Fillable Printable Power of Attorney for Financial and Property - Wisconsin
Fillable Printable Power of Attorney for Financial and Property - Wisconsin
Power of Attorney for Financial and Property - Wisconsin
State of Wisconsin
Department of Health Services
Wisconsin.gov
This Power of Attorney for Finances form allows you to plan for future financial decision-making even if you
are unable to make your own decisions. More information is available to assist you in filling out this form
1
.
This form is not the answer for everyone. Only select someone you trust to be your agent. You may wish
to consult with an attorney to explore other financial planning tools such as a Power of Attorney for
Finances drafted by an attorney, or special accounts or trusts.
This is an important legal document. Do not sign it until you, and your chosen agent, understand the
powers being granted. By signing this document, you are not giving up any powers or rights to control your
finances or property. Instead, you are giving your agent, in addition to yourself, the authority to handle your
finances and property. While it is not required that you sign this document in the presence of a notary,
acknowledged signatures create a lawful presumption of genuineness and will be more easily accepted by
businesses and financial institutions.
This document is effective immediately when executed unless you state a future date or occurrence that will
activate the powers expressed in this form.
This Power of Attorney for Finances is “durable” (does not terminate upon the principal’s incapacity) unless
you specifically state that it terminates if you become incapacitated.
If you name your spouse or domestic partner as your agent and the marriage or domestic partnership is
terminated (annulment or divorce), this document becomes invalid unless the special instructions in this
document state that such an action will not terminate the authority given to the agent.
If you used a former state Power of Attorney for Finances form, that form is still valid. Executing a new
Power of Attorney for Finances does not, automatically, revoke a prior document.
If you wish to change this Power of Attorney for Finances in the future, you must complete a new document
and revoke this one. You may revoke this document at any time; a suggested method is a written and
dated statement expressing your intent to revoke this document. If you revoke this document, you should
notify your agent and any other persons or entities that have a copy.
In general, an agent who is not the principal’s spouse or domestic partner may not use the principal’s
property for the benefit of the agent or a person to whom the agent owes an obligation of support. Gifting to
others is also generally not allowed
2
.
Your agent is entitled to reasonable compensation unless you state otherwise in the special instructions.
This document does not give your agent the power to make medical, long-term care or other health care
decisions for you.
Once your Power of Attorney for Finances form is completed and signed, send a copy of this document to
your financial contacts (e.g. your bank, stockbroker, mortgage company, insurance agent, etc.) Give a copy
to your agent and alternate agents as well as to trustworthy family members and/or to your attorney. Finally
place a copy in a safe place in your home along with a list of who has a copy of the document.
1
Coalition of Wisconsin Aging Groups: Guardianship Support Center (www.cwag.org)
2
For more information on gifting, see Wis. Stats. §244.57
Recording Area Ç
Name and Return Address
WISCONSIN STATUTORY
POWER OF ATTORNEY FOR
FINANCES AND PROPERTY
IMPORTANT INFORMATION
This Power of Attorney authorizes another person (your agent)
to make decisions concerning your property for you (the
principal). Your agent will be able to make decisions and act
with respect to your property (including your money) whether
or not you are able to act for yourself. The meaning of
authority over subjects listed on this form is explained in the
Uniform Power of Attorney for Finances and Property Act in
Chapter 244 of the Wisconsin Statutes.
This Power of Attorney does not authorize the agent to make
health-care decisions for you.
You should select someone you trust to serve as your agent.
Unless you specify otherwise, generally the agent’s authority will
continue until you die or revoke the Power of Attorney or the agent
resigns or is unable to act for you.
Parcel Identification Number (if any)
Your agent is entitled to reasonable compensation unless you state otherwise in the special instructions.
This form provides for designation of one agent. If you wish to name more than one agent, you may name
a co-agent in the special instructions. Co-agents are not required to act together unless you include that
requirement in the special instructions.
If your agent is unable or unwilling to act for you, your Power of Attorney will end unless you have named
a successor agent. You may also name a 2
nd
successor agent.
This Power of Attorney becomes effective immediately unless you state otherwise in the special
instructions. This Power of Attorney does not revoke any Power of Attorney executed previously unless
you so provide in the special instructions.
