Pennsylvania Durable Power of Attorney
This Pennsylvania Durable Power of Attorney is created pursuant to the Pennsylvania Consolidated Statutes, Title 20, Chapter 56, known as the Decedents, Estates, and Fiduciaries Code. Its purpose is to designate an individual, known as the Agent, to make decisions on behalf of another, known as the Principal, concerning financial, property, and health matters when the Principal is unable to do so due to incapacity or any other reason.
Part 1: Principal Information
Full Name of Principal: ___________________________________________
Date of Birth: ___________________________________________________
Address: ________________________________________________________
City: ___________________________________ State: PA Zip Code: ____________
Part 2: Agent Information
Full Name of Agent: _____________________________________________
Relationship to Principal: _______________________________________
Address: ________________________________________________________
City: ___________________________________ State: __________ Zip Code: __________
Part 3: Powers Granted
This Durable Power of Attorney grants the Agent authority to act on the Principal’s behalf in the following areas:
- Real property transactions
- Tangible personal property transactions
- Stock and bond transactions
- Commodity and option transactions
- Banking and financial service transactions
- Business operating transactions
- Insurance and annuity transactions
- Estate, trust, and other beneficiary transactions
- Claims and litigation
- Personal and family maintenance
- Benefits from governmental programs or civil or military service
- Retirement plan transactions
- Tax matters
Part 4: Signatures
The effectiveness of this Durable Power of Attorney is not affected by the Principal’s subsequent incapacity. This document shall remain in effect until the Principal’s death unless revoked earlier by the Principal.
Date: ___________________________________________
Principal's Signature: __________________________________________
The Principal’s signature must be notarized for this Durable Power of Attorney to be effective.
State of Pennsylvania
County of _________________
On this day, ___________________ (date), before me, a Notary Public, personally appeared _____________________________________ (name of Principal), known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand.
Notary Public's Signature: ________________________________________
My Commission Expires: __________________________________________
Part 5: Agent’s Acknowledgement
I, ___________________________________ (name of Agent), hereby acknowledge that I have been appointed as Agent under this Durable Power of Attorney. I understand my duties under this role and pledge to act to the best of my abilities and in the Principal’s best interest.
Date: ________________________________
Agent's Signature: ________________________________