Durable Power of Attorney Legal Forms and Contracts

The following free Durable Power of Attorney is a thorough document written for a married man with one child. This document and contract is being provided for example, sample, information and research purposes only, however it is a valid legal contract and agreement. Always consult an Attorney or Lawyer.

This document should be used in conjunction with a Trust, Living Will, Last Will and Testament and Health Care Power of Attorney. All these documents can be found in the Trusts and Estate Section of this website. This Agreement can apply in most states including California, New York, Florida, Nevada and others. Help improve this agreement by leaving a comment.

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WHEN RECORDED MAIL TO:

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DURABLE POWER OF ATTORNEY

To the person executing this document:

THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES A DURABLE POWER OF ATTORNEY. BEFORE EXECUTING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:

1. The powers granted by this document are broad and sweeping. If you become incapacitated, the person you designate as your attorney-in-fact will have broad powers to dispose, sell, convey and encumber your real and personal property, to allow your agent to transfer your property to himself/herself, and to perform other acts and make decisions on your behalf.

2. The powers in this Durable Power of Attorney shall become effective on your incapacitation and will exist for an infinite period of time unless you limited their duration in this document. These powers will exist during your incapacitation.

3. You have the right to revoke or terminate this Durable Power of Attorney at any time.

THIS POWER OF ATTORNEY TO BECOME EFFECTIVE ONLY
UPON INCAPACITY OF PRINCIPAL

I, __________________, principal, declare that this Durable Power of Attorney shall become effective only upon my incapacity. I grant the following persons the power to determine conclusively that I have become incapacitated and therefore that this power of attorney has become effective:

A. My treating physician.

B. __________________
(Principal's spouse)

This springable durable power of attorney shall become effective when both of the designated persons above execute declarations under penalty of perjury that I do not have sufficient understanding or ability to make or communicate decisions about my property, finances, or personal business.

My “Agent” (defined below) shall promptly attach both declarations to this power of attorney. Any person may act in reliance on this power of attorney with both such declarations attached without liability to me or to any other person regardless of whether I am later determined to have become incapacitated.

No licensed physician designated above who executes a medical opinion of my incapacity shall be subject to liability because of such execution. I hereby waive any privilege that may apply to released information included in such medical opinion.

While I am not incapacitated, this Durable Power of Attorney may be modified by me at any time by written notice given by me to my Agent, and may be terminated at any time by either me or my Agent by written notice given by the terminating party to the other terminating party.

This Durable Power of Attorney shall not be affected by my subsequent incapacity and shall continue after my incapacity in accordance with its terms.

On my death, this power shall terminate and my administrable assets, if any, shall be delivered to the duly appointed personal representative of my estate; and all assets that are a part of the __________________ TRUST shall be delivered to the Trustee of said Trust.

DESIGNATION OF AGENT

I, __________________, presently a resident of Maricopa County, Arizona, hereby appoint my Spouse also a resident of Maricopa County, Arizona, as my true and lawful attorneys-in-fact (my “Agent”) for me and in my name, place and stead:

1. Securities. To purchase, sell, invest, reinvest and generally deal with all stocks, bonds, debentures, warrants, partnership interests, rights and securities I own.

2. Power of Collection and Payment. To forgive, demand, pursue litigation, arbitrate, settle, recover, receive, deposit, hold all such sums of money, debts, dues, commercial paper, checks, drafts, accounts, deposits, annuities, pensions, profit sharing, individual retirement accounts, social security, insurance and other contractual benefits and proceeds, all documents of title, all property, real and personal, tangible or intangible property rights and demands whatsoever, liquidated or unliquidated, now or hereafter owned by or due, owing, payable or belonging to me, or in which I have or may hereafter acquire an interest, to have, use and take all lawful means and equitable and legal remedies and proceeding in my name for the collection and recovery thereof, and to adjust, sell, compromise and agree for the same, and to execute and deliver for me, on my behalf and in my name, all endorsements, release, receipts or other sufficient discharges for the same.

3. Power to Pay and Settle. To pay sums of money which may at any time be or become owing from me, to sell, and to adjust and compromise any claims which may be made against me as my Agent consider appropriate under the circumstances.

