Iowa Statutory Power of Attorney

In the case of wanting to allow a representative to make decisions concerning the property of a principal in the State of Iowa, the following form has to be completed and submitted.

Extracted Text for Proper Search

© The Iowa State Bar Association 2014	 	    IOWADOCS®  	 	120 	- Iowa Statutory Power of Attorney	 	Revised June 2014	 	
THE IOWA STATE BAR ASSOCIATION	 	Official Form No. 120	 	FOR THE LEGAL EFFECT OF THE USE OF	 	THIS FORM, CONSULT YOUR LAWYER	 	
1.  POWER OF ATTORNEY	 	
 
     	This  power  of  attorney  authorizes  another  person  (your  agent)  to  make  decisions 	
concerning  your  property  for  you  (the  principal).  Your  agent  will  be  able  to  make  decisions 
and act with respect to your property (including but not limited to your money) whether or not 
you  are  able  to  act  for  yourself.  The  meaning  of  authority  over  subjects  listed  on  this  form  is 
explained in the Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B.	 	
     	This power of attorney does not authorize the agent to make health care decisions for you.	 	
     	You  should  select  someone  you  trust  to  serve  as  your  agent.  Unless  you  specify 	
otherwise,  generally  the  agent’s  authority  will  continue  until  you  die  or  revoke  the  power  of 
attorney or the agent resigns or is unable to act for you.	 	
     	Your  agent  is  not  entitled  to  compensation  unless  you  state  otherwise  in  the  optional 	
Special Instructions.	 	
     	This form provides for designation of one agent. If you wish to name more than one agent, 	
you  may  name  a  coagent  in  the  optional  Special  Instructions.  Coagents  must  act  by  majority 
rule unless you provide otherwise in the optional Special Instructions.	 	
     	If  your  agent  is  unable  or  unwilling  to  act  for  you,  your  power  of  attorney  will  end  unless 	
you have named a successor agent. You may also name a second successor agent.	 	
     	This  power  of  attorney  becomes  effective  immediately  upon  signature  and 	
acknowledgment unless you state otherwise in the optional Special Instructions.	 	
     	If you have questions about this power of attorney or the authority you are granting to your 	
agent, you should seek legal advice before signing this form.	 	
 	
DESIGNATION OF AGENT	 	
 	
     	I, _____________________________________, name the following person as my agent:	 	
Name of Agent  ______________________	 	
Agent’s Address  _______________________________________________________	 	
Agent’s Telephone Number  ______________	 	
 	
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)	 	
 	
     	If my agent is unable or unwilling to act for me, I name as my successor agent:	 	
Name of Successor Agent  ______________________	 	
Successor Agent’s Address  ______________________________________________	 	
Successor Agent’s Telephone Number  _____________	 	
IOWA STATUTORY POWER OF ATTORNEY

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     	If my successor agent is unable or unwilling to act for me, I name as my second successor 	
agent: 	 
Name of Second Successor Agent  ______________________	 	
Second Successor Agent’s Address  _______________________________________	 	
Second Successor Agent’s Telephone Number  ______________________	 	
 	
GRANT OF GENERAL AUTHORITY	 	
 
     	I  grant  my  agent  and  any  successor  agent  general  authority  to  act  for  me  with  respect  to 	
the  following  subjects  as  defined  in  the  Iowa  Uniform  Power  of  Attorney  Act,  Iowa  Code 
chapter 633B:	 	
(Initial each  subject  you  want  to  include  in  the  agent’s  general authority.  If  you  wish  to 
grant  general  authority  over  all  of  the  subjects  you  may  initial  “All  Preceding  Subjects” 
instead of initialing each subject.)	 	
____ Real Property	 	
____ Tangible Personal Property	 	
____ Stocks and Bonds	 	
____ Commodities and Options	 	
____ Banks and Other Financial Institutions	 	
____ Operation of Entity or Business	 	
____ Insurance and Annuities	 	
____ Estates, Trusts, and Other Beneficial Interests	 	
____ Claims and Litigation	 	
____ Personal and Family Maintenance	 	
____ Benefits from Governmental Programs or Civil or Military Service	 	
____ Retirement Plans	 	
____ Taxes	 	
____ All Preceding Subjects	 	
 	
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)	 	
 
     	My  agent  shall  not  do  any  of  the  following  specific  acts  for  me  unless  I  have  initialed  the 	
specific authority listed below:	 	
(Caution: Granting any of the following will give your agent the authority to take actions 
that could significantly reduce your property or change how your property is distributed 
at your death. Initial only the specific authority you WANT to give your agent.)	 	
____  Amend,  revoke,  or  terminate  a  revocable  inter  vivos  trust,  if  authorized  by  the 
trust.	 	
____ Agree to the amendment or termination of any other inter vivos trust.	 	
____  Make  a  gift  to  an  individual  who  is  not  an  agent,  subject  to  the  limitations  of  the  
Iowa  Uniform  Power  of  Attorney  Act,  Iowa  Code  section  633B.217,  and  any  special 
instructions in this power of attorney.