If you revoke this Power of Attorney, you should notify your agent and any other person to whom you have
given a copy. If your agent is your spouse or domestic partner and your marriage is annulled or you are
divorced or legally separated or the domestic partnership is terminated after signing this document, the
document is invalid.
If you have questions about the Power of Attorney or the authority you are granting to your agent, you
should seek legal advice before signing this form.
DEPARTMENT OF HEALTH SERVICES
Division of Public Health
F-00036 (Rev. 09/10)
STATE OF WISCONSIN
Effective Date September 1, 2010
s. 244.06 (1), Wisconsin Statutes
DESIGNATION OF AGENT
I, (name of principal), name the following person as my agent:
Name of agent:
Agent’s address:
Agent’s telephone number:
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)
If my agent is unable or unwilling to act for me, I name as my successor agent:
Name of successor agent:
Successor agent’s address:
Successor agent’s telephone number:
If my successor agent is unable or unwilling to act for me, I name as my 2
nd
successor agent:
Name of 2
nd
successor agent:
Second successor agent’s address:
Second successor agent’s telephone number:
GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me with respect to the following subjects
as defined (see Appendix) in the Uniform Power of Attorney for Finances and Property Act in chapter 244 of
the Wisconsin statutes:
(INITIAL each subject you want to include in the agent’s general authority.)
Real property
Tangible personal property
Stocks and bonds
Commodities and options
Banks and other financial institutions
Operation of entity or business
Insurance and annuities
Estates, trusts, and other beneficial interests
Claims and litigation
Personal and family maintenance
Benefits from governmental programs or civil or military service
Retirement plans
Taxes
Page 2 Wisconsin Power of Attorney for Finances and Property
F-00036 (Rev. 09/10)
LIMITATION ON AGENT’S AUTHORITY
An agent who is not my spouse or domestic partner MAY NOT use my property to benefit the agent or a
person to whom the agent owes an obligation of support unless I have included that authority in the special
instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions in the following space
EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the special instructions.
NOMINATION OF GUARDIAN (OPTIONAL)
If it becomes necessary for a court to appoint a guardian of my estate or guardian of my person, I nominate the
following person(s) for appointment:
Name of nominee for guardian of my estate:
Nominee’s address:
Nominee’s telephone number:
Name of nominee for guardian of my person:
Nominee’s address:
Nominee’s telephone number:
Page 3 Wisconsin Power of Attorney for Finances and Property
F-00036 (Rev. 09/10)
RELIANCE ON THIS POWER OF ATTORNEY FOR FINANCES AND PROPERTY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that
person knows that the power of attorney has been terminated or is invalid.
SIGNATURE AND ACKNOWLEDGMENT
Your signature Date
Your name printed
Your address:
Your telephone number:
State of: County of:
This document was acknowledged before me on
Date by name of principal
(Seal, if any)
Signature of notary
Name of notary (typed or printed)
My commission expires:
This document prepared by:
Page 4 Wisconsin Power of Attorney for Finances and Property
F-00036 (Rev. 09/10)
IMPORTANT INFORMATION FOR AGENT
AGENT’S DUTIES
When you accept the authority granted under this Power of Attorney, a special legal relationship is created
between you and the principal. This relationship imposes upon you legal duties that continue until you resign
or the Power of Attorney is terminated or revoked. You must do all the following:
(1) Do what you know the principal reasonably expects you to do with the principal’s property or, if you do not
know the principal’s expectations, act in the principal’s best interest.
(2) Act in good faith.
(3) Do nothing beyond the authority granted in this Power of Attorney.
(4) Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the
principal and signing your own name as “agent” in the following manner:
(principal’s name) by (your signature) as agent
Unless the special instructions in the Power of Attorney state otherwise, you must also do all the following:
(1) Act loyally for the principal’s benefit.
(2) Avoid conflicts that would impair your ability to act in the principal’s best interest.
(3) Act with care, competence, and diligence.
(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal.
(5) Cooperate with any person that has authority to make health-care decisions for the principal to do what you
know the principal reasonably expects or, if you do not know the principal’s expectations, to act in the
principal’s best interest.
