Revocable Living Trust FormAny Doc You Want can be posted here – above the form that is on this page.Any Instructions Here.Revocable Living Trust CONTACT INFORMATION arrowup6 This is the person we will contact regarding the Living Trust. First Name * Middle Name (Initial) Last Name * Interest held by: Both SpousesHusbandOther Spouse Phone Number Alternate Phone Number Fax Number Contact Email Street Address Street Address Street Address Street Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/PostalPERSON(S) MAKING THE TRUST arrowup6 The person or persons creating a living trust are referred to as the Grantor, Settlor, Donor and Trustor. We will refer to the trust-creator as the Grantor(s). Single Person Single Person (Grantor) as Trustee, for lifetime use, then to othersOne person creates the trust for his or her lifetime use, then to the beneficiaries named in the trust. First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal County Husband and/or Spouse Husband and Spouse (Most Common) Husband and Spouse (AB Trust)H & W for their lifetime use, then to others. When a spouse passes away, the surviving spouse receives the deceased spouse’s portion of the property. When the surviving spouse passes away, then to the beneficiaries named in the trust. H & W for their lifetime use, then two trusts created until surviving spouse’s death, then to others (A-B Trust) Husband and wife (or domestic partners) create a trust for their lifetime use. When a spouse passes away, the trust property is split into two portions. The surviving spouse receives the deceased spouse's portion of the property with no restrictions. The surviving spouse will be able to use the deceased spouse's portion of the property. However, when the surviving spouse passes away, that property must go to the beneficiaries named by the other spouse. Husband's First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal County Spouse's First Name Middle Name (Initial) Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal County Single Person and Another Person Single Person and Another Person (Grantors), as Co-Trustees for their lifetime use, then to othersOne person creates a trust with another person for their lifetime use, then to the beneficiaries named in the trust. The other person may be a family member, domestic partner, friend, etc. This person will be called a Co-Grantor. First Person's First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal County Second Person's First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal County Other Other Type of TrustAnother type of trust is an “irrevocable” trust, where the assets in it are no longer yours, but the appreciated assets in the trust are not subject to estate taxes. Describe SUCCESSOR TRUSTEEPerson(s) or Entity that will manage the trust should the primary Trustee(s) pass away or become incapacitated. A Successor Trustee is a person, or persons, or an entity like a bank, usually named in the trust, that will manage the trust when the primary Trustee(s) pass away or become incapacitated.Successor Options arrowup6 1st Successor I (we) want the following individual(s) or entity(ies) to serve as my (our) Successor Trustee Successor Trustee #1 First Name or Corporate Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal 2nd Successor (Optional) I want a 2nd Successor Trustee to serve with the 1st Successor Trustee as Co-Trustees I want a 2nd Successor to serve ONLY if the 1st Successor Trustee cannot or will not serve.Two people serve as co-trustees of the trust, simultaneously, or one person serves as successor trustee and if they cannot or will not serve, then the named alternate successor trustee serves. Successor Trustee #2 First Name or Corporate Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal 3rd Successor (Optional) I want a 3rd Successor Trustee to serve with the 1st and 2nd Successor Trustee as Co-Trustees I want a 3rd Successor Trustee to serve ONLY if the 1st Successor Trustee and the 2nd Successor Trustee cannot or will not serve.Three people serve as co-trustees of the trust, simultaneously, or two people serve as successor trustees and if both of them cannot or will not serve, then the named third alternate successor trustee serves. Successor Trustee #3 First Name or Corporate Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/PostalAdditional Successor Trustee arrowup6 Successor Trustee #4 First Name or Corporate Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/PostalPROPERTY TO TRANSFER INTO THE TRUSTA living trust can only control the assets (property) that are put into it, so you must transfer property into the trust (called “funding the trust"). To do this, you physically change the titles of your assets from your individual name (or joint names, if married) to the name of the trust and also change most beneficiary designations to the trust name.Property Type - Real Estate arrowup6 Examples of Real Property (also called real estate) are your home, condominium, vacation house, certain timeshares, undeveloped land, etc. A Deed is usually used to transfer ownership from you to the Living Trust. You can send us a current copy of your Deed by clicking on [Upload Deed]. Property Types - Real Estate Real Property (Real Estate) Street Address Street Address Street Address Street Address City City State/Province State/Province Zip/Postal Zip/Postal County Assessor's Parcel Number (APN) if known Type of Property