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to my Agent.

_________________________________________
Principal Signature

_____________________
Date

Notarization
State of ________________________
County of _______________________

I certify that I know or have satisfactory evidence that__________________________,
is the person who appeared before me, signed above, and acknowledged that the signing
was done freely and voluntarily for the purposes mentioned in this instrument.

Subscribed and Sworn to before me on _____________________.

________________________
Notary

Notary Public for the State of __________________.
My commission expires _________________.