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Home
Annuities
What is an Annuity?
Fixed Annuities
Fixed Indexed Annuities
CD Annuities
Income Rider
Income Calculator
Insurance
Term Life Insurance
Indexed
Universal Life Insurance
Long-Term Care
Life Insurance with Long Term Care Rider
Estate Planning
Revocable Living Trusts
Irrevocable Trusts
Special Needs Trusts
Life Insurance Trusts
Trust Amendments
Trust Restatements
Wills
Codicils
Deeds (Property Transfer)
Beneficiary Deeds
Financial Power of Attorney
Advanced Health Care Directives
Mental Health Care Power of Attorney
Estate Settlement
Tax Planning
Tools
Useful Links
Tax Resources
Glossary
Calculators
Client Intake Form
The Retiretastic Show
Search for:
Power of Attorney
Step
1
of
5
20%
Section A:
Client Personal Information
Client 1
Name
*
Date of Birth
*
Email
*
Marital Status
*
Married
Divorced
Widowed
Previously Divorced
Citizenship
*
US
Other
Client 1 Citizenship Other
*
Home Phone #
*
Work Phone #
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
County
*
Client 2
Name
Date of Birth
Email
Marital Status
Married
Divorced
Widowed
Previously Divorced
Citizenship
US
Other
Client 2 Citizenship Other
Section B:
Durable Power of Attorney for Asset Management
In the event you become incapacitated, the person(s) you have chosen as Power of Attorney, or “Attorney in Fact,” is to act on your behalf in managing your assets that have not been put into your trust. Your spouse would ordinarily be named as Primary Agent.
The Agent(s) named
*
The Agent(s) named are to serve in order listed
The Agent(s) named are to serve together (jointly)
Power of Attorney for Client 1:
Durable POA Assets Client 1 Spouse
Spouse or:
Name
I or IC
I
IC
Name
I or IC
I
IC
Name
I or IC
I
IC
Power of Attorney for Client 2:
Durable POA Assets Client 2 Spouse
Spouse or:
Name
I or IC
I
IC
Name
I or IC
I
IC
Name
I or IC
I
IC
Section C:
Durable Power of Attorney for Health Care
In the event you become incapacitated, the person(s) you have chosen as Power of Attorney, or “Attorney in Fact,” is to act on your behalf in making health care decisions for you. Your spouse would ordinarily be named as Primary Agent.
The Agent(s) named
*
The Agent(s) named are to serve in order listed
The Agent(s) named are to serve together (jointly)
Power of Attorney for Client 1:
Durable POA Health Client 1 Spouse
Spouse or:
Name
Phone
Name
Phone
Name
Phone
Remains
Cremation
Burial
Power of Attorney for Client 2:
Spouse
Spouse or:
Name
Phone
Name
Phone
Name
Phone
Remains
Cremation
Burial
Section D:
Tell Us More
Untitled
ACKNOWLEDGMENT:
I/We have read the information on this application and confirm that it is true and correct.
Client 1 Signature
*
Date
*
Client 2 Signature
Date
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