Connecticut Durable Power of Attorney
This Durable Power of Attorney ("Agreement") is created and entered into this ____ [day] of ____ [month], ____ [year], pursuant to the Connecticut Uniform Power of Attorney Act (Sections 1-350 to 1-353b of the Connecticut General Statues). By this document, the principal, whose signature appears below, designates the person(s) named below as their attorney(s)-in-fact.
1. Principal Information
Full Name: _____________________________
Address: _____________________________
City, State, Zip: Connecticut, _____________
Telephone Number: _____________________________
2. Attorney(s)-in-Fact
By this document, the principal appoints the following individual(s) as attorney(s)-in-fact to make decisions on their behalf should they become disabled or legally incompetent. It is important to choose someone trustworthy, as they will have broad powers to manage your affairs.
Primary Attorney-in-Fact Name: _____________________________
Address: _____________________________
City, State, Zip: _____________________________
Telephone Number: _____________________________
Successor Attorney-in-Fact Name (optional): _____________________________
Address: _____________________________
City, State, Zip: _____________________________
Telephone Number: _____________________________
3. Powers Granted
The principal grants their attorney(s)-in-fact powers to act in their stead in matters relating to:
- Real property transactions.
- Tangible personal property transactions.
- Stock and bond transactions.
- Commodity and option transactions.
- Banking and other financial institution transactions.
- Business operating transactions.
- Insurance and annuity transactions.
- Estate, trust, and other beneficiary transactions.
- Claims and litigation.
- Personal and family maintenance.
- Benefits from social security, Medicare, Medicaid, or other governmental programs, or civil or military service.
- Retirement plan transactions.
- Tax matters.
4. Special Instructions
If the principal wishes to limit the powers or set specific requirements for the attorney(s)-in-fact, they should describe these below:
____________________________________________________________________________________
____________________________________________________________________________________
5. Durable Power of Attorney
This power of attorney shall not be affected by subsequent disability or incapacity of the principal or lapse of time. This is a Durable Power of Attorney and will continue to be effective even if the principal becomes disabled, incapacitated, or incompetent.
6. Signatures
Principal's Signature: _____________________________ Date: ________________
Attorney(s)-in-Fact Signature: _____________________________ Date: ________________
Successor Attorney(s)-in-Fact Signature (if applicable): _____________________________ Date: ________________
7. Acknowledgment by Notary Public
This document was acknowledged before me on ____ [date] by ____ [name of principal].
Name of Notary: _____________________________
Notary Public Signature: _____________________________
My commission expires: ____.