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Indiana General (Financial) Power of Attorney

Indiana General Power of Attorney Form delivers the authority one has to another entity (such as a relative or friend whom you trust) intended to represent the issuer in financial transactions and/or generally manage his or her affairs. The user of this template will have to take care when filling it out so a proper definition of how this agent may act is supplied. This form is different from the durable power of attorney in that it will automatically become void if the listed principal is adjudged incompetent. If you are looking for a POA that stays in effect in the event of your incompetence, you should use the durable POA form instead.

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1 – Name The Parties Involved

Locate the blank line below the Title, then enter the Full Name of the Principal or Grantor of Power.

The main paragraph will also need the Full Name of the Principal reported. Make sure to enter this on the first blank line.

In order to positively identify the Grantor or Principal, enter the Complete Street Address (including the City or County) where the Principal resides on the second blank line in this paragraph.

Then on the third blank line of this paragraph record the State where the Principal lives.

Next, the Full Name of the Attorney-in-Fact should be entered on the blank space just after the words "…designate."

The next two blank spaces in this paragraph will also seek to further identify the Attorney-in-Fact by having the Street Address and State where he or she lives recorded (in that order).

2 – The Principal's Personal Approval For Each Power And Action Available To The Agent Must Be Supplied.

Section I will have a list of sixteen paragraphs. The Principal must read through each one then initial the blank line containing a description of the Principal Powers he or she wishes to designate to the Agent.

The first paragraph, designated as Item "1," will allow the Agent to make and collect Payments on behalf of the Principal. The Principal should initial the blank line preceding the number "1" to grant the Powers, defined in this paragraph, to the Agent.

The second paragraph delivers the ability to Acquire, Lease, and Sell the Principal's Personal Property to the Attorney-in-Fact once it is initialed by the Principal.

The third item shall appoint the Attorney-in-Fact with the Authority to wield Principal Powers regarding the Principal's Real Property only if it initialed by the Principal.

The Attorney-in-Fact will be appointed with the Principal's Management Powers (in regards to any type of Principal Property) when the fourth item is initialed by the Principal.

The Principal may choose to appoint Authority in his or her Banking Affairs to the Attorney-in-Fact. If so, then he or she must initial the fifth paragraph.

Should the Principal decided to appoint the Attorney-in-Fact with the Power of Principal Authority over his or her Motor Vehicles, then he or she should initial the sixth item.

The Principal's decision and action making powers in his or Tax Matters will be designated to the Attorney-in-Fact upon the Principal's initials in the paragraph labeled "Tax Powers."

The Principal's Safe-Deposit Boxes may be accessed and acted upon by the Attorney-in-Fact when the Principal initials the eighth paragraph.

The Attorney-in-Fact will be appointed with Gift Making Powers, in the ninth paragraph, if the Principal places his or her initials on the blank line.

The Principal will grant the Attorney-in-Fact with the ability to Lend and Borrow on his or her behalf by initialing the tenth paragraph.

Contacts may be entered by the Attorney-in-Fact, in the Principal's Name, if the Principal initials the eleventh statement.

The Attorney-in-Fact will be empowered to make Health Care Decisions concerning the Principal's Health if the Principal initials the twelfth paragraph in this section.

The Attorney-in-Fact will be appointed with Power and Authority in representing the Principal according to the Health Insurance Portability and Accountability Act if the Principal initials the blank line before the number 13.

The right to Hire and Pay for services on behalf of the Principal, and in the Principal's Name, will be appointed to the Agent once the Principal initials the fourteenth paragraph.

If the Principal will allow for the Attorney-in-Fact to determine and collect Reimbursement (for his or her services) from the Principal, the fittest paragraph should be initialed by the Principal.

The Principal may choose to empower the Agent with the Authority to Sue Third Parties who do not act in accordance with this document by recognizing the Agent's Principal Authority in the matters defined and approved by the Principal above. If so, the Principal will need to initial the sixteenth paragraph in this section.

The seventeenth paragraph, "Other," will allow for additional Powers to be defined and appointed to the Attorney-in-Fact by reporting them on the blank lines after the word "Other" and initialing the blank line before the number 17.

3 – Declare Effective Dates When The Attorney-in-Fact's Principal Authority Begins And Ends

The next section requiring attention is labeled "Effective Date and Termination." This area will be divided into two distinct parts. The first will declare when the Attorney-in-Fact may begin wielding the Powers defined in this form. If this Start Date is immediately upon the Signature of the Principal, then mark the first choice. If the Effect of this document should take hold on a future date, then mark the second choice and enter the Start Date using the blank lines provided in that statement.

The second area will need a declaration as to when (or if) the Principal Powers defined in this document. If the Effectiveness of this document will automatically expire on a specific Date, then mark the first choice and enter the Date in this statement. If the Effectiveness of this document expires only when the Principal issues a written revocation, then mark the second choice. The third choice will name the document's Effect to expire when the Principal is diagnosed (by a Physician) as being incapacitated or disabled.

4 – The Principal's Statement Of Authority

In the section labeled "Third Party Reliance," the Principal must read the paragraph provided. Below this, will be a statement with three blank spaces where the Principal should enter the Date he or she is signing this form.

Below the words "Principal's Signature" and "Principal's Printed Name," the Granting Principal must sign and print his or her name on the blank lines provided.

Just below the Principal's Signature will be an "Acceptance of Appointment" statement the Attorney-in-Fact will need to attend to. In the first blank line, the Attorney-in-Fact must print his or her Name. Then below the statement, the Attorney-in-Fact must sign and print his or her Name.

Note Indiana's signing requirements dictate that the Principal sign before either a Notary Public or Two (2) Witnesses. Therefore, the steps below apply only to the option the Principal chooses.

If the Principal opts for Two Witnesses, said Witnesses shall observe the Principal sign this document. Each Witness must read the testimony then provide an acknowledging Signature and his or her Residential Address on the blank lines provided.

If a Notary is sought, the Notary Public shall supply the "Acknowledgement of Notary Public" with its requirements only after the signing. This is strictly in the power of the Notary Public to fulfill.