Tennessee Durable Power of Attorney
This document grants another individual the right to act on your behalf in matters you specify. Its durability means it remains in effect even if you become incapacitated. This document is governed by the Tennessee Uniform Durable Power of Attorney Act.
Principal Information
Name: ___________________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Phone Number: ____________________________________________
Agent Information
Name: ___________________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Phone Number: ____________________________________________
In accordance with the Tennessee Uniform Durable Power of Attorney Act, I appoint the above-named Agent to act on my behalf in all matters that I specify below. This authority shall continue to be effective even if I become disabled, incapacitated, or incompetent.
Powers Granted
Check the powers you are granting to your Agent:
- ___ 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
Other powers granted: _________________________________________________________________
_______________________________________________________________________________________
Special Instructions
Special instructions for your Agent that limit or extend the powers granted above, if any:
_______________________________________________________________________________________
_______________________________________________________________________________________
By signing below, I affirm that the individual named as Agent is someone I trust to manage my affairs in my best interest. I acknowledge this document does not revoke any powers of attorney that were effective before the date this document is signed. I understand that this Durable Power of Attorney is not terminated by subsequent incapacity of the Principal except as provided by the Tennessee Uniform Durable Power of Attorney Act.
This Power of Attorney shall become effective on the date of ______________, 20_____, and shall remain effective indefinitely unless I specify a termination date here: _________________, 20_____.
Signature of Principal: _______________________________ Date: ______________, 20_____
This document was signed in the presence of:
Witness 1
Name: ___________________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Signature: _______________________________ Date: ______________, 20_____
Witness 2
Name: ___________________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Signature: _______________________________ Date: ______________, 20_____
Notarization (if required or desired):
This document was acknowledged before me on (date) _____________, 20_____, by (name of Principal) ________________________, who is personally known to me or has produced identification in the form of ___________________________.
Signature of Notary Public: _____________________________________
My commission expires: _____________, 20_____