Please SelectHouse- Single Family DwellingCondominiumVacation HomeVacant LandOther Owned by Both spouses Husband Other Spouse Single Person Upload copy of current Deed, if available. Drop a file here or click to upload Choose FileMaximum file size: 516MBClick on “Locate File”. Then browse to the location on your computer where a JPEG or PDF of the deed is found. Click “Attach File”. When finished attaching files, Click “Upload File” and your files are sent to us.plus1 Add minus1 RemoveProperty Type - Financial Accounts arrowup6 Examples of Financial Accounts are bank checking and savings accounts, certificate of deposits (CDs), money market accounts, IRAs, etc. Property Type - Financial Accounts Financial Accounts Name of Financial Institution Type of Accounts Account Numbers (optional) Account Held by Select OneBoth SpousesHusbandOther SpouseSingle Person plus1 Add minus1 RemoveProperty Type - Stocks and Bonds arrowup6 List any individual stocks and bonds in publicly held companies, usually traded on a US stock exchange. Mutual Funds are also included. (If you hold any stocks in a private, or closely held company, list them under the heading “Business Interests”). Property Type - Stocks and Bonds Stocks and Bonds Name of Issuer Number of Shares Certificate Numbers (Optional) Description (Common Stock, Preferred Stock, Bond, etc.) Interest held by: Both SpousesHusbandOther SpouseSingle Person plus1 Add minus1 RemoveProperty Type - Business Interests arrowup6 Examples of Business Interests are sole proprietorships, partnerships, corporations, LLCs, etc. A closely held company is privately owned, usually by the people who created it or invested in it. (Shares in a publicly owned company are usually listed under the heading “Stocks and Bonds”). Additional Type of Property Business Interests Name of Business Description of Interest (100% Sole Proprietorship interest; 50% LLC Membership interest, etc...) Account Held By Select OneBoth SpousesHusbandOther SpouseSingle Person plus1 Add minus1 RemoveProperty Type - Contractual Interests arrowup6 Examples of Contractual Interests are royalties, commissions, notes receivable (promissory notes), deeds of trust, mortgages, etc. Property Type - Contractual Interests Contractual Interests Description of Contract Name of Other Parties Date of Contract Contract Signed by: Both SpousesHusbandOther SpouseSingle Person plus1 Add minus1 RemoveProperty Type - Life Insurance Proceeds arrowup6 Proceeds from whole life or term life insurance policies. Property Type - Life Insurance Proceeds Life Insurance Proceeds Name of Issuer Type of Policy Select OneTermWhole LifeOther Type of Policy Policy Numbers (Optional) Policy Owned by: Both SpousesHusbandOther SpouseSingle Person plus1 Add minus1 RemoveProperty Type - Retirement Account arrowup6 IRAs, 401(k) retirement accounts, profit sharing, pensions, etc., usually cannot be owned by the trust, however the trust may be the beneficiary. Property Type - Retirement Account Proceeds Retirement Account Proceeds Name of Issuer Description of Retirement Account Select OneAnnuity401KIRAProfit SharingPension401K - SEPOther Account Numbers (Optional) Account Owned by: Both SpousesHusbandOther SpouseSingle Person plus1 Add minus1 RemoveProperty Type - Personal Property arrowup6 Personal property includes most tangible items that are not real property, such as vehicles, furniture, boats, collectibles, artwork, antiques, jewelry, clothes, coin collections, pets, etc. Personal Property Art Jewelry Furniture Home Furnishings (Not including furniture) Antiques, Collectibles Additional Assets List any additional assets not previously listed Description plus1 Add minus1 RemoveBENEFICIARY INFORMATIONA beneficiary is a person or entity (organization) entitled to receive funds or other property under the trust. In a family trust, the beneficiaries are generally family relations to the grantor(s).1st Beneficiary's Name (or Charitable Organization) arrowup6 The trust beneficiary(ies) are named in the trust and can be individuals or entities, such as educational, religious or charitable organizations. First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Relationship Son Daughter Stepchild Brother Sister Niece Nephew Friend Charitable Organization OtherOther Minor's Trust Hold this beneficiary's gift in a "minor's trust"A “minor’s trust” is a ‘sub trust’ that leaves property to a minor child, but in the care of a trustee, until the child reaches a designated age, often age 18, 21, or 25. The minor’s trust may specify that trust funds may only be used for specific purposes, such as education, or medical expenses, particularly in instances where a minor has a disability or illness. When the child reaches the age stated by the trust, the trustee will then transfer property from the minor’s trust to the beneficiary outright, including any income the trust has produced. Until the Minor reaches the age of: Specific Gift Specific Gift - Give this beneficiary the following specific property: (Describe property or amount of money.)Three basic types of gifts given through a trust are a Specific Gift, a General Gift and a Residuary Gift. A specific gift includes details so it's very clear what property is being given away and to whom. An example of a specific gift states that "Bob Jones receives all of my furniture." A specific gift is given to the recipients before general and residuary gifts are distributed from the