"Power of Attorney Form" - Washington

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Download "Power of Attorney Form" - Washington

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Washington Power of Attorney
I, hereby
[Legal Name], AKA [Name]
A resident of
[City][State]
Located at
[Address]
[City], [State] [Zip Code]
Appoint:
Name
[Legal Name]
A resident of
[City][State]
Located at
[Address]
[City], [State] [Zip Code]
As my attorney-in-fact may act on my behalf for the following purpose(s):
[____] Real Estate Transactions
[____] Stock and Bond Transactions
[____] Commodity and Option Transactions
[____] Tangible Personal Property 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 Government Programs
[____] Retirement Plan Transactions
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Washington Power of Attorney
I, hereby
[Legal Name], AKA [Name]
A resident of
[City][State]
Located at
[Address]
[City], [State] [Zip Code]
Appoint:
Name
[Legal Name]
A resident of
[City][State]
Located at
[Address]
[City], [State] [Zip Code]
As my attorney-in-fact may act on my behalf for the following purpose(s):
[____] Real Estate Transactions
[____] Stock and Bond Transactions
[____] Commodity and Option Transactions
[____] Tangible Personal Property 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 Government Programs
[____] Retirement Plan Transactions
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[____] Tax Matters, including any transactions with the Internal Revenue Service
[____] Decisions Regarding Lifesaving and Life Prolonging Medical Treatment.
[____] Decisions Relating to Medical Treatment, Surgical Treatment, Nursing Care, Medication,
Hospitalization, Institutionalization in a nursing home or other facility and home health care.
[____] Transfer of Property or Income as a Gift to the Principal’s Spouse for the purpose of
qualifying the principal for governmental medical assistance.
[____] All OF THE ABOVE POWERS, INCLUDING FINANCIAL AND HEALTH CARE DECISIONS.
I do hereby grant my attorney in fact complete authority to act in any reasonable manner that
is necessary to execute the above mentioned powers that are granted.
This power of attorney shall become effective immediately unless specified otherwise in the
special instructions.
This power of attorney shall continue until I revoke it or it is terminated by my death.
I agree that any third party who is given a copy of this power of attorney may act relying on it. I
also agree that revocation of this power of attorney is effective as to a third party only upon
receipt of actual notice by the third party. I agree to indemnify the third party for any loss that
may be suffered while carrying out this power of attorney.
This contract shall be governed by the laws of the State of Washington in __________ County and any
applicable Federal Law.
__________________________________________________________
Date____________
Signature
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By accepting this appointment and acting under it, I the attorney-in-fact (“Agent”) do hereby assume the
legal responsibilities of an agent.
_____________________________________________________________________Date____________
Signature of Attorney-in-Fact
WITNESS #1) _________________________________
WITNESS #2) _________________________________
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