Fillable Printable General Durable Power of Attorney Form - Michigan
Fillable Printable General Durable Power of Attorney Form - Michigan
General Durable Power of Attorney Form - Michigan
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GENERAL DURABLE POWER OF ATTORNEY
OF
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GENERAL DURABLE POWER OF ATTORNEY
I, ___________________, of _______________, ___________ County, Michigan, make this
General Durable Power of Attorney (“Power”), and appoint ______________ of __________,
____________ County, Michigan, as my attorney-in-fact (“Agent”) with the following powers to
be exercised in my name and for my benefit:
1. General Grant of Power
To do anything that I have a right or duty to do, now or in the future.
2. Real and Personal Property
To maintain, transfer, encumber, and manage any of my real and personal property.
3. Motor Vehicles
To apply for a certificate of title upon, and endorse and transfer title thereto, for any
automobile, or other motor vehicle, and to represent in such transfer assignment that the title to
said motor vehicle is free and clear of all liens and encumbrances except those specifically set
forth in such transfer assignments.
4. Business
To collect money and manage my real and personal property, to transact business for me,
to conduct any business in which I may be engaged, and to carry out or amend any agreement to
which I may be a party.
5. Borrow
To borrow money and sign promissory notes that are either unsecured or secured by any
of my real or personal property.
6. Debts and Expenses
To pay bills and other debts and all reasonable expenses for the management of my
property and the support of myself and my dependents, including reasonable compensation for
the services of my Agent and agents my Agent may employ in the management of any of my
affairs.
7. Banking
To carry on all my ordinary banking business by depositing funds (by check or other
negotiable paper) and withdrawing funds (by check or withdrawal slip) in and from any bank,
savings and loan, or other financial institution.
8. Safe Deposit Box
To access, or to withdraw or change the contents of, any safe deposit box of which I am
tenant or co-tenant.
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9. Investments
To invest in stock, bonds, and any other investment which my Agent may deem proper;
to receive and reinvest stock dividends, sign proxies, vote at stockholder meetings, and sell
shares of stock; to reduce the interest rate of any mortgage or land contract; to instruct any
brokerage firm with respect to these investments.
10. Insurance and Employee Benefit Plans
To exercise all powers concerning any insurance policies in which I may have an interest;
except my Agent will have no power over life insurance policies I may own on my Agent’s life;
to exercise all powers concerning employee benefit plans.
11. Social Security and other Governmental Benefits
To apply for social security and other governmental benefits to which I may be entitled,
and to endorse government checks that are payable to me.
12. Legal Actions and Settlements
To begin or defend any legal actions and settle any claims that involve me or my
property.
13. Tax Returns
To prepare, sign and file income or other tax returns and other tax related documents; to
pay taxes and any interest or penalty on or additions to taxes; to represent me before any
administrative tax authority; to pay taxes and employ agents for any of these purposes for all tax
years.
14. Gifts
To continue to complete any gifts or gift program of mine with any of my real estate or
personal property, to my spouse, any of my children, their spouses, or their descendants, or to
any charitable organization; to make such gifts as my Agent may deem proper either outright, in
trust, and in custodianship, and including charitable gifts and charitable pledges, all in the sole
discretion of my Agent.
15. Funding of Trusts
To make any transfer of my property to any Revocable Living Trust of which I am the
Settlor or Irrevocable Trust of which I am the Grantor established prior to my incapacity.
16. IRA Accounts
To deal with my IRA accounts with respect to making investments, transfers and taking
minimum distributions required in compliance with all tax laws including, but not limited to:
a. opening or closing accounts within my IRA accounts.
b. making withdrawals from my IRA accounts and to direct that the distribution of
these funds be made to other checking or savings accounts or as a cash
withdrawal.
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c. withdrawing a minimum distribution as required by the law.
d. changing the title on my accounts from sole owner to a revocable living trust, if a
revocable living trust has been established.
e. making a roll-over contribution to or from my deceased spouse’s retirement
account and to or from my retirement account.
f. making a roll-over contribution from one IRA account that I own to another IRA
account.
g. closing my IRA accounts with one financial institution and making a roll-over
contribution to another financial institution.
h. closing my IRA accounts and withdrawing all the funds.
i. acting in my name as current or future rules and regulations require.