4. Power to Hypothecate and Alienate. To grant, sell, transfer, borrow, mortgage, deed in trust, pledge, execute such other security agreements as may be necessary or proper in the exercise of the rights and powers herein granted, and otherwise deal in all property, real and personal, which I may own; including but not limited to any real property described on any exhibit attached to this power of attorney including property acquired after execution of this power of attorney; to attach exhibits to this power of attorney which provide legal descriptions of all such property; and to execute such powers of attorney as my Agent deems proper in conjunction with all matters covered in this Paragraph 4. My Agent is authorized to execute deeds of gift and changes of ownership and/or beneficiary designations to my Agent for his/her own benefit and this shall not constitute self-dealing or breach of my Agent's fiduciary duties. My Agent shall have the power to sell, assign, hypothecate, borrow upon, or pledge the interest that I may have in any contract of insurance or annuity.

5. Power to File Tax Returns and Receive Refunds. To prepare and file all income and other federal and state tax returns, and extensions of time, which I am required to file; to sign my name; to hire preparers and advisors and pay for their services and to do whatever is necessary to protect my assets from assessments for income taxes and other taxes for any tax year upon which the statute of limitations has not run. My Agent is specifically authorized to receive any confidential information; to receive checks in payment of any refund of taxes, penalties, or interest; to execute waivers (including offers of waivers) of restrictions on assessment or collection of tax deficiencies and waivers of notice of disallowance of claims for credit or refund; to execute closing agreements under Internal Revenue Code Section 7121, or any successor statute; and to delegate authority or substitute another representative with respect to these matters.

6. Deposit and Demand Accounts. To deposit in and draw on any checking, savings, money market deposit or other accounts which I may have in any banks, savings and loan associations, mutual fund, and any accounts with security brokers or other commercial institutions, and to establish and terminate all such accounts; and to receive and endorse checks and drafts.

7. Power to Invest. To invest and reinvest my funds in every kind of property, real, personal or mixed, and every kind of investment, specifically including, but not limited to, corporate obligations of every kind; preferred or common stocks; shares of investment trusts; investment companies and mutual funds; and mortgage participations that under the circumstances then prevailing (specifically including but not limited to the general economic conditions and my anticipated needs) persons of skill, prudence and diligence acting in a similar capacity and familiar with those matters would use in the conduct of an enterprise of a similar character with similar aims, to attain my goals; and to consider individual investments as part of an over all plan.

8. Real Estate. To sell, buy, exchange, convey with or without covenants, quitclaim, release, surrender, partition, consent to partitioning, subdivide, apply for zoning, rezoning, or other governmental permits, plat or consent to platting, develop, grant or exercise options, lease, sublease, or otherwise dispose of, an interest in real property or a right incident to real property.

9. Business Operations and Transactions. To operate, manage, enter into all types of contracts, buy, sell, enlarge, reduce, and terminate any business interest.

10. Governmental Programs. To prepare, file and prosecute any claim that I may have under a statute or governmental regulation including without limitation social security, Medicare, Medicaid or other governmental programs.

11. Safety Deposit Boxes. To have access to all safe deposit boxes in my name or to which I am an authorized signatory; to contract with financial institutions for the maintenance and continuation of safe deposit boxes in my name; to add to and remove the contents of all such safe deposit boxes; and to terminate contracts for all such safe deposit boxes.

12. Action to Compel Honoring Agent's Authority. To bring lawsuits against any bank, savings and loan association, or other person or entity that fails or refuses to honor this power of attorney.

13. Trusts. To execute and deliver revocable or irrevocable trust agreements, and amendments thereto, for the benefit of myself, and my children; to make additions to any existing or future living trusts of which I am the grantor or a grantor; and to amend or terminate such trusts, all so long as such acts do not substantially alter distribution of my estate during my lifetime or on my death and so long as such acts are in the best interest of the trust(s), and so long as all such acts do not cause adverse tax consequences for my estate or my Agent's estate. My Agent is authorized to establish and fund any trust, revocable or irrevocable, with all or any part of my assets, which contains dispositive provisions consistent with those set forth in my will (or my revocable living trust).

14. Power to Make Gifts. To make gifts on my behalf to a class composed of my children, any of their issue, or both (even if serving as my Attorney in Fact under this Power of Attorney), to the full extent of the federal annual gift tax exclusion in effect from time to time, including the $10,000 per donee annual exclusion under Internal Revenue Code §2503(b) or any successor statute, and for such purposes to remove my assets from any grantor revocable trust of which I am a grantor. If a gift is made to any one of my children, my Agent shall make a substantially similar concurrent gift to each of my other children.