estate. A general gift isn't described precisely enough to distinguish it from the rest of the property. For example, “Bob Smith receives a computer”, is a general gift if you own more than one computer, since it is unknown which computer is being given. A residuary gift is the property that remains, or is leftover, after the specific and general gifts are distributed. For example, the residuary gift might state: "The rest of my property goes to my daughter, Nancy". Description of Specific Gift General Gift General Gift - Give this beneficiary the following Percentage of the total Trust Property remaining after specific gifts have been distributed Percentage of General Gift Three basic types of gifts given through a trust are a Specific Gift, a General Gift and a Residuary Gift. A specific gift includes details so it's very clear what property is being given away and to whom. An example of a specific gift states that "Bob Jones receives all of my furniture." A specific gift is given to the recipients before general and residuary gifts are distributed from the estate. A general gift isn't described precisely enough to distinguish it from the rest of the property. For example, “Bob Smith receives a computer”, is a general gift if you own more than one computer, since it is unknown which computer is being given. A residuary gift is the property that remains, or is leftover, after the specific and general gifts are distributed. For example, the residuary gift might state: "The rest of my property goes to my daughter, Nancy". If the 1st Beneficiary predeceases the Grantor(s), then this gift shall be distributed to: The 1st Beneficiary's children that survive the Grantor(s); in equal shares The remaining Beneficiaries that survive the Grantor; in equal shares Other DistributionA beneficiary named in a trust may die before the Trust Grantor dies, and the gift to that beneficiary must go elsewhere. Commonly, the trust either names the child or children of the deceased beneficiary as the “alternate beneficiary(ies)” that will receive that gift, or that the deceased beneficiary’s gift will be split equally among the surviving beneficiaries.Describe how you would like a gift to a predeceased beneficiary to be distributed when it is not given to the predeceased beneficiary’s children or to the surviving beneficiaries of the trust. Description of Other Distribution 2nd Beneficiary's Name (or Charitable Organization) arrowup6 The trust beneficiary(ies) are named in the trust and can be individuals or entities, such as educational, religious or charitable organizations. First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Relationship Son Daughter Stepchild Brother Sister Niece Nephew Friend Charitable Organization OtherOther Minor's Trust Hold this beneficiary's gift in a "minor's trust" until they reach the age of:A “minor’s trust” is a ‘sub trust’ that leaves property to a minor child, but in the care of a trustee, until the child reaches a designated age, often age 18, 21, or 25. The minor’s trust may specify that trust funds may only be used for specific purposes, such as education, or medical expenses, particularly in instances where a minor has a disability or illness. When the child reaches the age stated by the trust, the trustee will then transfer property from the minor’s trust to the beneficiary outright, including any income the trust has produced. Until the minor reaches the age of: Specific Gift Specific Gift - Give this beneficiary the following specific property: (Describe property or amount of money.) Description of Specific Gift General Gift General Gift - Give this beneficiary the following Percentage of the total Trust Property remaining after specific gifts have been distributedThree basic types of gifts given through a trust are a Specific Gift, a General Gift and a Residuary Gift. A specific gift includes details so it's very clear what property is being given away and to whom. An example of a specific gift states that "Bob Jones receives all of my furniture." A specific gift is given to the recipients before general and residuary gifts are distributed from the estate. A general gift isn't described precisely enough to distinguish it from the rest of the property. For example, “Bob Smith receives a computer”, is a general gift if you own more than one computer, since it is unknown which computer is being given. A residuary gift is the property that remains, or is leftover, after the specific and general gifts are distributed. For example, the residuary gift might state: "The rest of my property goes to my daughter, Nancy". Percentage If the 2nd Beneficiary predeceases the Grantor(s), then this gift shall be distributed to: The 2nd Beneficiary's children that survive the Grantor(s); in equal shares The remaining Beneficiaries that survive the Grantor; in equal shares Other DistributionA beneficiary named in a trust may die before the Trust Grantor dies, and the gift to that beneficiary must go elsewhere. Commonly, the trust either names the child or children of the deceased beneficiary as the “alternate beneficiary(ies)” that will receive that gift, or that the deceased beneficiary’s gift will be split equally among the surviving beneficiaries. Describe how you would like a gift to a predeceased beneficiary to be distributed when it is not given to the predeceased beneficiary’s children or to the surviving beneficiaries of the trust. Description of Other