Connecticut Durable Power of Attorney
This Durable Power of Attorney is created in accordance with the Connecticut Uniform Power of Attorney Act. It grants the person you choose as your Agent broad powers to handle your financial and personal affairs, even if you become unable to manage them yourself.
Principal Information:
Name: ___________________________
Address: _________________________
City/State/Zip: ___________________
Phone Number: ____________________
Agent Information:
Name: ___________________________
Address: _________________________
City/State/Zip: ___________________
Phone Number: ____________________
Successor Agent Information (Optional):
If my primary Agent is unable or unwilling to serve, I designate the following person as my successor Agent.
Name: ___________________________
Address: _________________________
City/State/Zip: ___________________
Phone Number: ____________________
This Durable Power of Attorney becomes effective immediately and will continue to be effective even if I become disabled, incapacitated, or incompetent.
Powers Granted to My Agent
I grant my Agent the power to act in my name, place, and stead in any way which I myself could do, if I were personally present, with respect to the following matters, as each of them is defined in the Connecticut Uniform Power of Attorney Act:
- Real property transactions.
- Tangible personal property transactions.
- Stock and bond transactions.
- Commodity and option 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 governmental programs, or military service.
- Retirement plan transactions.
- Tax matters.
Signatures
This document must be signed by the Principal, acknowledged before a notary public, and should preferably be witnessed by two individuals who are not the named Agent or Successor Agent.
Principal's Signature: ______________________ Date: ____________
Agent's Acknowledgment: I acknowledge that the above-named Principal has designated me as their Agent under this Durable Power of Attorney. I accept this designation and agree to act according to the Principal's expectations to the best of my abilities.
Agent's Signature: _________________________ Date: ____________
Successor Agent's Signature (If Applicable): _________________________ Date: ____________
Witness 1 Signature: _________________________ Date: ____________
Witness 2 Signature: _________________________ Date: ____________
Notary Public:
State of Connecticut)
County of _______________)
On this day, _____________, before me, ______________________, a notary public, personally appeared ________________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she/they executed the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
Notary Public Signature: ___________________________
My Commission Expires: ___________________________