(6) Attempt to preserve the principal’s estate plan if you know the plan and preserving the plan is consistent
with the principal’s best interest.
TERMINATION OF AGENT’S AUTHORITY
You must stop acting on behalf of the principal if you learn of any event that terminates this Power of Attorney
or your authority under this Power of Attorney. Events that terminate a Power of Attorney or your authority to
act under a Power of Attorney include all the following:
(1) Death of the principal
(2) The principal’s revocation of the Power of Attorney or your authority.
(3) The occurrence of a termination event stated in the Power of Attorney.
(4) The purpose of the Power of Attorney is fully accomplished.
(5) If you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal
separation, unless the special instructions in this Power of Attorney state that such an action will not
terminate your authority.
(6) If you are the principal’s domestic partner and your domestic partnership is terminated, unless the special
instructions in this Power of Attorney state that such an action will not terminate your authority.
Page 5 Wisconsin Power of Attorney for Finances and Property
F-00036 (Rev. 09/10)
LIABILITY OF AGENT
The meaning of the authority granted to you is defined in the Uniform Power of Attorney for Finances and
Property Act in Chapter 244 of the Wisconsin Statutes. If you violate the Uniform Power of Attorney for
Finances and Property Act in Chapter 244 of the Wisconsin Statutes or act outside the authority granted, you
may be liable for any damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you should seek legal
advice.
OPTIONAL SIGNATURE OF AGENT
I have read and accept the duties and liabilities of the agent as specified in this Power of Attorney.
Agent’s signature Date
Attached:
(1) Agent’s certification as to the validity of Power of Attorney for Finances and Property and agent’s
authority (Optional).
(2) Appendix: Power of Attorney for Finances and Property Statutory Authority Definitions (Optional).
Page 6 Wisconsin Power of Attorney for Finances and Property
F-00036 (Rev. 09/10)
The following optional form may be used by an agent to certify facts
concerning a power of attorney for finances and property:
AGENT’S CERTIFICATION AS TO THE VALIDITY OF
POWER OF ATTORNEY FOR FINANCES AND PROPERTY AND AGENT’S AUTHORITY
State of:
County of:
I, (name of agent), certify under penalty of perjury that
(name of principal) granted me authority as an agent or
successor agent in a power of attorney dated .
I further certify that to my knowledge:
(1) The principal is alive and has not revoked the power of attorney or my authority to act under the power of
attorney, and the power of attorney and my authority to act under the power of attorney have not
terminated.
(2) If the power of attorney was drafted to become effective upon the happening of an event or contingency,
the event or contingency has occurred.
(3) If I was named as a successor agent, the prior agent is no longer able or willing to serve.
(4)
(insert other relevant statements)
SIGNATURE AND ACKNOWLEDGMENT
Agent’s signature Date
Agent’s name printed
Agent’s address:
Agent’s telephone number:
State of: County of:
This document was acknowledged before me on
Date by (name of agent)
(Seal, if any)
Signature of notary
Name of notary (typed or printed)
My commission expires:
This document prepared by:
Page 7 Wisconsin Power of Attorney for Finances and Property
F-00036 (Rev. 09/10)
APPENDIX
Power of Attorney for Finances and Property
Statutory Authority Definitions
(6) Use, develop, alter, replace, remove, erect, or
install structures or other improvements upon real
property in or incident to which the principal has, or
claims to have, an interest or right.
244.44 Real property. Unless the power of
attorney otherwise provides, language in a power of
attorney granting general authority with respect to
real property authorizes the agent to do all of the
following:
(7) Participate in a reorganization with respect to
real property or an entity that owns an interest in or
right incident to real property and receive, hold, and
act with respect to stocks and bonds or other
property received in a plan of reorganization,
including by doing any of the following:
(1) Demand, buy, lease, receive, accept as a gift or
as security for an extension of credit, or otherwise
acquire or reject an interest in real property or a
right incident to real property.
(2) Sell; exchange; convey with or without
covenants, representations, or warranties; quit
claim; release; surrender; retain title for security;
encumber; partition; consent to partitioning; subject
to an easement or covenant; subdivide; apply for
zoning or other governmental permits; plat or
consent to platting; develop; grant an option
concerning; lease; sublease; contribute to an entity
in exchange for an interest in that entity; or
otherwise grant or dispose of an interest in real
property or a right incident to real property.
