POWERS OF ATTORNEY
INSTRUCTIONS
| PERSONAL INFORMATION |
Full Name:
______________________________________________________________________________________
(as on your birth certificate or latest change of name certificate) |
Street Address 1:
______________________________________________________________________________________ |
Street Address 2:
______________________________________________________________________________________ |
Home Telephone:
______________________________________________________________________________________ |
Office Telephone:
______________________________________________________________________________________ |
Occupation:
______________________________________________________________________________________ |
Date of Birth:
______________________________________________________________________________________ |
Domestic Status:
______________________________________________________________________________________ |
|
| CONTINUING POWER OF ATTORNEY FOR
PROPERTY |
Please state who you want to appoint as you
attorney for property. You can choose anyone as long as he or she is 18 years of age or
more. Many trust companies are prepared to act as attorney, but they charge a fee for this
service.
Talk to the person(s) you wish to appoint and make sure he or she is willing and able to
accept the responsibility involved in being you attorney for property.
If you want more than one person involved in your financial decisions you can name more
than one person to be your attorney for property, but you are not required to do so.
The person(s) you appoint could have significant power over your finances. Although you
attorney is required by law to act in your best interests, misuse can and does happen.
Please consider whether the person you name is someone you know well, is someone you trust
completely, is concerned only with your best interests and has good judgment and financial
management skills. |
ATTORNEY:
(Address, Relationship & Occupation) (Does not mean "lawyer")
______________________________________________________________________________________ |
Alternate:
______________________________________________________________________________________ |
SPECIAL CLAUSES: |
| ______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
Under the new law, your attorney(s) will be entitled to take payment for acting
as your attorney at a rate to be set out by law, unless you say otherwise. If there is
more than one attorney, they will have to share the permitted amount. If you want to
prohibit your attorney(s) from taking any payment or you want to set a specific amount
yourself you can do that also. |
COMPENSATION:
______________________________________________________________________________________ |
POWER OF ATTORNEY FOR PERSONAL CARE : Please state who you want to appoint as you attorney for personal care You can
choose anyone as long as he or she is 16 years of age or more. The person(s) you appoint
should be someone you know very well and whom you trust completely with you personal care
decisions. Do not appoint anyone who provides you with "health care or residential,
social, training, advocacy, or support services for compensation" unless that person
is also your spouse, partner, orrelative. |
| ATTORNEY: (Address,
Relationship & Occupation) (Does not mean "lawyer")
______________________________________________________________________________________ |
Alternate:
______________________________________________________________________________________ |
SPECIAL CLAUSES:
The most common type of special instruction clause about health care is the idea of a
"living will" in which a person declines certain treatment, such as artificial
life support, if the time should come in which there is no reasonable expectation of
recovery from extreme physical or mental disability
Do you want a Living Will included in your Power of Attorney for Personal Care? __________
If you wish, you may specify in advance whom you want to perform an assessment should it
become necessary. If you wish to include this clause, please complete the following:
In the event my capacity for personal care is in issue and an assessment of my capacity is
required, my physician, Dr.__________________________________________________, shall
perform the assessment, or if he is unable or unwilling to do so, then any other two (2)
physicians selected by my attorney or attorneys then acting hereunder shall perform such
assessment. |
Other Special Clauses:
______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
| ______________________________________________________________________________________ |
 |
