MAKE YOUR FREE Illinois Power of Attorney

NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS

STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY

 

PLEASE READ THIS NOTICE CAREFULLY. The form that you will be signing is a legal document. It is governed by the Illinois Power of Attorney Act. If there is anything about this form that you do not understand, you should ask a lawyer to explain it to you.

 

The purpose of this Power of Attorney is to give your designated "agent" broad powers to handle your financial affairs, which may include the power to pledge, sell, or dispose of any of your real or personal property, even without your consent or any advance notice to you.

 

This form does not impose a duty upon your agent to handle your financial affairs, so it is important that you select an agent who will agree to do this for you. It is also important to select an agent whom you trust, since you are giving that agent control over your financial assets and property. Any agent who does act for you has a duty to act in good faith for your benefit and to use due care, competence, and diligence. He or she must also act in accordance with the law and with the directions in this form. Your agent must keep a record of all receipts, disbursements, and significant actions taken as your agent.

 

Unless you specifically limit the period of time that this Power of Attorney will be in effect, your agent may exercise the powers given to him or her throughout your lifetime, both before and after you become incapacitated. A court, however, can take away the powers of your agent if it finds that the agent is not acting properly. You may also revoke this Power of Attorney if you wish.

 

This Power of Attorney does not authorize your agent to appear in court for you as an attorney-at-law or otherwise to engage in the practice of law unless he or she is a licensed attorney who is authorized to practice law in Illinois.

 

The powers you give your agent are explained more fully in Section 3-4 of the Illinois Power of Attorney Act. This form is a part of that law. The "NOTE" paragraphs throughout this form are instructions.

 

You are not required to sign this Power of Attorney, but it will not take effect without your signature. You should not sign this Power of Attorney if you do not understand everything in it, and what your agent will be able to do if you do sign it.

 

Please place your initials on the following line indicating that you have read this Notice:

 

________ Principal's Initials

 

 

I, , residing at , , , hereby appoint Each Agent may act independently, without the consent of the other Agent. The Agents must act jointly, with the consent of the other Agent. However, if prompt action is required to accomplish the purposes of the Power of Attorney or to avoid irreparable injury to my interests and an Agent is unavailable because of absence, illness, or other temporary incapacity, the other Agent may act for me.

 

or if we become legally separated or divorced, If we become legally separated or divorced, the other Agent shall serve alone. If both Agents are unable to serve (either together or independently) I appoint , , , to act as my Alternate Successor Agent to serve alone. If either Agent is unable to serve for any reason, I appoint , of , , , as my Successor Agent to serve alone. If either Agent is unable to serve for any reason or if we become legally separated or divorced, I appoint , of , , as my Successor Agent to serve alone.

I hereby revoke any and all general powers of attorney that previously have been signed by me. I hereby revoke any and all special powers of attorney that previously have been signed by me. I hereby revoke any and all general powers of attorney and special powers of attorney that previously have been signed by me. However, the preceding sentence shall not have the effect of revoking any powers of attorney that are directly related to my healthcare that previously have been signed by me.

My Agent shall have full power and authority to act on my behalf. This power and authority shall authorize my Agent to manage and conduct all of my affairs and to exercise all of my legal rights and powers, including all rights and powers that I may acquire in the future. My Agent's powers shall include, but not be limited to, authority over:

 

 

My Agent will be entitled to reimbursement for all reasonable expenses incurred in acting under this Power of Attorney.

 

I am fully informed as to all the contents of this form and understand the full import of this grant of powers to my agent.

 

(NOTE: This form does not authorize your agent to appear in court for you as an attorney-at-law or otherwise to engage in the practice of law unless he or she is a licensed attorney who is authorized to practice law in Illinois.)

 

This Power of Attorney is granted in, and shall be governed by the laws of the state of Illinois; however, I intend that this Power of Attorney be universally recognized and that it be universally admissible to recordation. In the event that I become a resident of another jurisdiction, or obtain property, including real property or any other property interest, in another jurisdiction, it remains my intention that the laws of Illinois shall continue to govern this Power of Attorney.

 

This Power of Attorney shall become effective immediately. on . upon written certification by my physician that I am incapacitated or mentally incapable of managing my financial affairs, and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. immediately, and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. on , and shall not be affected by my disability or lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a Durable Power of Attorney. This Power of Attorney shall continue effective until or until I lack sufficient mental competence to understand and handle my financial and personal affairs or until I lack sufficient mental competence to understand and handle my financial and personal affairsThis Power of Attorney may be revoked by me at any time by providing written notice to my Agent.

 

Dated ____________________, ______, at , .