Distribution Additional Beneficiary arrowup6 First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Relationship Son Daughter Stepchild Brother Sister Niece Nephew Friend Charitable Organization OtherOther Minor's Trust Hold this beneficiary's gift in a "minor's trust" until they reach the age of:A “minor’s trust” is a ‘sub trust’ that leaves property to a minor child, but in the care of a trustee, until the child reaches a designated age, often age 18, 21, or 25. The minor’s trust may specify that trust funds may only be used for specific purposes, such as education, or medical expenses, particularly in instances where a minor has a disability or illness. When the child reaches the age stated by the trust, the trustee will then transfer property from the minor’s trust to the beneficiary outright, including any income the trust has produced. Until the Minor reaches the age of: Specific Gift Specific Gift - Give this beneficiary the following specific property: (Describe property or amount of money.) Description of Specific Gift General Gift General Gift - Give this beneficiary the following Percentage of the total Trust Property remaining after specific gifts have been distributedThree basic types of gifts given through a trust are a Specific Gift, a General Gift and a Residuary Gift. A specific gift includes details so it's very clear what property is being given away and to whom. An example of a specific gift states that "Bob Jones receives all of my furniture." A specific gift is given to the recipients before general and residuary gifts are distributed from the estate. A general gift isn't described precisely enough to distinguish it from the rest of the property. For example, “Bob Smith receives a computer”, is a general gift if you own more than one computer, since it is unknown which computer is being given. A residuary gift is the property that remains, or is leftover, after the specific and general gifts are distributed. For example, the residuary gift might state: "The rest of my property goes to my daughter, Nancy". Percentage If the above Beneficiary predeceases the Grantor(s), then this gift shall be distrbuted to: The above Beneficiary's children that survive the Grantor(s); in equal shares The remaining Beneficiaries that survive the Grantor; in equal shares Other DistributionA beneficiary named in a trust may die before the Trust Grantor dies, and the gift to that beneficiary must go elsewhere. Commonly, the trust either names the child or children of the deceased beneficiary as the “alternate beneficiary(ies)” that will receive that gift, or that the deceased beneficiary’s gift will be split equally among the surviving beneficiaries. Describe how you would like a gift to a predeceased beneficiary to be distributed when it is not given to the predeceased beneficiary’s children or to the surviving beneficiaries of the trust. Description of Other Distribution plus1 Add minus1 RemovePOUR-OVER WILL INFORMATIONAny existing Wills will be revoked by the creation and execution of this New Will. The purpose of a pour-over will is to “pour” assets that have not already been transferred into the living trust, into the living trust, when the Grantor(s) pass away. It acts like a safety net that “catches” property not in the trust, due to negligence, mistake, procrastination, or other cause. It will revoke prior wills and can also name a guardian for any minor children.Will for Grantor #1 arrowup6 First Name Middle Name (Initial) Last Name Executor of Will I wish to appoint the following person(s) to be the Executor of my Will.An executor is a person or institution appointed by a testator to carry out the terms of their will. The executor is responsible for gathering up and protecting the assets of the estate, obtaining information in regard to all beneficiaries named in the will and any other potential heirs, collecting and arranging for payment of debts of the estate, approving or disapproving creditor's claims, making sure estate taxes are filed, and tax payments made, as well as other probate-related items. Executor First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Guardian(s) I wish to appoint the following person(s) to be the Guardian or Joint-Guardians of my minor child(ren):A guardian is often an adult that can make legal decisions for children who are not their own, and may care for them, just like a parent would. The guardian is usually named in one’s will to take charge of minor children in case of the death of the parent(s). If more than one guardian is named, they are called joint guardians. Guardian First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Joint Guardian First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Comments Will for Grantor #2 arrowup6 First Name Middle Name (Initial) Last Name Excutor of Will I wish to appoint the following person(s) to be the Executor of my Will.An executer is a person or institution appointed by a testator to carry out the terms of their will. The executor is responsible for gathering up and protecting the assets of the estate, obtaining information in regard to all beneficiaries named in the will and any other potential heirs, collecting and arranging for payment of debts of the estate, approving or disapproving creditor's claims, making sure estate taxes are filed, and tax payments made, as well as other probate-related items. Executor First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Guardian(s) I