Illinois Durable Power of Attorney Template
This Durable Power of Attorney ("Document") is created pursuant to the Illinois Power of Attorney Act (755 ILCS 45/1-1 et seq.). It allows you, the Principal, to designate an individual, referred to as the Agent, to make decisions on your behalf. This Document remains effective in the event you become incapacitated or disabled.
1. Principal Information:
Full Name: ___________________________
Address: _____________________________
City, State, Zip: ______________________
Phone Number: ________________________
2. Agent Information:
Full Name: ___________________________
Address: _____________________________
City, State, Zip: ______________________
Phone Number: ________________________
3. Successor Agent Information (Optional):
If the initial Agent is unable or unwilling to serve, the Successor Agent will take over these duties.
Full Name: ___________________________
Address: _____________________________
City, State, Zip: ______________________
Phone Number: ________________________
4. Powers Granted:
This Document grants the Agent the authority to act on your behalf regarding the following matters (initial next to each power you wish to grant):
- ____ 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 military service
- ____ Retirement plan transactions
- ____ Tax matters
5. Durable Nature of Power of Attorney:
This Power of Attorney shall continue to be effective in the event that I become disabled, incapacitated, or incompetent.
6. Effective Date and Signatures:
This Document becomes effective immediately upon the date of signing, unless otherwise specified:
Effective Date: ________________________
Principal's Signature: ____________________ Date: _____________
Agent's Signature: ______________________ Date: _____________
Successor Agent's Signature (If Applicable): ____________________ Date: _____________
7. Acknowledgement of Notary Public:
State of Illinois
County of _______________
On this day, before me appeared _______________ [Principal], to me known to be the person(s) described in and who executed the foregoing instrument, and acknowledged that he/she/they executed the same as his/her/their free act and deed.
Notary Signature: ________________________
Date: __________________
My Commission Expires: _________________