15. Credit Cards. To use any credit cards in my name and to make purchases and to sign charge slips on my behalf as may be required to use such credit cards; and to close my charge accounts and terminate my credit cards under circumstances where my Agent considers such to be in my best interest.

16. Retirement Plan Payment Options. To select payment options under any retirement plan in which I participate, including plans for self-employed individuals, or any individual retirement plan.

17. General Grant of Power. Generally to do, execute and perform any other act, deed, matter or thing, that in the opinion of my Agent ought to be done, executed or performed in conjunction with this power of attorney, of every kind and nature, as fully and effectively as I could do if personally present. The enumeration of specific items, acts, rights or powers in this instrument does not limit or restrict, and is not to be construed as limiting or restricting, the general powers granted to my Agent except where power are expressly restricted.

18. Release of Information. Any third party from whom my Agent may request information, records or other documents regarding my personal affairs may release and deliver all such information, records, or documents to my Agent. I hereby waive any privilege that may apply to release of such information, records, or other documents.

19. Reliance on Agent's Authority. My Agent's signature under the authority granted in this power or attorney may be accepted by any third party or organization with the same force and effect as if I were personally present and acting on my own behalf. No person or organization who relies on my Agent's authority under this instrument shall incur any liability to me, my estate, heirs, successors or assigns, because of reliance on this instrument.

20. Successor Agent. In the event that My Spouse becomes incompetent or has pre-deceased, then I appoint __________________ as my Agent, with all of the powers and duties set forth herein. In the event that he should be deceased or become incompetent, then I appoint __________________, so long as he is twenty-five (25) years of age as my Agent, with all of the powers and duties set forth herein. For the purposes under this Instrument, a person shall be deemed “incompetent” if and so long as a conservator of his or her person or estate duly appointed by a court of competent jurisdiction is serving, or upon certification by two physicians (licensed to practice under the laws of the state where the person is domiciled) that the person is unable properly to care for himself or herself, for his or her person, or for his or her property.

21. Binding on Successors. My estate, heirs, successors and assigns shall be bound by my Agent's acts under this power of Attorney.

22. Ratification by Principal. I hereby ratify and confirm all that my Agent shall do, or cause to be done, by virtue of this power of attorney.

23. Personal Care of Principal. My Agent is authorized to do all things and enter into all transactions necessary to provide for my personal care, to maintain my customary standard of living, to provide suitable living quarters for me, and to hire, compensate and discharge household, nursing, and other employees as my Agent considers advisable for my well being. This shall specifically include but not be limited to the authority to procure and pay for clothing, transportation, recreation, travel, medicine, medical care, food and other needs; and to make arrangements and enter into contracts on my behalf with hospitals, hospices, nursing homes, convalescent homes, retirement homes and similar organizations.

My Agent is authorized to make arrangements for my spiritual and religions needs.

My Agent is authorized to make advance funeral and burial arrangements in accordance with my wishes, known to my Agent.

My Agent is authorized to purchase, maintain and repair my clothing, household furniture, furnishings and other tangible effects. This includes the authority to dispose of worthless items that cannot be properly cleaned or repaired and to store items no longer needed or used by me while in a hospital, nursing home, or other residential facility.

23. Special Use Valuation. My Agent is authorized to execute and file consent, agreements and related documents under Internal Revenue Code §2032A or any successor statute, for the special use valuation of any property of which I am the beneficiary or have an interest which is affected by §2032-2046.

24. New HIPAA Regulations Require Amendment. A recent federal regulations known as the Health Insurance Portability and Accountability Act (HIPAA) regarding disclosure of individually identifiable health information necessitated the addition of a special release and consent authority to all healthcare providers before medical information will be released to the Attorney-in-Fact of the patient.

25. HIPAA Release Authority. I instruct that my Attorney-in-Fact be treated as I want to be treated with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act, 42 USC 1320d and 45 CFR 160-164.

26. Legal Consent for Disclosure of Health Care Information. Any physician, healthcare professional, dentist, health plan, hospital, clinic, laboratory, pharmacy or other health care provider, any insurance company, the Medical Information Bureau Inc. or other health care clearinghouse that has provided treatment or services shall give, disclose and release to my designated Attorney-in-Fact, without restriction, identifiable health information and medical records regarding any past, present or future medical or mental health condition, to include all information relating to the diagnoses treatment of HIV / AIDS sexually transmitted diseases, mental illness and drug or alcohol abuse.

