Wyoming Durable Power of Attorney
This Durable Power of Attorney is established in accordance with the Wyoming Uniform Power of Attorney Act (Wyoming Statutes, Title 3, Chapter 9). It grants the authority to an individual, known as the Agent, to make decisions and act on behalf of the Principal.
The powers granted by this document become effective immediately and will remain in effect even if the Principal becomes incapacitated, unless explicitly stated otherwise in this document.
Principal Information:
- Full Name: _____________________________
- Physical Address: _______________________, _______________________, Wyoming, Zip Code: ________
- Date of Birth: __________________________
Agent Information:
- Full Name: _____________________________
- Physical Address: _______________________, _______________________, Wyoming, Zip Code: ________
- Contact Number: ________________________
Alternate Agent Information (Optional):
To act if the primary Agent is unable, unwilling, or unavailable to serve.
- Full Name: _____________________________
- Physical Address: _______________________, _______________________, Wyoming, Zip Code: ________
- Contact Number: ________________________
Powers Granted:
Select the areas in which the Agent will have authority to act on behalf of the Principal by initialing next to each applicable power.
- Real Property Transactions: __________
- Tangible Personal Property Transactions: __________
- Stock and Bond Transactions: __________
- Commodity and Option Transactions: __________
- Banking and Financial Service Operations: __________
- 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: __________
Special Instructions: (Optional)
Use the space below to specify any limitations on the Agent's powers or to provide additional instructions.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
This Power of Attorney will continue to be effective if I become disabled, incapacitated, or incompetent.
Signatures:
This document must be signed by the Principal in the presence of a Notary Public or two (2) witnesses not related by blood or marriage and not entitled to any portion of the Principal’s estate under a will or codicil.
Principal's Signature: _________________________, Date: ________________
Agent's Signature: ____________________________, Date: ________________
Alternate Agent's Signature (if applicable): ____________________________, Date: ________________
Witness #1 Signature: _________________________, Date: ________________
Witness #2 Signature: _________________________, Date: ________________
Notary Public: (This section to be completed by a Notary Public)
State of Wyoming )
County of ____________ )
Subscribed and sworn to (or affirmed) before me on this ____ day of _____________, 20__, by ____________________________, 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 have hereunto set my hand and notarial seal.
Notary Public: _________________________
My commission expires: ________________