(a) Selling or otherwise disposing of the stocks,
bonds, or property.
(b) Exercising or selling an option, right of
conversion, or similar right with respect to the
stocks, bonds, or property.
(c) Exercising any voting rights in person or by
proxy.
(8) Change the form of title of an interest in or right
incident to real property.
(9) Dedicate to public use, with or without
consideration, easements or other real property in
which the principal has, or claims to have, an
interest.
(3) Pledge or mortgage an interest in real property
or right incident to real property as security to
borrow money or pay, renew, or extend the time of
payment of a debt of the principal or a debt
guaranteed by the principal.
(4) Release, assign, satisfy, or enforce by any
lawful means a mortgage, deed of trust, conditional
sale contract, encumbrance, lien, or other claim to
real property which exists or is asserted.
244.45 Tangible personal property. Unless the
power of attorney otherwise provides, language in a
power of attorney granting general authority with
respect to tangible personal property authorizes
the agent to do all of the following:
(5) Manage or conserve an interest in real property
or a right incident to real property owned or claimed
to be owned by the principal, including by doing any
of the following:
(1) Demand, buy, receive, accept as a gift or as
security for an extension of credit, or otherwise
acquire or reject ownership or possession of
tangible personal property or an interest in tangible
personal property.
(a) Insuring against liability or casualty or other
loss.
(2) Sell; exchange; convey with or without
covenants, representations, or warranties; quit
claim; release; surrender; create a security interest
in; grant options concerning; lease; sublease; or
otherwise dispose of tangible personal property or
an interest in tangible personal property.
(b) Obtaining or regaining possession of or
protecting the interest or right by litigation or
otherwise.
(c) Paying, assessing, compromising, or contesting
taxes or assessments or applying for and receiving
refunds in connection with taxes or assessments.
(d) Purchasing supplies, hiring assistance or labor,
and making repairs or alterations to the real
property.
Page 1 Power of Attorney for Finances Appendix – Statutory Authority Definitions
(3) Grant a security interest in tangible personal
property or an interest in tangible personal property
as security to borrow money or pay, renew, or
extend the time of payment of a debt of the
principal or a debt guaranteed by the principal.
(4) Release, assign, satisfy, or enforce by litigation
or otherwise, a security interest, lien, or other claim
on behalf of the principal, with respect to tangible
personal property or an interest in tangible personal
property.
(5) Manage or conserve tangible personal property
or an interest in tangible personal property on
behalf of the principal, including by doing any of the
following:
(a) Insuring against liability or casualty or other
loss.
(b) Obtaining or regaining possession of or
protecting the property or interest, by litigation or
otherwise.
(c) Paying, assessing, compromising, or contesting
taxes or assessments or applying for and receiving
refunds in connection with taxes or assessments.
(d) Moving the property from place to place.
(e) Storing the property for hire or under a
gratuitous bailment.
(f) Using and making repairs, alterations, or
improvements to the property.
(6) Change the form of title of an interest in tangible
personal property.
244.46 Stocks and bonds. Unless the power of
attorney otherwise provides, language in a power of
attorney granting general authority with respect to
stocks and bonds authorizes the agent to do all of
the following:
(1) Buy, sell, and exchange stocks and bonds.
(2) Establish, continue, modify, or terminate an
account with respect to stocks and bonds.
(3) Pledge stocks and bonds as security to borrow,
pay, renew, or extend the time of payment of a debt
of the principal.
(4) Receive certificates and other evidences of
ownership with respect to stocks and bonds.
(5) Exercise voting rights with respect to stocks and
bonds in person or by proxy, enter into voting
trusts, and consent to limitations on the right to
vote.
(6) Exercise in person or by proxy, or enforce by
litigation or otherwise, a right, power, privilege, or
option the principal has or claims to have as the
holder of stocks and bonds.
(7) Initiate, participate in, submit to alternative
dispute resolution, settle, oppose, or propose or
accept a compromise with respect to litigation to
which the principal is a party concerning stocks and
bonds.