27. Legal Consent for Disclosure of Specific Mental Health Care Information. Any psychologist, psychiatrist, licensed therapist or other healthcare provider involved with diagnoses or therapy or other treatment of me which pertains to my mental health shall give disclose and release to my designated Attorney-in-Fact any and all individually identifiable health information and medical records involving any past present or future mental health condition. This specific authorization includes but is not limited to psychotherapy notes defined by HIPA as “notes recorded in any medium by a mental health professional documenting or analyzing the contents of conversation during a private counseling session”, as well as medication prescription and monitoring, counseling session start and stop times, modalities and frequencies of treatment, results of clinical tests, and any summary of diagnosis, functional status, treatment plans, symptoms, prognosis or progress. My Attorney-in-Fact shall have the same rights of access to these notes as I am entitled to under the provisions of HIPAA and under applicable state law.

28. Supersession of Prior Documents and Expiration Event. The authority given my agent in this legal consent form shall supercede any prior agreements that I may have made with my health care providers to restrict access or disclosure of my individually identifiable health information. The authority given my agent has no expiration date and shall expire only in the event that I revoke the authority in writing and deliver it to my health care provider.

29. Release and Hold Harmless Provision. In order to induce the disclosing party to disclose the aforesaid private and / protected confidential information, I forever release and hold harmless said disclosing party who relies on this instrument from any liability under confidentiality rules arising from HIPAA as a consequence of said disclosure.

By my signature or mark below I indicate that I understand the purpose and effect of this document.

IN WITNESS WHEREOF, I, the Principal, execute this document, intending it to be effective on the date hereinabove first stated. I understand that (a) this document gives my Agent serious powers over me and my assets, (b) the powers continue even after I am disabled and (c) I can revoke and cancel this document at any time. Further, I, the Principal, sign my name to this Power of Attorney on the date Signed below, and being first duly sown, do declare to the undersigned authority that I sign and execute this instrument as my power of attorney and that I sign it willingly, or direct another to sign for me, that I execute it as my free and voluntary act of the purposes expressed in the Power of Attorney and that I am eighteen years of age or older, of sound mind and under no constraint or undue influence.

_________________________________ _________________________________
Date Signed __________________, Principal

WITNESSES

This Durable Power of Attorney, consisting of 9 pages, including this page and the following page(s), was signed in the presence of us who, at the request and in the presence of Testator and in the presence of each other, have signed the same as witnesses thereto. WE ALSO AFFIRM THAT WE ARE NOT RELATED TO THE PRINCIPAL BY BLOOD, MARRIAGE OR ADOPTION AND THAT WE ARE AWARE OF NO INHERITANCE RIGHTS, GIFTS, OR DISTRIBUTIONS THAT WE SHALL RECEIVE FROM PRINCIPAL’S WILL OR FROM ANY OTHER SOURCE FROM THE PRINCIPAL AND ARE NOT PERSONS INVOLVED WITH THE MEDICAL CARE OF THE PRINCIPAL.

Witness Signature

Witness Name (Printed) Witness Address

Witness Signature

Witness Name (Printed) Witness Address

ACKNOWLEDGMENT AND VERIFICATION
OF PRINCIPAL AND WITNESSES

STATE OF: Arizona
COUNTY OF: Maricopa

On this _______ day of _________________, ________, this instrument was acknowledged before me, a Notary Public, personally appeared the above witnesses known to me or satisfactorily proven to be the person whose names are subscribed to this instrument and acknowledged that they executed the same for the purposes contained therein.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

______________________________
Notary Public

Printed Name: _________________

My Commission Expires: ______________________

Commission # __________________

ACCEPTANCE BY AGENT
(This Acceptance Must Not be signed until this
Power of Attorney is used by Agent.)

At this time, when I first use this Power of Attorney on behalf of the Principal, I affirm I have read this entire document, agree to abide by is terms, and I am unaware at this time that the Principal has died or has revoked this Power of Attorney. I sing with my official signature as evidence of its authenticity for comparing it with what I sign.

DATED:________________________________ By________________________________
Signature of Agent

ACKNOWLEDGMENT OF AGENT

STATE OF: Arizona
COUNTY OF: Maricopa

On this _______ day of _________________, ________, this instrument was acknowledged before me, a Notary Public, personally appeared the above witnesses known to me or satisfactorily proven to be the person whose names are subscribed to this instrument and acknowledged that they executed the same for the purposes contained therein.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

______________________________
Notary Public

Printed Name: _________________

My Commission Expires: ______________________

Commission # __________________