Hawaii Standard Power of Attorney Form

In the case of wanting to assign another person to make decisions related to your financial and medical issues on your behalf in the State of Hawaii, the following form has to be completed and submitted.

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Hawaii Power of Attorney 	
Effective Date: ____/____/______  
I,      [Legal Name] 
A resident of    [City], Hawaii  
Located at    [Address]  
      [City], Hawaii [Zip Code] 
Do Hereby Appoint,  [Legal Name] 
A resident of    [City], Hawaii  
Located at    [Address]  
      [City], Hawaii [Zip Code] 
As my attorney-in-fact.  1
st Successor Agent: 
      [Legal Name]  
A resident of    [City], Hawaii 
Located at    [Address]  
      [City], Hawaii [Zip Code]   2
nd Successor Agent:	 	
      [Legal Name] 
A resident of    [City], Hawaii 
Located at    [Address] 
      [City], Hawaii [Zip Code]

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My attorney-in-fact may act on my behalf for the fo llowing purpose(s): 
 __________________________________________________ ___________________________	
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
___________________________________________________ __________________________
 
This power of attorney shall take effect on the abo ve mentioned effective date and will 
continue indefinitely or until revoked by me or by  my death. 
I do hereby grant my attorney in fact complete auth ority to act in any reasonable manner that 
is necessary to execute the above mentioned powers  that are granted. 
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 attorne y is effective as to a third party only upon 
receipt of actual notice by the third party. I agre e to indemnify the third party for any loss that 
may be suffered while carrying out this power of at torney.

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  Signature & Acknowledgment 
 
This contract shall be governed by the laws of the  State of 	
Hawaii	 in __________	 County and any 
applicable Federal Law.         
___________________________________________________ _______                         Date____________	
  
Signature      
By accepting this appointment and acting under it,  I the attorney-in-fact (“Agent”) do hereby assume t he 
legal responsibilities of an agent.       ___________________________________________________ __________________Date____________
 
Signature of Attorney-in-Fact     
___________________________________________________ __________________Date____________
 
Signature of 1	
ST Successor Agent 
      ___________________________________________________ __________________Date____________	
 
Signature of 2	
nd  Successor Agent 
    
WITNESS #1) _________________________________	
 
   
WITNESS #2) _________________________________