Fill and Sign the Springing Power Attorney Form

Springing Power of Attorney for Financial Decision Making General Durable Power of Attorney for Financial Decision Making of ___________________ (Name of Principal) to be Effective only upon Incapacity or Disability I, ________________ (Name of Principal) , hereinafter called the Principal , domiciled and residing at _________________________________________________ (street address, city, state, zip code) , designate ______________________ (Name of Attorney-in-Fact) of __________________________________________________ (street address, city, state, zip code) , as my Attorney-in-Fact for Financial Decision Making, if I later become incapacitated or disabled. 1. Revocation of Previous Powers of Attorney for Financial Decision Making The Principal hereby revokes any and all Powers of Attorney for Financial Decision Making which have been previously executed by him and declares that this General Durable Power of Attorney for Financial Decision Making shall supersede any previous Powers of Attorney which authorized financial decision making. This document shall not revoke the Durable Power of Attorney for Health Care Decision Making executed concurrently with this document on _________________ (date) . This document, known as General Durable Power of Attorney for Financial Decision Making of ___________________ (Name of Principal) , once in effect shall remain in full force and effect until revoked or terminated. 2. Effectiveness This Power of Attorney shall become effective only upon the disability or incapacity of the Principal and once in effect shall continue throughout the disability or incapacity of the Principal. Disability shall include the inability to manage property and affairs effectively for reasons such as: mental illness, dementia, mental deficiency, physical illness or disability, chronic use of drugs, or chronic intoxication. In order for this document to become effective due to incapacity or disability, a written statement of the Principal's attending physician stating the condition of the Principal and the need for an Attorney-in-Fact must accompany this document. 3. Nomination of Guardian The Principal, __________________ (Name of Principal) , nominates ____________________ (Name of Nominee Guardian) as Guardian of his Estate for consideration by the Court if guardianship proceedings for his Estate are later commenced. If __________________ (Name of nominee Guardian) is unwilling or unable to serve, or if the Court refuses to appoint ________________ (Name of Nominee Guardian) as the Guardian, the Principal nominates ____________________ (Name of Alternate Nominee Guardian) to serve as Guardian of his Estate. The Principal has executed this document as an alternative to guardianship. 4. Authority and Power of Attorney-in-Fact The Attorney-in-Fact, as fiduciary, shall act in the best interests of the Principal and shall have authority over the assets of the Principal, whether these are located in the State of _________________ (Name of State) , or any other State. These powers shall include: A. Selling or otherwise disposing of the Principal's separate or community property interest. The Attorney-in-Fact shall have the specific authority to make, alter or revoke life insurance Beneficiary designations, or to change or assign ownership of any life insurance policies owned by the Principal. The Attorney-in- Fact is also authorized to make transfers of property to any Trust established for the benefit of the Principal or his spouse and to enter into or revoke Community Property Agreements; B. Signing the name of the Principal to any real property instruments, including deeds, conveyances, mortgages, leases or other documents which are necessary to carry out the business or personal affairs of the Principal; C. Opening and closing bank accounts and other financial instruments, making deposits to and withdrawals from bank accounts, and investing and reinvesting funds. This power shall include but is not limited to investments in stocks, bonds and government securities, and withdrawing, transferring or cashing in any and all financial or investment accounts. The Attorney-in-Fact shall have the power to borrow on behalf of the Principal and to endorse and/or cash any and all checks issued by the United States Treasury and/or United States Government, and sign forms and receive checks from the Department of Veterans Affairs; D. Having access to the Principal's safe deposit box; E. Signing tax returns on behalf of the Principal and representing or obtaining representation of the Principal at a tax audit; F. Borrowing funds for the benefit of the Principal which may be desirable if the other alternative would be to sell a highly appreciated asset during the life of the Principal, thus forfeiting the stepped-up basis at death; G. Forgiving or collecting debts owed to the Principal; H. Redirecting (forwarding) the Principal's mail; I. Continuing or canceling the credit cards of the Principal; J. Appealing Medicare Denials: The Principal hereby specifically authorizes the Attorney-in-Fact to act on the Principal's behalf to take any action or actions necessary to pursue and appeal any denials of Medicare coverage which have been issued by any health care facility or institution regarding the Principal's eligibility for Medicare benefits; K. The Principal hereby authorizes his Attorney-in-Fact to make transfers of his property to his wife if necessary or desirable to qualify the Principal for Medicaid or other governmental programs which provide assistance in paying for long-term care. 5. Powers not Specifically Enumerated The Attorney-in-Fact shall also have all powers which may be necessary or desirable to provide for the support or maintenance of the Principal, even if these powers are not specifically set forth in this document. 6. Duration This Durable Power of Attorney shall become effective only upon the disability or incapacity of the Principal, and shall remain in effect to the extent permitted by _________________ (Name of State) State Law or until revoked or terminated, even if it is not certain whether the Principal is alive. If there is any doubt as to whether the Principal is alive, this Power of Attorney shall remain in full force and effect until conclusive proof of death is obtained, or until legal proceedings declare the Principal deceased. 7. Revocation This Durable Power of Attorney may be revoked, suspended or terminated if the Principal gives written notice to the acting Attorney-in-Fact. Unless provided herein to the contrary, any notice provided for or concerning revocation shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the address of the Attorney-in-Fact set forth at the beginning of this document or an address set forth in writing and delivered to Principal. 8. Termination of this Document A. This Power of Attorney shall not be revoked by any subsequent guardianship action, unless specifically set forth in the Court's Order. It is the intention of the Principal that the powers granted herein shall eliminate the need for the appointment of a Guardian of the Estate of the Principal. B. The death of Principal shall revoke this Power of Attorney. 9. Reliance All persons dealing with the Attorney-in-Fact because of this document shall be entitled to rely upon this Power of Attorney, so long as neither the Attorney-in-Fact, nor any person with whom the Attorney-in-Fact was dealing, had received actual knowledge or notice of any revocation, suspension, or termination of this document. Any action taken in good faith by all parties shall be binding on the heirs and Personal Representative(s) of the Principal. 10. Indemnity The Attorney-in-Fact shall not have any personal liability for any acts done by virtue of this Power of Attorney, so long as the acts are done in good faith. The Estate of the Principal shall defend, hold harmless, and indemnify the Attorney-in-Fact from all liability for acts done in good faith and not by or with fraud of the Principal. 11. Applicable Law The laws of the State of ________________ (Name of State) shall govern this Power of Attorney. Although this Power of Attorney is signed in the State of ___________________ (Name of State) , it is the intention of the Principal that this document be valid in all states and territories of the United States. If any provision in this document is held invalid or inconsistent with the laws of the state where the Principal is located, then the inconsistent or invalid part shall be deleted and disregarded, and the remaining parts shall not be affected. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of ______________, 20___. ______________________ (Printed Name of Principal) ______________________ (Signature of Principal) (Acknowledgment form may vary by state) STATE OF __________________ COUNTY OF ____________________ Personally appeared before me, the undersigned authority in and for said County and State, on this __ day of ____________, 20_____, within my jurisdiction, the within-named _________________ (Name of Principal) who acknowledged that he executed the above and foregoing instrument. ___________________________ NOTARY PUBLIC My Commission Expires: ____________________