Indiana Durable Power of Attorney
This Durable Power of Attorney is made in accordance with the laws of the State of Indiana.
Principal Information:
Name: ___________________________________________
Address: _________________________________________
City, State, Zip: _________________________________
Date of Birth: ____________________________________
Agent Information:
Name: ___________________________________________
Address: _________________________________________
City, State, Zip: _________________________________
Phone Number: ___________________________________
Effective Date:
This Durable Power of Attorney shall become effective immediately upon execution or at a future date specified here: __________________________.
Durability:
This Power of Attorney shall not be affected by my subsequent disability or incapacity.
Powers Granted:
I grant my Agent the authority to act on my behalf in the following matters:
- Real estate transactions
- Banking and financial transactions
- Insurance and annuity transactions
- Tax matters
- Healthcare decisions
- Legal claims and litigation
Revocation:
This Durable Power of Attorney may be revoked by me at any time, provided that I do so in writing and notify my Agent.
Signatures:
In witness whereof, I have hereunto set my hand this ____ day of __________, 20__.
___________________________
Principal Signature
___________________________
Witness Signature
___________________________
Witness Signature
Notary Public:
State of Indiana
County of ____________________
Subscribed, sworn to, and acknowledged before me this ____ day of __________, 20__.
___________________________
Notary Public Signature
My Commission Expires: _______________