wish to appoint the following person(s) to be the Guardian or Joint-Guardians of my minor child(ren):A guardian is often an adult that can make legal decisions for children who are not their own, and may care for them, just like a parent would. The guardian is usually named in one’s will to take charge of minor children in case of the death of the parent(s). If more than one guardian is named, they are called joint guardians. Guardian First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Joint Guardian First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Comments POWER OF ATTORNEY INFORMATIONA Power of Attorney lets you appoint someone to manage your financial and legal matters if you become mentally incapacitated. A durable power of attorney is a document that grants the legal rights and powers of a person, the "principal," to another, the "agent" or "attorney-in-fact." It lets you appoint someone to manage your financial and legal matters if you become mentally incapacitated, or do not wish to make these decisions yourself. The word “durable” means that the power of attorney stays in effect even after you are incapacitated.Power of Attorney for Grantor #1 arrowup6 First Name Middle Name (Initial) Last Name Attorney in Fact I wish to appoint the following person(s) to be my Agent (Attorney in Fact)An agent or “attorney in fact” is a person, named in a power of attorney document, who is authorized to perform business-related transactions on behalf of someone else, usually called the “principal”. The person you choose as your agent should know that he or she has a duty of trust and must always act in your best interests. Agent First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Co-Agent First Name If more than one agent is named, they are called co-agents or joint agents. Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Alternate Agent First Name If the original agent or co-agent cannot or will not serve, then the person named as the ‘alternate’ agent can serve. Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal DESIGNATION OF POWERS ALL OF THE POWERS LISTED BELOW (Check this box when All the powers listed below are to be given to your agent.) Tangible personal property transactions Stock and bond transactions Commodity and option transactions Banking and other financial institution transactions Business operating transactions Insurance and annuity transactions Estate, trust and other beneficiary transactions Claims and litigation Personal and family maintenance Benefits from Social Security, Medicare, Medicaid, or other governmental programs, or civil or military service Retirement plan transactions Tax matters Real Estate MattersCheck each power you would like to give your agent. A general power of attorney gives broad powers to a person or organization (known as an agent or attorney-in-fact) to act in your behalf. These powers include, among others, buying life insurance, settling claims, operating business interests, opening and closing bank accounts, withdrawing funds, trading stocks, and paying bills. SPECIAL INSTRUCTIONS List any special instructions limiting or extending the powers granted to your agent. Some powers cannot be given to an agent, such as the power to make or alter a will, marry, adopt, or vote in public elections. (The power to make health care decisions can be given through a Healthcare Power of Attorney or advance medical directive). Other powers are given only if they are specifically mentioned, such as: the power to make gifts of your money or other property; the power to change your community property agreement; and the power to designate beneficiaries of your insurance policies. Normally, your agent is required by law to keep his or her money separate from yours. If your agent is your spouse or other close family member, and your finances are already commingled (mixed), do you want your agent to be able to continue to commingle (mix) your funds with his or her own? Yes NoAn agent is generally not allowed to commingle (mix) the principal’s funds or property with the agent’s own funds or property, and must keep them separate. However, you may wish to specifically authorize your agent to commingle funds, if for example, you appoint your spouse or partner as agent, and your finances are already thoroughly mixed together in joint bank accounts.) Normally, your agent is not permitted to financially benefit from any actions taken on your behalf. If your agent is your spouse or other close family member, and your financial interests are already intertwined with yours, do you want your agent to be able to financially benefit from any transactions taken on your behalf? Yes NoThe agent must be loyal to the principal and deal honestly within the boundaries of the power of attorney relationship. The agent cannot engage in self-dealing practices, especially if those acts would not be in the principal’s best interests. However, in some circumstances, the power of attorney may specifically grant the agent permission to benefit from transactions carried out under the power of attorney, such as where the agent is the principal’s spouse, a close family member, a business partner, or other person whose affairs are already intertwined. Do you want your agent to be compensated for acting as your attorney-in-fact Yes NoGenerally, agents are entitled to reasonable compensation and to reimbursement for reasonable