US Territories Power of Attorney
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PDF Power of Attorney Form

A Power of Attorney is used to give someone you trust the legal authority to manage your financial, property, and/or legal matters. Often, a Power of Attorney is used to ensure that your affairs will be administered according to your wishes in the event that you become mentally or physically incapable. Alternately, it may be convenient for persons who will be away for an extended period, and unable to personally sign documents or make financial and property decisions.

More about Power of Attorney legal forms.

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This form has not been reveiwed by an attorney specializing in the laws of the U.S. Territories. You should speak with a lawyer in your jurisdiction to ensure it is valid for your purposes.

Governing Jurisdiction:

Governing Jurisdiction:
This is where the Power of Attorney will actually be used - in other words, the physical location of the property or assets that are being controlled.
Where will the Power of Attorney be used?

Principal's Contact Information:

Principal's Contact Information:
The Principal is the person who is granting the powers.
Full Name:

Address:

City:

Nation:

Select a province or territory:

Select a country:

Select a state:

Attorney-in-Fact Details:

Attorney-in-Fact Details:
Each person whom the Principal is granting powers to is called an Attorney-in-Fact, or Agent, depending on the jurisdiction. If you choose two, they can make decisions "jointly" (MUST have consent of other Attorney-in-fact) or "jointly and independently" (do not require consent of the other Attorney-in-fact to make decisions).
How many Attorneys-in-fact do you wish to have?

Attorney-in-Fact Contact Information:

First Attorney-in-Fact Contact Information:

Full Name:

Address:

City:

Nation:

Select a province or territory:

Select a country:

Select a state:

Second Attorney-in-Fact Contact Information:

Full Name:

Address:

City:

Nation:

Select a province or territory:

Select a country:

Select a state:

I wish for my Attorneys-in-fact to make decisions:

Successor Attorney-in-Fact Details:

Successor Attorney-in-Fact Details:
If your Attorney(s)-in-Fact are unwilling or unable to exercise their powers, the Successor Attorney(s)-in-Fact will be able to exercise them.
Do you wish to name any Successor Attorneys-in-fact?
 Yes No

How many Successor Attorneys-in-fact do you wish to name?

Successor Attorney-in-Fact Contact Information:

First Successor Attorney-in-Fact Contact Information:

Full Name:

Address:

City:

Nation:

Select a province or territory:

Select a country:

Select a state:

Second Successor Attorney-in-Fact Contact Information:

Full Name:

Address:

City:

Nation:

Select a province or territory:

Select a country:

Select a state:

Delegation of Authority:

Can your Attorney(s)-in-fact and Successor Attorney(s)-in-fact delegate their authority to others?
 Yes No

Attorney-in-Fact Compensation/Benefits:

Do you wish your Attorney(s)-in-fact to be compensated?

Describe how your Attorney-in-fact will be compensated:


Can your Attorney(s)-in-fact personally benefit from control of your assets?
 Yes No

Does your Attorney(s)-in-fact co-own some of these assets?
 Yes No

Power of Attorney Duration:

Power of Attorney Duration:
A Durable Power of Attorney will remain effective if you lose mental capacity. It can come into effect immediately, or only once you become incapacitated. A non-Durable Power of Attorney will automatically end upon your incapacitation, or at a time you specify.
Do you wish to create a Durable Power of Attorney (one that will remain effective if you become incapacitated)?
 Yes No

This Durable Power of Attorney will come into effect:

Do you wish to specify a termination date for your Power of Attorney?
 Yes No

Enter the termination date here (e.g. March 18th, 2007):

Determination of Incapacity:

Who will decide if you are incapacitated?

Powers Granted:

Power to purchase, sell, lease, or mortgage real estate
 Yes No

Power to purchase, sell, and manage tangible personal property
 Yes No

Power to maintain and re-invest my assets
 Yes No

Power to manage bank accounts and perform banking transactions
 Yes No

Power to manage any government benefits I receive
 Yes No

Power to manage my retirement savings or pension plans
 Yes No

Power to file tax returns and handle other tax matters
 Yes No

Power to control and manage my insurance policies
 Yes No

Power to manage the affairs of any businesses I own or have an interest in
 Yes No

Power to participate in claims and litigation matters on my behalf
 Yes No

Power to control my estate, beneficiary, and trust matters
 Yes No

Power to manage the transfer of my assets to living trusts
 Yes No

Power to pay for living expenses, education, medical treatment of me and my family
 Yes No

Power to hire caretakers for me and my family
 Yes No

Power to provide seasonal gifts to my family members
 Yes No

Power to continue donating to my charitable organizations
 Yes No

Power to do anything I could otherwise do if personally present
 Yes No

Limited Powers:

Power to manage a particular property I own
 Yes No

Power to control specific bank accounts
 Yes No

Additional Powers:

How many additional powers do you wish to specify:

Additional power one:


Additional power two:


Additional power three:


Additional power four:


Additional power five:


Attorney-in-Fact Responsibilities/Restrictions:

Attorney-in-Fact Responsibilities / Restrictions:
A guardian is somebody who physically cares for and has custody of a disabled adult, whereas a conservator manages their property and affairs. Often, one person takes on both roles.
Do you wish to nominate your Attorney-in-fact as your guardian/conservator if you ever need one?
 Yes No

Do you wish your Attorney-in-fact to prepare financial reports?

Address where reports will be sent (e.g. Address, City, State, Zip Code):


Do you wish to restrict the powers of your Attorney-in-fact?
 Yes No

My Attorney-in-fact must make appropriate expenditures to allow me and my family to remain independent as long as possible
 Yes No

My Attorney-in-fact may invest my money ONLY in government savings bonds
 Yes No

Number of additional restrictions to add:

Additional restriction one:


Additional restriction two:


Additional restriction three:


Additional restriction four:


Additional restriction five:


Signatures Required:

Will a notary public be signing?
 Yes No

How many witnesses will be signing?

Do you wish to include a physician's affidavit to certify your condition if you have become incapacitated?
 Yes No

Date of Signing, if known:

Do you know when you will be signing this agreement?
 Yes No

Month:

Day of month (e.g. 5):

Year (e.g. 2006):

Place of Signing:

City:

Nation:

Select a province or territory:

Select a country:

Select a state: