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Wisconsin Financial Power of Attorney Form

If granted, the financial power of attorney allows another person to represent the granting individual in financial decisions/matters. This form, if fulfilled, awards the FPOA to the named person. Download

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Recording Area Ç 	
Name and Return Address 	
      
      
      
 
      	
     WISCONSIN STATUTORY 	
POWER OF ATTORNEY FOR  
FINANCES AND PROPERTY 
IMPORTANT INFORMATION 	
 	
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 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 
Uniform Power of Attorney for Finances and Property Act in 
Chapter 244 of the Wisconsin Statutes. 
 
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.	
 	Parcel Identification Number (if any) 	
 
Your agent is entitled to reasonable compensation unless you state otherwise in the special instructions. 
 
This form provides for designation of one agent.  If you wish to name more than one agent, you may name 
a co-agent in the special instructions.  Co-agents are not required to act together unless you include that 
requirement in the 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 2	nd successor agent. 	
 
This Power of Attorney becomes effective immedi ately unless you state otherwise in the special 
instructions.  This Power of Attorney does not revoke  any Power of Attorney executed previously unless 
you so provide in the special instructions.   
 
If you revoke this Power of Attorney, you should not ify your agent and any other person to whom you have 
given a copy.  If your agent is your spouse or do mestic partner and your marriage is annulled or you are 
divorced or legally separated or the domestic partnership is terminated after signing this document, the 
document is invalid.   
 
If you have questions about the Power of Attorney or the authority you are granting to your agent, you 
should seek legal advice before signing this form.  
DEPARTMENT OF HEALTH SERVICES  
Division of Public Health 
F-00036 (Rev. 09/10) 
 STATE OF WISCONSIN 
 Effective Date September 1, 2010 s. 244.06 (1), Wisconsin Statutes

DESIGNATION OF AGENT 	
I,  	           	(name of principal), 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: 	      	
 
If my successor agent is unable or unwilling to act for me, I name as my 2	nd successor agent: 	
Name of 2	nd 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 (see Appendix) in the Uniform Power of Attorney for Finances and Property Act in chapter 244 of 
the Wisconsin statutes: 	
(INITIAL each subject you want to include in the agent’s general authority.) 	
      	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 	
 	
Page 2  Wisconsin Power of Attorney for Finances and Property 
F-00036 (Rev. 09/10)

LIMITATION ON AGENT’S AUTHORITY 	
An agent who is not my spouse or domestic partner MAY 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 special 
instructions.  
 	
SPECIAL INSTRUCTIONS (OPTIONAL) 	
You may give special instructions in the following space 
      	
 	
EFFECTIVE DATE 	
This power of attorney is effective immediately unless I have stated otherwise in the special instructions. 	
 	
NOMINATION OF GUARDIAN (OPTIONAL) 	
If it becomes necessary for a court to appoint a guardian of  my estate or guardian of my person, I nominate the 
following person(s) for appointment: 
Name of nominee for guardian 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: 	      	
 	
Page 3  Wisconsin Power of Attorney for Finances and Property 
F-00036 (Rev. 09/10)

RELIANCE ON THIS POWER OF ATTORNEY FOR FINANCES AND PROPERTY 	
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that 
person knows that the power of attorney has been 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 on 
Date 	 	by name of principal 	 	
 
 
 	
(Seal, if any) 	
 
 
 
Signature of notary 	      	
Name of notary (typed or printed) 	           	
My commission expires: 	      	
 
This document prepared by: 	      	
 	
Page 4 Wisconsin Power of Attorney for Finances and Property 
F-00036 (Rev. 09/10)

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 you and the principal.  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 the following: 
(1)  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. 
(2)  Act in good faith. 
(3)  Do nothing beyond the authority granted in this Power of Attorney. 
(4)  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: 	
      	(principal’s name) by 	 	(your signature) as agent 	
 
Unless the special instructions in the Power of Attorney state otherwise, you must also do all the following: 
(1)  Act loyally for the principal’s benefit. 
(2)  Avoid conflicts that would impair your ability to act in the principal’s best interest. 
(3)  Act with care, competence, and diligence. 
(4)  Keep a record of all receipts, disbursements, and transactions made on behalf of the principal. 
(5)  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. 
(6)  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 all the following: 
(1)  Death of the principal 
(2)  The principal’s revocation of the Power of Attorney or your authority. 
(3)  The occurrence of a termination event stated in the Power of Attorney. 
(4)  The purpose of the Power of Attorney is fully accomplished. 
(5)  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. 
(6)  If you are the principal’s domestic partner and your domestic partnership is terminated, unless the special 
instructions in this Power of Attorney state that such an action will not terminate your authority.  
Page 5  Wisconsin Power of Attorney for Finances and Property 
F-00036 (Rev. 09/10)

LIABILITY OF AGENT 	
The meaning of the authority granted to you is defined in the Uniform Power of Attorney for Finances and 
Property Act in Chapter 244 of the Wisconsin Statutes.  If you violate the Uniform Power of Attorney for 
Finances and Property Act in Chapter 244 of the Wisconsin Statutes 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. 
 	
OPTIONAL SIGNATURE OF AGENT 	
I have read and accept the duties and liabilities of the agent as specified in this Power of Attorney. 
 
Agent’s signature 	 	Date	 	
 
 
Attached: 	
(1)  Agent’s certification as to the validity of Power of Attorney for Finances and Property and agent’s authority (Optional). 
(2)  Appendix:  Power of Attorney for Finances and Pr operty Statutory Authority Definitions (Optional). 	
 
 
 
 
Page 6  Wisconsin Power of Attorney for Finances and Property 
F-00036 (Rev. 09/10)

The following optional form may be used by an agent to certify facts  	
concerning a power of attorney for finances and property: 	
 	
AGENT’S CERTIFICATION AS TO THE VALIDITY OF 	
POWER OF ATTORNEY FOR FINANCES AND PROPERTY AND AGENT’S AUTHORITY 	
State of: 	      	
County of: 	      	
 
I,  	           	(name of agent), certify under penalty of perjury that 	
           	(name of principal) granted me authority as an agent or  	
successor agent in a power of attorney dated	 	.	
 
I further certify that to my knowledge: 
(1)  The principal is alive and has not revoked the power of attorney or my authority to act under the power of 
attorney, and the power of attorney and my authori ty to act under the power of attorney have not 
terminated. 
(2)  If the power of attorney was drafted to become effective upon the happening of an event or contingency,  the event or contingency has occurred. 
(3)  If I was named as a successor agent, the prior agent is no longer able or willing to serve. 
(4)  	      	
 	(insert other relevant statements) 	
 	
SIGNATURE AND ACKNOWLEDGMENT 	
Agent’s signature 	 	Date	 	
Agent’s name printed 
Agent’s address: 	      	
Agent’s telephone number: 	      	
 
State of: 	      	County of: 	      	
 
This document was acknowledged before me on 
Date 	 	by (name of agent) 	 	
 
 	
(Seal, if any) 	
 
Signature of notary 	      	
Name of notary (typed or printed) 	           	
My commission expires: 	      	
 
This document prepared by: 	      	
Page 7  Wisconsin Power of Attorney for Finances and Property 
F-00036 (Rev. 09/10)
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