Government Lasting Power of Attorney
Government Lasting Power of Attorney
Table of Contents
I. Reason for Appointment
II. Powers of Attorney-in-Fact
III. Limitations on Powers
IV. Revocation
V. Governing Law
VI. Signatures
VII. Witnesses
VIII. Notary Acknowledgement
I. Reason for Appointment:
I, [Your Name], of the city of [City], located at [Your Company Address], hereby appoint [Agent's Name], residing at [Agent's Address], as my true and lawful attorney-in-fact, to act on my behalf in relation to my personal care, health, legal matters, and financial affairs, effective from [Date of Effectivity].
Reason for Appointment: I appoint [Agent's Name] to ensure that my affairs are managed appropriately in the event that I become unable to make decisions for myself due to incapacity, illness, or any other reason.
II. Powers of Attorney-in-Fact:
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Personal Care: To make decisions concerning my daily living routine, accommodation, and medical care, including the consent to or refusal of medical treatment on my behalf.
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Health: To have access to my medical records, consult with healthcare professionals, and make decisions regarding my health and medical treatment.
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Legal Matters: To manage and settle legal claims, engage legal counsel, and make decisions concerning legal proceedings on my behalf.
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Financial Affairs: To manage my financial affairs, including but not limited to, operating bank accounts, paying bills, managing investments, and buying or selling property.
III. Limitations on Powers:
The attorney-in-fact is not authorized to make decisions regarding my personal relationships, voting in elections, or any act that would constitute a conflict of interest with my best interests.
IV. Revocation:
I reserve the right to revoke this Power of Attorney at any time, provided I am of sound mind. Any such revocation must be made in writing and delivered to my attorney-in-fact and any relevant institutions or individuals.
V. Governing Law:
This Power of Attorney form is to be governed and construed in accordance with the laws of [City, State], and any applicable Federal law.
VI. Signatures:
I, [Your Name], sign this Power of Attorney on this [Date of Signature].
I, [Agent's Name], agree to serve as Attorney-in-Fact on this [Date of Signature].
VII. Witnesses:
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Name: [Witness 1 Name]
[Date Signed]
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Name: [Witness 2 Name]
[Date Signed]
VIII. Notary Acknowledgement:
State of [State]
Subscribed and sworn to before me, [Notary's Name], a Notary Public in and for said state, on this [Date].
[Date Signed]
Please ensure to customize the template to meet the specific requirements of your jurisdiction and seek legal advice if necessary.