 

 

 

__________________________________

 

 

 

Witness Signature:	___________________________________

Name:

City:

State:

 

 

 

WITNESS ATTESTATION

 

The undersigned witness certifies that , known to me to be the same person whose name is subscribed as Principal to the foregoing Power of Attorney, appeared before me and the notary public and acknowledged signing and delivering the instrument as the free and voluntary act of the Principal, for the uses and purposes therein set forth. I believe him or her to be of sound mind and memory. The undersigned witness also certifies that the witness is not: (a) the attending physician or mental health service provider or a relative of the physician or provider; (b) an owner, operator, or relative of an owner or operator of a healthcare facility in which the Principal is a patient or resident; (c) a parent, sibling, descendant, or any spouse of such parent, sibling, or descendant of either the Principal or any Agent or Successor Agent under the foregoing Power of Attorney, whether such relationship is by blood, marriage, or adoption; or (d) an Agent or Successor Agent under the foregoing Power of Attorney.

 

Dated:___________

 

 

___________________________________

,

 

STATE OF ,

COUNTY OF , ss:

 

This instrument was acknowledged before me on this _____ day of ____________________, ______ by .

 

 

_________________________________

Notary Public

 

My commission expires _____________

 

 

 

This document was prepared by:

Notice to Person Executing Power of Attorney

 

A Power of Attorney is an important legal document. By signing the Power of Attorney, you are authorizing another person to act for you, the principal. Before you sign this Power of Attorney, you should know these important facts:

 

Your Agent (attorney-in-fact) has no duty to act unless you and your Agent agree otherwise in writing.

 

This document gives your Agent the powers to manage, dispose of, sell and convey your real and personal property, and to use your property as security if your Agent borrows money on your behalf, unless you provide otherwise in this Power of Attorney.

 

Your Agent will have the right to receive reasonable payment for services provided under this Power of Attorney unless you provide otherwise in this Power of Attorney.

 

The powers you give your Agent will continue to exist for your entire lifetime, unless you state that the Power of Attorney will last for a shorter period of time or unless you otherwise terminate the Power of Attorney. The powers you give your Agent in this Power of Attorney will continue to exist even if you can no longer make your own decisions respecting the management of your property, unless you provide otherwise in this Power of Attorney.

 

You can change or correct the terms of this Power of Attorney only by executing a new Power of Attorney, or by executing an amendment through the same formalities as an original. You have the right to revoke or terminate this Power of Attorney at any time, so long as you are competent.

 

This Power of Attorney must be dated and must be acknowledged before a notary public and at least one witness. All witnesses must be mentally competent and they must witness the principal's signing of the Power of Attorney or (2) the principal's signing or acknowledgment of his or her signature. A Power of Attorney that may affect real property should be acknowledged before a notary public so that it may easily be recorded.

 

You should read this Power of Attorney carefully. When effective, this Power of Attorney will give your Agent the right to deal with property that you now have or might acquire in the future. The Power of Attorney is important to you. If you do not understand the Power of Attorney, or any provision of it, then you should obtain the assistance of an attorney or other qualified person.

 

Notice to Agent

 

When you accept the authority granted under this Power of Attorney a special legal relationship, known as agency, is created between you and the Principal. Agency imposes upon you duties that continue until you resign or the Power of Attorney is terminated or revoked. As Agent you must:

 

1.	do what you know the Principal reasonably expects you to do with the Principal's property;

 

2.	act in good faith for the best interest of the Principal, using due care, competence, and diligence;

 

3.	keep a complete and detailed record of all receipts, disbursements, and significant actions conducted for the Principal;

 

4.	attempt to preserve the Principal's estate plan, to the extent actually known by the Agent, if preserving the plan is consistent with the Principal's best interest; and

 

5.	cooperate with a person who has authority to make healthcare decisions for the Principal to carry out the Principal's reasonable expectations to the extent actually in the Principal's best interest.

As Agent you must not do the following:

 

1.	act so as to create a conflict of interest that is inconsistent with the other principles in this Notice to Agent;

2.	do any act beyond the authority granted in this Power of Attorney;

3.	commingle the Principal's funds with your funds;

4.	borrow funds or other property from the Principal, unless otherwise authorized;

5.	continue acting on behalf of the Principal if you learn of any event that terminates this Power of Attorney or your authority under this Power of Attorney, such as the death of the Principal, your legal separation from the Principal, or the dissolution of your marriage to the Principal.

If you have special skills or expertise, you must use those special skills and expertise when acting for the Principal. You must disclose your identity as an Agent whenever you act for the Principal by writing or printing the name of the Principal and signing your own name "as Agent" in the following manner: "(Principal's Name) by (Your Name) as Agent".

The meaning of the powers granted to you is contained in Section 3-4 of the Illinois Power of Attorney Act, which is incorporated by reference into the body of this Power of Attorney.

If you violate your duties as Agent or act outside the authority granted to you, you may be liable for any damages, including attorney's fees and costs, caused by your violation.

If there is anything about this document or your duties that you do not understand, you should seek legal advice from an attorney.

I have read the foregoing notice and I understand the legal and fiduciary duties that I assume by acting or agreeing to act as the Agent (attorney-in-fact) under the terms of this Power of Attorney.

 

Date:

 

Signed:

 

 

_________________________________