out-of-pocket expenses incurred on behalf of the principal. However, in family situations, an agent is normally not paid if the duties are not complicated or time-consuming. If the agent is to be paid, include the payment arrangement in the power of attorney. Would you like to protect your agent and others from liability when they are acting on this Power of Attorney, as long as they are acting in good faith? Yes NoGenerally, agents are not liable to the principal, his or her estate, heirs or other parties in interest, for any action taken or not taken under a power of attorney, except for willful misconduct or gross negligence. Do you want this Power of Attorney to remain in force and be effective even though you become incapacitated? Yes NoA “durable” power of attorney is a power of attorney that remains in full force and effect even if the principal can no longer make decisions for himself. Most powers of attorney are durable. If you appointed more than one agent, do you want them to be able to act alone (separately) without the other agent joining, or do you want all of your agents to act or sign together (jointly)? Separately JointlyWhen two or more persons are appointed agents, they are known as co-agents. The power of attorney states whether they can either act independently or whether they must act together. If they are to act together, the manner in which disputes should be resolved, can be described in the “Special Instructions – Other” field, below. Other (Specify) OtherDescribe your own restrictions or additions to any of the powers granted to the agent. For example, if a power listed seems too broad, add limits to it, such as “My agent shall have no authority to sell, transfer, or otherwise encumber my business, Ajax Trucking Co.” Description of any restrictions or additions. TAKES EFFECT - When do you want this Power of Attorney to become effective: Immediately upon signing by me Only if I become mentally incapacitatedA Power of Attorney can take effect immediately upon signing or at some time in the future (known as a “springing” durable power of attorney). The future time may be a specific date or an occurrence of some event, such as a decision by a doctor that the principal is mentally incompetent and unable to make decisions on his or her own. Commonly, a specific doctor is named to determine mental incompetence, or that two licensed physicians agree the principal is mentally incompetent. DURATION - How long do you want this Power of Attorney to be in force: Until revoked by me in writing For the following period of time only (specifiy):A durable power of attorney continues even when the principal becomes incapacitated, but it automatically ends when the principal dies. The power of attorney can also state that it will end at a specific time. Furthermore, the principal can revoke a power of attorney at any time, so long as he or she is mentally competent to do so. Specific Duration of Time Power of Attorney for Grantor #2 arrowup6 First Name Middle Name (Initial) Last Name Attorney in Fact I wish to appoint the following person(s) to be my Agent (Attorney in Fact)An agent or “attorney in fact” is a person, named in a power of attorney document, who is authorized to perform business-related transactions on behalf of someone else, usually called the “principal”. The person you choose as your agent should know that he or she has a duty of trust and must always act in your best interests. Agent First Name Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Co-Agent First Name If more than one agent is named, they are called co-agents or joint agents. Middle Name Middle Name (Initial) Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Alternate Agent First Name If the original agent or co-agent cannot or will not serve, then the person named as the ‘alternate’ agent can serve. Middle Name (Initial) Last Name Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal DESIGNATION OF POWERS ALL OF THE POWERS LISTED BELOW (Check this box when All the powers listed below are to be given to your agent.) Tangible personal property transactions Stock and bond transactions Commodity and option transactions Banking and other financial institution transactions Business operating transactions Insurance and annuity transactions Estate, trust and other beneficiary transactions Claims and litigation Personal and family maintenance Benefits from Social Security, Medicare, Medicaid, or other governmental programs, or civil or military service Retirement plan transactions Tax matters Real EstateCheck each power you would like to give your agent. A general power of attorney gives broad powers to a person or organization (known as an agent or attorney-in-fact) to act in your behalf. These powers include, among others, buying life insurance, settling claims, operating business interests, opening and closing bank accounts, withdrawing funds, trading stocks, and paying bills. SPECIAL INSTRUCTIONS List any special instructions limiting or extending the powers granted to your agent. Some powers cannot be given to an agent, such as the power to make or alter a will, marry, adopt, or vote in public elections. (The power to make health care decisions can be given through a Healthcare Power of Attorney or advance medical directive). Other powers are given only if they are specifically mentioned, such as: the power to make gifts of your money or other property; the power to change