244.47 Commodities and options. Unless the
power of attorney otherwise provides, language in a
power of attorney granting general authority with
respect to commodities and options authorizes the
agent to do all of the following:
(1) Buy, sell, exchange, assign, settle, and exercise
commodity futures contracts and call or put options
on stocks or stock indexes traded on a regulated
option exchange.
(2) Establish, continue, modify, and terminate
option accounts.
244.48 Banks and other financial institutions.
Unless the power of attorney otherwise provides,
language in a power of attorney granting general
authority with respect to banks and other financial
institutions authorizes the agent to do all of the
following:
(1) Continue, modify, and terminate an account or
other banking arrangement made by or on behalf of
the principal.
(2) Establish, modify, and terminate an account or
other banking arrangement with a bank, trust
company, savings and loan association, credit
union, thrift company, brokerage firm, or other
financial institution selected by the agent.
(3) Contract for services available from a financial
institution, including renting a safe deposit box or
space in a vault.
Page 2 Power of Attorney for Finances Appendix – Statutory Authority Definitions
(4) Withdraw, by check, order, electronic funds
transfer, or otherwise, money or property of the
principal deposited with or left in the custody of a
financial institution.
(5) Receive statements of account, vouchers,
notices, and similar documents from a financial
institution and act with respect to them.
(6) Enter a safe deposit box or vault and withdraw
or add to the contents.
(7) Borrow money and pledge as security personal
property of the principal necessary to borrow
money or pay, renew, or extend the time of
payment of a debt of the principal or a debt
guaranteed by the principal.
(8) Make, assign, draw, endorse, discount,
guarantee, and negotiate promissory notes,
checks, drafts, and other negotiable or
nonnegotiable paper of the principal or payable to
the principal or the principal’s order; transfer
money, receive the cash or other proceeds of those
transactions; and accept a draft drawn by a person
upon the principal and pay it when due.
(9) Receive for the principal and act upon a sight
draft, warehouse receipt, or other document of title
whether tangible or electronic, or other negotiable
or nonnegotiable instrument.
(10) Apply for, receive, and use letters of credit,
credit and debit cards, electronic transaction
authorizations, and traveler’s checks from a
financial institution and give an indemnity or other
agreement in connection with letters of credit.
(11) Consent to an extension of the time of
payment with respect to commercial paper or a
financial transaction with a financial institution.
244.49 Operation of entity or business. Subject
to the terms of a document or an agreement
governing an entity or business or an entity or
business ownership interest, and unless the power
of attorney otherwise provides, language in a power
of attorney granting general authority with respect
to operation of an entity or business authorizes the
agent to do all of the following:
(1) Operate, buy, sell, enlarge, reduce, or terminate
an ownership interest.
(2) Perform a duty or discharge a liability and
exercise in person or by proxy a right, power,
privilege, or option that the principal has, may have,
or claims to have.
(3) Enforce the terms of an ownership agreement.
(4) Initiate, participate in, submit to alternative
dispute resolution, settle, oppose, or propose or
accept a compromise with respect to litigation to
which the principal is a party because of an
ownership interest.
(5) Exercise in person or by proxy, or enforce by
litigation or otherwise, a right, power, privilege, or
option the principal has or claims to have as the
holder of stocks and bonds.
(6) Initiate, participate in, submit to alternative
dispute resolution, settle, oppose, or propose or
accept a compromise with respect to litigation to
which the principal is a party concerning stocks and
bonds.
(7) With respect to an entity or business owned
solely by the principal, do all of the following:
(a) Continue, modify, renegotiate, extend, and
terminate a contract made by or on behalf of the
principal with respect to the entity or business
before execution of the power of attorney.
(b) Determine all of the following:
1. The location of its operation.
2. The nature and extent of its business.
3. The methods of manufacturing, selling,
merchandising, financing, accounting, and
advertising employed in its operation.
4. The amount and types of insurance carried.
5. The mode of engaging, compensating, and
dealing with its employees and accountants,
attorneys, or other advisors.
(c) Change the name or form of organization under
which the entity or business is operated and enter
into an ownership agreement with other persons to
take over all or part of the operation of the entity or
business.
Page 3 Power of Attorney for Finances Appendix – Statutory Authority Definitions
