Power of Attorney For Dementia Patient
I, [Your Name], residing at [Your Company Address], hereby designate and appoint [Agent's Full Name], residing at [Agent's Address], as my attorney-in-fact (hereinafter referred to as "Agent") to act on my behalf following the terms and conditions outlined in this Power of Attorney.
I. Roles and Responsibilities of the Agent
Financial Management:
My Agent shall have the authority to manage all of my financial affairs, including but not limited to:
Accessing and managing my bank accounts, investments, and retirement funds.
Paying bills, taxes, insurance premiums, and other financial obligations.
Buying, selling, or leasing real estate or personal property on my behalf.
Healthcare Decisions:
My Agent shall have the authority to make healthcare decisions on my behalf, including:
Consenting to or refusing medical treatments, surgeries, or procedures.
Selecting healthcare providers, hospitals, or long-term care facilities.
Accessing my medical records and communicating with healthcare professionals regarding my care.
Legal Matters:
My Agent shall have the authority to handle legal matters on my behalf, including:
Initiating or defending legal actions, claims, or proceedings.
Signing legal documents, contracts, agreements, and other legal instruments.
Managing my estate planning documents, including wills, trusts, and beneficiary designations.
Property Management:
My Agent shall have the authority to manage my real and personal property, including:
Maintaining, renting, or selling real estate owned by me.
Managing and overseeing repairs, renovations, or improvements to my property.
Ensuring the safekeeping and proper management of my personal belongings and assets.
Personal Care and Welfare:
My Agent shall have the authority to make decisions concerning my care and welfare, including:
Arranging for necessary assistance, care, or support services.
Making decisions regarding my living arrangements and accommodations.
Ensuring that my preferences and wishes regarding my care are respected and followed.
II. EFFECTIVE DATE AND DURATION
This Power of Attorney shall become effective upon the date of my disability or incapacity and will end on my death unless I revoke it earlier.
III. REVOCATION
I have the right to revoke this Power of Attorney at any time by placing my revocation in writing and delivering it to my Attorney-in-Fact.
IV. ELECTRONIC TRANSACTIONS
To the extent permitted by applicable law, the powers granted to my Attorney-in-Fact include all power and authority to conduct any business with any third party using electronic communication of any kind, including but not limited to, transactions conducted via the Internet.
V. GOVERNING LAW
This Power of Attorney will be governed by and construed following the laws of [STATE]
In witness whereof, I have executed this Power of Attorney on [Date].
[YOUR NAME][Principal]
[DATE]
[Agent's Full Name]
[DATE]
Witness Acknowledgement
We, the undersigned witnesses, hereby attest that the Principal willingly signed this Power of Attorney in our presence on the date mentioned above.
[Witness Name][Witness 1]
[DATE]
[Witness Name][Witness 2]
[DATE]
Notary Acknowledgement
On this [DATE], before me, a Notary Public, personally appeared [Your Name], known to me (or proved to me based on satisfactory evidence) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
[Notary Public Name]
[DATE]
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