your community property agreement; and the power to designate beneficiaries of your insurance policies. Normally, your agent is required by law to keep his or her money separate from yours. If your agent is your spouse or other close family member, and your finances are already commingled (mixed), do you want your agent to be able to continue to commingle (mix) your funds with his or her own? Yes NoAn agent is generally not allowed to commingle (mix) the principal’s funds or property with the agent’s own funds or property, and must keep them separate. However, you may wish to specifically authorize your agent to commingle funds, if for example, you appoint your spouse or partner as agent, and your finances are already thoroughly mixed together in joint bank accounts. Normally, your agent is not permitted to financially benefit from any actions taken on your behalf. If your agent is your spouse or other close family member, and your financial interests are already intertwined with yours, do you want your agent to be able to financially benefit from any transactions taken on your behalf? Yes NoThe agent must be loyal to the principal and deal honestly within the boundaries of the power of attorney relationship. The agent cannot engage in self-dealing practices, especially if those acts would not be in the principal’s best interests. However, in some circumstances, the power of attorney may specifically grant the agent permission to benefit from transactions carried out under the power of attorney, such as where the agent is the principal’s spouse, a close family member, a business partner, or other person whose affairs are already intertwined. Do you want your agent to be compensated for acting as your attorney-in-fact Yes NoGenerally, agents are entitled to reasonable compensation and to reimbursement for reasonable out-of-pocket expenses incurred on behalf of the principal. However, in family situations, an agent is normally not paid if the duties are not complicated or time-consuming. If the agent is to be paid, include the payment arrangement in the power of attorney. Would you like to protect your agent and others from liability when they are acting on this Power of Attorney, as long as they are acting in good faith? Yes NoGenerally, agents are not liable to the principal, his or her estate, heirs or other parties in interest, for any action taken or not taken under a power of attorney, except for willful misconduct or gross negligence. Do you want this Power of Attorney to remain in force and be effective even though you become incapacitated? Yes NoA “durable” power of attorney is a power of attorney that remains in full force and effect even if the principal can no longer make decisions for himself. Most powers of attorney are durable. If you appointed more than one agent, do you want them to be able to act alone (separately) without the other agent joining, or do you want all of your agents to act or sign together (jointly)? Separately JointlyWhen two or more persons are appointed agents, they are known as co-agents. The power of attorney states whether they can either act independently or whether they must act together. If they are to act together, the manner in which disputes should be resolved, can be described in the “Special Instructions – Other” field, below. Other (Specify) OtherDescribe your own restrictions or additions to any of the powers granted to the agent. For example, if a power listed seems too broad, add limits to it, such as “My agent shall have no authority to sell, transfer, or otherwise encumber my business, Ajax Trucking Co.” Description of restrictions or additions. TAKES EFFECT - When do you want this Power of Attorney to become effective: Immediately upon signing by me Only if I become mentally incapacitatedA Power of Attorney can take effect immediately upon signing or at some time in the future (known as a “springing” durable power of attorney). The future time may be a specific date or an occurrence of some event, such as a decision by a doctor that the principal is mentally incompetent and unable to make decisions on his or her own. Commonly, a specific doctor is named to determine mental incompetence, or that two licensed physicians agree the principal is mentally incompetent. DURATION - How long do you want this Power of Attorney to be in force: Until revoked by me in writing For the following period of time only (specifiy):A durable power of attorney continues even when the principal becomes incapacitated, but it automatically ends when the principal dies. The power of attorney can also state that it will end at a specific time. Furthermore, the principal can revoke a power of attorney at any time, so long as he or she is mentally competent to do so. Specific Duration of Time HEALTH CARE DIRECTIVE INFORMATION arrowup6 An Advance Health Care Directive is actually one document that combines the contents of a “health care power of attorney” and a “living will”. It lets you appoint someone to make healthcare decisions on your behalf, if you become mentally or physically incapacitated, and cannot make your own decisions. It also tells medical professionals what types of medical treatments a person wishes at the end of life, such as the use of ventilators or cardiopulmonary resuscitation. Grantor #1 I Want to create a Health Care Directive Grantor #2 I want to create a Health Care Directive If you are human, leave this field blank.