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Make  gifts,  either direct  or indirect,  to my  agent  acting  under this  power of  attorney  as 
follows:	 	
____ Any such gift must be approved in writing by ____________________________; 
 	or	 	
____ No third party approval is needed.	 	
____  Authorize  another  person  to  exercise  the  authority  granted  under  this  power  of 
attorney.	 	
____  Waive  the  principal’s  right  to  be  a  beneficiary  of  a  joint  and  survivor  annuity, 
including a survivor benefit under a retirement plan.	 	
____ Exercise fiduciary powers that the principal has authority to delegate.	 	
____ Disclaim or refuse an interest in property, including a power of appointment.	 	
 	
LIMITATION ON AGENT’S AUTHORITY	 	
 	
     	An  agent  that  is  not  my  ancestor,  spouse,  or  descendant  shall  not  use  my  property  to 	
benefit the agent or a person to whom the agent owes an obligation of support unless I have 
included that authority in the optional Special Instructions.	 	
 	
SPECIAL INSTRUCTIONS (OPTIONAL)	 	
 	
     	You may give special instructions on the following lines:	 	
_________________________________________________________________________	 	
_________________________________________________________________________	 	
_________________________________________________________________________	 	
 
_________________________________________________________________________	 	
shall have the authority to request an accounting of any agent. 	 	
 	
EFFECTIVE DATE	 	
 	
     	This  power  of  attorney  is  effective  immediately  upon  signature  and  acknowledgment 	
unless I have stated otherwise in the optional Special Instructions.	 	
 	
NOMINATION OF CONSERVATOR AND GUARDIAN (OPTIONAL)	 	
 	
     	If it becomes necessary for a court to appoint a conservator of my estate or guardian of my 	
person, I nominate the following person(s) for appointment:	 	
Name of Nominee for Conservator of My Estate  ______________________________	 	
Nominee’s Address  ____________________________________________________	 	
Nominee’s Telephone Number  ______________________	 	
 
Name of Nominee for Guardian of My Person  ________________________________	 	
Nominee’s Address  ____________________________________________________	 	
Nominee’s Telephone Number  ______________________

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RELIANCE ON THIS POWER OF ATTORNEY	 	
 	
     	Any  person,  including  my  agent,  may  rely  upon  the  validity  of  this  power  of  attorney  or  a 	
copy of it unless that person knows it has terminated or is invalid.	 	
 	
SIGNATURE AND ACKNOWLEDGMENT	 	
 	
_________________________________	 	 	______________________	 	
Your Signature	 	 	 	 	 	 	Date	 	
 	_________________________________	 	
Your Name Printed	 	
 	_____________________________________________________________________	 	
Your Address	 	
 	_________________________________	 	
Your Telephone Number	 	
 
STATE OF ___________________, COUNTY OF ___________________	 	
     	This document was acknowledged before me this ____ day of ______________, ______, 	
by _______________________________________________________________________.	 	
 	
________________________________	 	
Signature of Notary Public	 	
 
 
 
This document prepared by __________________________________________________	_ 	
__________________________________________________	________________________	 	
 
2. IMPORTANT INFORMATION FOR AGENT	 	
 	
AGENT’S DUTIES	 	
 	
When you accept the authority granted under this power of attorney, a special legal 	
relationship is created between the principal and you. This relationship imposes upon you 
legal duties that continue until you resign or the power of attorney is terminated or revoked. 
You must do all of the following:	 	
Do what you know the principal reasonably expects you to do with the principal’s 	
property or, if you do not know the principal’s expectations, act in the principal’s best interest.	 	
Act in good faith.	 	
Do nothing beyond the authority granted in this power of attorney.

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Disclose your identity as an agent whenever you act for the principal by writing or 	
printing the name of the principal and signing your own name as agent in the following 
manner: 	 	
________________________________ by ________________________________ as Agent.	 	
Unless the Special Instructions in this power of attorney state otherwise, you must also 	
do all of the following:	 	
Act loyally for the principal’s benefit.	 	
Avoid conflicts that would impair your ability to act in the principal’s best interest. Act 	
with care, competence, and diligence.	 	
Keep a record of all receipts, disbursements, and transactions made on behalf of the 	
principal.	 	
Cooperate with any person that has authority to make health care decisions for the 	
principal to do what you know the principal reasonably expects or, if you do not know the 
principal’s expectations, to act in the principal’s best interest.	 	
Attempt to preserve the principal’s estate plan if you know the plan and preserving the 	
plan is consistent with the principal’s best interest.	 	
 	
TERMINATION OF AGENT’S AUTHORITY	 	
 	
You must stop acting on behalf of the principal if you learn of any event that terminates 	
this power of attorney or your authority under this power of attorney. Events that terminate a 
power of attorney or your authority to act under a power of attorney include any of the 
following:	 	
Death of the principal.	 	
The principal’s revocation of the power of attorney or your authority.	 	
The occurrence of a termination event stated in the power of attorney.	 	
The purpose of the power of attorney is fully accomplished.	 	
If you are married to the principal, a legal action is filed with a court to end your 	
marriage, or for your legal separation, unless the Special Instructions in this power of attorney 
state that such an action will not terminate your authority.	 	
 	
LIABILITY OF AGENT	 	
 	
The meaning of the authority granted to you is defined in the Iowa Uniform Power of 	
Attorney Act, Iowa Code chapter 633B. If you violate the Iowa Uniform Power of Attorney Act, 
Iowa Code chapter 633B, or act outside the authority granted, you may be liable for any 
damages caused by your violation.	 	
If there is anything about this document or your duties that you do not understand, you 	
should seek legal advice.