This Durable Power of Attorney with Guardian Provision is used for the purpose of
granting an Attorney-in-Fact the power to manage a principal's assets and financial
affairs. It gives the principal's attorney the power to buy or sell property, collect money,
file taxes and sue on behalf of the principal. This document contains a provision that
appoints the attorney as guardian or conservator of the principal's estate, should it
become necessary. This power of attorney becomes effective upon its execution and
remains in effect in event of the principal's disability or incapacity.
DURABLE POWER OF ATTORNEY WITH GUARDIAN PROVISION IF GUARDIAN
KNOW ALL MEN BY THESE PRESENTS, That I, ____________________________
[Instruction: Insert the name of Principal] residing at ______________________________
[Instruction: Insert the address of Principal] ( hereinafter referred to as the â€œPrincipalâ€), have
made, constituted and appointed, ____________________________ [Instruction: Insert the
name of Agent] residing at _________________________________ [Instruction: Insert the
address of Agent], as my true and lawful attorney ( hereinafter referred to as the â€œAttorney-in-
Factâ€), to operate for me and in my name, place and stead, and for my use and benefit.
This Power of Attorney shall not be affected by my disability, incompetency or incapacity;
1. My Attorney-in-Fact is hereby empowered to ask, demand, sue for, recover, collect and
receive all such sums of money, debts, dues, accounts, legacies, bequests, interests,
dividends, annuities and demands whatsoever as are now, or shall hereafter become due,
owing, payable or belonging to me, and have, use and take all lawful ways and means in my
name or otherwise for the recovery thereof, to bargain, contract, agree to, purchase, receive
and take lands, tenements, hereditaments, and accept the seizing and possession of all lands
and all deeds and other assurances, in the law therefor, and to lease, let, demise, bargain, sell,
remise, release, convey, mortgage and hypothecate lands, tenements and hereditaments, upon
such terms and conditions, and under such covenants as my Attorney-in-Fact shall think fit.
2. My Attorney-in-Fact can bargain and agree for, buy, sell, mortgage, hypothecate and in any
and every way and manner deal in and with goods, wares, and merchandise, chooses in
action and other property in possession or in action, and to make, do, and transact all and
every kind of business of what nature or kind so ever, and also for me and in my name, and
as my act and deed, to sign, seal, execute, deliver and acknowledge such deeds, leases and
assignment of leases, covenants, indentures, agreements, mortgages, hypothecations, bills,
bonds, notes, receipts, evidences of debts, releases and satisfaction of mortgages, judgments
and other debts, and such other instruments in writing of whatever kind and nature as may be
necessary or proper.
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3. My Attorney-in-Fact shall have unrestricted access to, and the right to enter into, any safety
deposit box, vault, storage warehouse or other depository which I may lease or own, which
may be registered in my name, or in which any property may be held for me.
4. My Attorney-in-Fact shall have the power to prepare, make, execute, and file any and all
federal, state, local or other tax returns, claims for refunds, or declarations of estimated tax.
This power shall include the power to represent me (directly or through attorneys,
accountants, or other agents) in any matter before the Internal Revenue Service or any other
federal, state, or local agency. In connection with such representation, my Attorney-in-Fact
may execute consents extending the statutory period for the assessment or collection of taxes,
may pay all taxes and interest thereon which I may properly owe or which may be assessed
against me, and may contest the validity of any proposed assessment.
5. Giving and granting unto my Attorney-in-Fact full power and authority to do and perform all
and every act and thing whatsoever requisite and necessary to be done in and about the
premises as fully to all intents and purposes as I might or could do if personally present, with
full power of substitution or revocations, hereby ratifying and confirming all that my
Attorney-in-Fact, shall lawfully do or cause to be done by virtue of these presents.
6. In the event that it shall become necessary for any Court for a guardian to be appointed over
my estate, I hereby direct that my Attorney-in-Fact shall serve as such guardian/conservator.
WITNESS my hand this _______ [Month] _______ [Date], 20_____
[Instruction: Insert signature of Principal]
[Instruction: Insert typed/printed name of Principal]
Signed sealed and delivered in the presence of:
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[Instruction: Insert signature of Witness #1]
[Instruction: Insert name and address of Witness #1]
[Instruction: Insert signature of Witness #2]
[Instruction: Insert name and address of Witness #2]
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STATE OF ____________________
COUNTY OF ______________________
I, _________________________, a Notary Public in and for said County and State, hereby
certify that _______________________, whose name is signed to the foregoing instrument and
who is known to me, acknowledged before me on this day that, being of the contents of the said
instrument, he/she executed the same voluntarily on the day the same bears date.
Given under my hand this _____ day of __________
Printed Name: ____________________________
My Commission Expires: ___________________
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INFORMATION AND FORMS ARE PROVIDED "AS IS" WITHOUT ANY EXPRESS OR IMPLIED WARRA