17. Restrictions on Agent’s Powers
My Agent:
a. cannot sign a Will, or Codicil (amendment to a will), or Trust on my behalf;
however, my Agent can sign a custodial agreement with a bank which has trust
powers.
b. cannot divert my assets to my Agent or my Agent’s creditors or estate, except as a
gift described in paragraph 14.
c. is a fiduciary and possesses no general or limited power of appointment.
d. has no authority to exercise any powers, the exercise of which would cause my
assets to be considered as taxable in my Agent’s estate for federal estate tax or
any state’s inheritance or estate tax.
18. Interpretation and Governing Law
This document is to be interpreted under Michigan law as a general durable power of
attorney. Paragraph headings are for convenience only and must not be used to interpret this
document. Statements of specific powers do not restrict general powers granted to my Agent.
19. Third-Party Reliance
Third parties have the right to rely on my Agent’s representation of any power that I have
granted to my Agent. Any person who relies on these representations will not be liable to me or
my estate for his reliance. To induce third parties to rely on this Power, I warrant that if this
Power is revoked by me or otherwise terminated, I will indemnify any third party from any loss
suffered or liability incurred in good faith reliance on the authority of my Agent before the third
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party knows of revocation or termination. This warranty binds my personal representatives and
successors.
20. Photographic Copies
My Agent has the right to make copies of this Power, and anyone has the right to rely on
these copies as though they were originals. Anyone who relies on my Agent’s representations,
or on a copy of this Power, will not be liable for permitting my Agent to act under this Power.
21. Power of Substitution
My Agent shall perform all and every act and thing whatsoever requisite and necessary to
be done, as fully to all intents and purposes as I might or could do if personally present, with full
power of substitution or revocation. I hereby ratify and confirm all that my Agent, or my
Agent’s substitute or substitutes, shall lawfully do or cause to be done by virtue hereof.
22. Termination
This Power will not be affected by my disability or by any uncertainty as to whether I am
alive, but will be terminated by my written revocation or by my death.
23. HIPAA Authorization
This instrument is meant to be an unlimited, full and complete authorization for the
release of any and all protected medical information as defined under the Health Insurance
Portability and Accountability Act of 1996 (“HIPAA”), 42 USC 1320d and 45 CFR 160-164, as
amended, and under the rules and regulations thereunder, and covers all protected information.
It is understood that my attorney to whom this authorization is given has my permission to use
and disseminate this information in my attorney’s sole discretion.
a. I intend for my attorney to be treated as I would be 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 HIPAA.
b. I authorize any physician, health care professional, dentist, health plan, hospital,
clinic, laboratory, pharmacy or other covered health care provider, any insurance
company and the Medical Information Bureau, Inc. or other health care
clearinghouse that has provided treatment or services to me or that has paid for or
is seeking payment from me for such services to give, disclose and release to my
attorney, without restriction, all my individually identifiable health information
and medical records, including all information relating to the diagnosis and
treatment of HIV/AIDS, sexually transmitted diseases, mental illness and drug or
alcohol abuse.
c. The authority given my attorney shall supersede any prior agreement that I may
have made with my health care providers to restrict access to or disclosure of my
individually identifiable health information.
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d. The authority given my attorney 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.
24. Alternate Attorney-In-Fact
In the event _______________ is unable to act for any reason whatsoever, then I appoint
__________________, of ________________, Michigan, as my attorney-in-fact with full power
and authority to act under this Power of Attorney.
25. Revocations.
I hereby revoke any and all prior General Durable Powers of Attorney executed by me.
Date:
Witnessed by: Signed by:
_______________________________ ____________________________________
_______________________________
Acknowledged before me in Oakland County, Michigan, on ____________________, by
______________________________.
Notary Stamp: Notary Signature:
____________________________________
1945-7.bus
