FINANCIAL POWER OF ATTORNEY

THIS FINANCIAL POWER OF ATTORNEY is given by [NAME OF PERSON GRANTING POWER] (hereinafter “Principal”), an individual residing in the County of [PRINCPAL’S COUNTY], State of [PRINCIPAL’S STATE], at [COMPLETE ADDRESS, CITY, STATE, AND ZIP CODE OF PRINCIPAL].

I, the undersigned, do hereby appoint [AGENT'S NAME - PERSON RECEIVING POWER] 
of [ADDRESS, CITY, STATE, AND ZIP CODE OF AGENT] to be my true and lawful ATTORNEY-IN-FACT (hereinafter “Agent”) for financial matters with the following limited powers:

PRINCIPAL:  INITIAL EACH POWER GRANTED; CROSS OUT, RATHER THAN INITIAL, EACH POWER WITHHELD:

______ (A)  Real property transactions.
______ (B)  Tangible personal property transactions.
______ (C)  Stock and bond transactions.
______ (D)  Commodity and option transactions.
______ (E)  Banking and other financial institution transactions.
______ (F)  Business operating transactions.
______ (G)  Insurance and annuity transactions.
______ (H)  Estate, trust, and other beneficiary transaction.
______ (I)   Claims and litigation.
______ (J)  Personal and family maintenance.
______ (K)  Benefits from Social Security, Medicare, Medicaid, of other governmental programs,
       or civil or military service.
______ (L)  Retirement plan transactions.
______ (M) Tax matters.
______ (N)  ALL OF THE POWERS LISTED ABOVE.  (YOU NEED NOT INITIAL ANY OTHER
                                 LINES IF YOU INITIAL LINE (N).)

SUBJECT, HOWEVER, TO THE FOLLOWING LIMITATIONS:
 
[ENTER ANY LIMITATIONS ON THE POWERS GRANTED ABOVE].

[If my Agent is unable to serve for any reason, I designate {NAMES AND ADDRESSES OF ANY ALTERNATE AGENTS; NONE IS REQUIRED – DELETE THIS SENTENCE IF NO ALTERNATES ARE SELECTED} as my successor Agent.]

I authorize my Agent to execute, acknowledge, and deliver any instrument and do all things necessary to carry out the intent hereof, hereby granting to my Agent full power and authority to act in and concerning the premises as fully and effectually as I may do if present, provided, however that all business transacted by my Agent hereunder shall be transacted in my name, and that all endorsements and instruments executed by my Agent for the purpose of carrying out the foregoing powers shall contain my name, followed by that of my Agent, and the designation “Attorney-in-Fact.”

The effective date of this Power of Attorney is [SPECIFY THE DATE YOU WANT THIS POWER OF ATTORNEY TO TAKE EFFECT, GENERALLY THE DATE IT IS EXECUTED.  TO MAKE THE POWER OF ATTORNEY EFFECTIVE ONLY WHEN YOU BECOME INCAPACITATED, YOU MUST INSERT THE FOLLOWING LANGUAGE AND CHOOSE ONLY ‘DURABLE’ BELOW:  the date on which my personal ].

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.  I authorize my Agent to indemnify and hold harmless any third party who accepts and acts under this Power of Attorney.

My Agent shall be entitled to reimbursement of all reasonable expenses incurred in connection with this Power of Attorney, [CHOOSE ONE: and shall OR but shall not] be entitled to reasonable compensation on account of the services performed hereunder.

My Agent shall provide an accounting for all funds handled and all acts performed as my Agent, 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 [CHOOSE ONE:  shall not be durable  OR  shall be durable and this Power of Attorney and the authority of my Agent shall not terminate if I subsequently become disabled or incapacitated].  This Power of Attorney may be revoked by me at any time by written notice to my Agent. This Power of Attorney shall automatically be revoked upon my death.

IN WITNESS WHEREOF, I have executed this Power of Attorney on this ____ day of _________, 201__.

							
SIGNATURE OF PRINCIPAL

							
PRINTED NAME OF PRINCIPAL

Witness Signature:___________________________________

Name:_____________________________________________

Address:___________________________________________

Witness Signature:___________________________________

Name:_____________________________________________

Address:___________________________________________

=============================

(THIS AREA FOR NOTARY PUBLIC)

STATE OF __________________
COUNTY OF __________________

	On ______________, before me, _____________________________, a Notary Public, personally appeared _____________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
       
WITNESS my hand and official seal.			_________________________________
							Signature of Notary Public

My commission expires: ______________		

(This area for notary seal.)

ACCEPTANCE OF APPOINTMENT AS ATTORNEY-IN-FACT

NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS ATTORNEY-IN-FACT:  

BY ACTING OR ACCEPTING THIS APPOINTMENT AS THE AGENT (ATTORNEY-IN-FACT) UNDER THIS POWER OF ATTORNEY, YOU ASSUME THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.  These responsibilities include:

1.	The legal duty to act solely in the interest of the Principal and to avoid conflicts of interest.

2.	The legal duty to keep the Principal’s property separate and distinct from any other property owned or controlled by you.  You may not transfer the Principal’s property to yourself without a full and adequate consideration, or accept a gift of the Principal’s property, unless this Power of Attorney specifically authorizes you to transfer property to yourself or accept a gift of the Principal’s property.  If you transfer the Principal’s property to yourself or accept a gift of the Principal’s property without specific authorization in the Power of Attorney, you may be prosecuted for fraud and/or embezzlement and/or elder abuse.  In addition to criminal prosecution, you may also be sued in civil court.

I have read the foregoing notice, and I understand and accept the legal and fiduciary duties that I assume by acting or agreeing to act as the Attorney-in-Fact under the terms of this Power of Attorney.

DATE:						 	

							
SIGNATURE OF AGENT

							
PRINTED NAME OF AGENT

ACCEPTANCE OF APPOINTMENT AS ATTORNEY-IN-FACT

NOTICE TO PERSON ACCEPTING THE APPOINTMENT AS ATTORNEY-IN-FACT:  

BY ACTING OR ACCEPTING THIS APPOINTMENT AS THE AGENT (ATTORNEY-IN-FACT) UNDER THIS POWER OF ATTORNEY, YOU ASSUME THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.  These responsibilities include:

1.	The legal duty to act solely in the interest of the Principal and to avoid conflicts of interest.

2.	The legal duty to keep the Principal’s property separate and distinct from any other property owned or controlled by you.  You may not transfer the Principal’s property to yourself without a full and adequate consideration, or accept a gift of the Principal’s property, unless this Power of Attorney specifically authorizes you to transfer property to yourself or accept a gift of the Principal’s property.  If you transfer the Principal’s property to yourself or accept a gift of the Principal’s property without specific authorization in the Power of Attorney, you may be prosecuted for fraud and/or embezzlement and/or elder abuse.  In addition to criminal prosecution, you may also be sued in civil court.

I have read the foregoing notice, and I understand and accept the legal and fiduciary duties that I assume by acting or agreeing to act as the Attorney-in-Fact under the terms of this Power of Attorney.  

I understand that my duties as Attorney-in-Fact will be effective only when and if the primary Attorney-in-Fact and any successor Attorney-in-Fact named by the Principal before me in the Power of Attorney is unable to serve.

DATE:						 	

							
SIGNATURE OF AGENT

							
PRINTED NAME OF AGENT