Sample Power of Attorney Form
A sample power of attorney form is used by a client when they wish to give an attorney power and authority to handle matters such as decision making in case the client becomes medically incapacitated. The power of attorney form explains when and how the attorney should act. The document below is a sample power of attorney form.
Sample Power of Attorney Form
I (Name of client) _____________________, (Address) ___________________ appoint
(Name of lawyer) ____________________________ of
(Address)_________________________ as my attorney. I hereby transfer my authority and rights to the
undersigned attorney to make decisions on my behalf in case I am incapacitated as a result of medical related reasons.
(Description of extent of authority)
The appointed party shall have the rights and powers to make decisions on my behalf as
defined by the client in effect from _________________ and shall act accordingly
until___________________ with except when an extension or prior notice of termination by either party is issued.
Dated _________________Sign _________________________
The authority in this matter hereby appoints as me as the attorney and grants full
authority and power to act on his behalf concerning the described matter as from
________________________in person and in full knowledge.
Sign __________________Date_____________________
Expiry of Commission _________________________
Category: Power of Attorney forms
