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Illinois Statutory Short Form Power Of Attorney For Property Form. This is a Illinois form and can be use in Miscellaneous Statewide.
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Statutory Short Form Power of Attorney for Property
Eff. 7/1/11
(Text of Section after amendment by P.A. 96-1195)
Sec. 3-3. Statutory short form power of attorney for property.
(a) The form prescribed in this Section may be known as “statutory property power” and
may be used to grant an agent powers with respect to property and financial matters.
The “statutory property power” consists of the following: (1) Notice to the Individual
Signing the Illinois Statutory Short Form Power of Attorney for Property; (2) Illinois
Statutory Short Form Power of Attorney for Property; and (3) Notice to Agent. When a
power of attorney in substantially the form prescribed in this Section is used, including
all 3 items above, with item (1), the Notice to Individual Signing the Illinois Statutory
Short Form Power of Attorney for Property, on a separate sheet (coversheet) in 14-point
type and the notarized form of acknowledgment at the end, it shall have the meaning
and effect prescribed in this Act.
(b) A power of attorney shall also be deemed to be in substantially the same format as
the statutory form if the explanatory language throughout the form (the language
following the designation “NOTE:”) is distinguished in some way from the legal
paragraphs in the form, such as the use of boldface or other difference in typeface and
font or point size, even if the “Notice” paragraphs at the beginning are not on a separate
sheet of paper or are not in 14-point type, or if the principal's initials do not appear in the
acknowledgement at the end of the “Notice” paragraphs.
(c) The Notice to the Individual Signing the Illinois Statutory Short Form Power of
Attorney for Property shall be substantially as follows:
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS
STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY
PLEASE READ THIS NOTICE CAREFULLY. The form that you will be signing
is a legal document. It is governed by the Illinois Power of Attorney Act. If there is
anything about this form that you do not understand, you should ask a lawyer to
explain it to you.
The purpose of this Power of Attorney is to give your designated “agent” broad
powers to handle your financial affairs, which may include the power to pledge, sell,
or dispose of any of your real or personal property, even without your consent or any
advance notice to you. When using the Statutory Short Form, you may name
successor agents, but you may not name co-agents.
This form does not impose a duty upon your agent to handle your financial affairs,
so it is important that you select an agent who will agree to do this for you. It is
also important to select an agent whom you trust, since you are giving that agent
control over your financial assets and property. Any agent who does act for you
has a duty to act in good faith for your benefit and to use due care, competence,
and diligence. He or she must also act in accordance with the law and with the
directions in this form. Your agent must keep a record of all receipts,
disbursements, and significant actions taken as your agent.
Unless you specifically limit the period of time that this Power of Attorney will be in
effect, your agent may exercise the powers given to him or her throughout your
lifetime, both before and after you become disabled. A court, however, can take
away the powers of your agent if it finds that the agent is not acting properly. You
may also revoke this Power of Attorney if you wish.
This Power of Attorney does not authorize your agent to appear in court for you as
an attorney-at-law or otherwise to engage in the practice of law unless he or she is
a licensed attorney who is authorized to practice law in Illinois.
The powers you give your agent are explained more fully in Section 3-4 of the
Illinois Power of Attorney Act. This form is a part of that law. The “NOTE”
paragraphs throughout this form are instructions.
You are not required to sign this Power of Attorney, but it will not take effect
without your signature. You should not sign it if you do not understand everything
in it, and what your agent will be able to do if you do sign it.
Please place your initials on the following line indicating that you have read this
Notice:
......................................
(Principal’s initials)
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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(d) The Illinois Statutory Short Form Power of Attorney for Property shall be substantially
as follows:
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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ILLINOIS STATUTORY SHORT FORM
POWER OF ATTORNEY FOR PROPERTY
1.
I, ...................................................................................................................................., (insert
name and address of principal) hereby revoke all prior powers of attorney for property executed by me and
appoint: ..................................................................................................................................... (insert
name and address of agent)
(NOTE: You may not name co-agents using this form.)
as my attorney-in-fact (my “agent”) to act for me and in my name (in any way I could act in
person) with respect to the following powers, as defined in Section 3-4 of the “Statutory Short
Form Power of Attorney for Property Law” (including all amendments), but subject to any
limitations on or additions to the specified powers inserted in paragraph 2 or 3 below:
(NOTE: You must strike out any one or more of the following categories of powers you do not
want your agent to have. Failure to strike the title of any category will cause the powers
described in that category to be granted to the agent. To strike out a category you must draw
a line through the title of that category.)
(a) Real estate transactions.
(b) Financial institution transactions.
(c) Stock and bond transactions.
(d) Tangible personal property transactions.
(e) Safe deposit box transactions.
(f) Insurance and annuity transactions.
(g) Retirement plan transactions.
(h) Social Security, employment and military service benefits.
(i) Tax matters.
(j) Claims and litigation.
(k) Commodity and option transactions.
(l) Business operations.
(m) Borrowing transactions.
(n) Estate transactions.
(o) All other property transactions.
(NOTE: Limitations on and additions to the agent’s powers may be included in this power of
attorney if they are specifically described below.)
2.
The powers granted above shall not include the following powers or shall be modified or
limited in the following particulars:
(NOTE: Here you may include any specific limitations you deem appropriate, such as a
prohibition or conditions on the sale of particular stock or real estate or special rules on
borrowing by the agent.)
3.
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
In addition to the powers granted above, I grant my agent the following powers:
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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(NOTE: Here you may add any other delegable powers including, without limitation, power
to make gifts, exercise powers of appointment, name or change beneficiaries or joint tenants
or revoke or amend any trust specifically referred to below.)
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
(NOTE: Your agent will have authority to employ other persons as necessary to enable the
agent to properly exercise the powers granted in this form, but your agent will have to make
all discretionary decisions. If you want to give your agent the right to delegate discretionary
decision-making powers to others, you should keep paragraph 4, otherwise it should be
struck out.)
4.
My agent shall have the right by written instrument to delegate any or all of the foregoing
powers involving discretionary decision-making to any person or persons whom my agent may
select, but such delegation may be amended or revoked by any agent (including any successor)
named by me who is acting under this power of attorney at the time of reference.
(NOTE: Your agent will be entitled to reimbursement for all reasonable expenses incurred in
acting under this power of attorney. Strike out paragraph 5 if you do not want your agent to
also be entitled to reasonable compensation for services as agent.)
5.
My agent shall be entitled to reasonable compensation for services rendered as agent under
this power of attorney.
(NOTE: This power of attorney may be amended or revoked by you at any time and in any
manner. Absent amendment or revocation, the authority granted in this power of attorney will
become effective at the time this power is signed and will continue until your death, unless a
limitation on the beginning date or duration is made by initialing and completing one or both
of paragraphs 6 and 7.)
6.
[ ] This power of attorney shall become effective on
............................................................................................
(NOTE: Insert a future date or event during your lifetime, such as a court determination of
your disability or a written determination by your physician that you are incapacitated, when
you want this power to first take effect.)
7.
[ ] This power of attorney shall terminate on
............................................................................................
(NOTE: Insert a future date or event, such as a court determination that you are not under a
legal disability or a written determination by your physician that you are not incapacitated, if
you want this power to terminate prior to your death.)
(NOTE: If you wish to name one or more successor agents, insert the name and address of
each successor agent in paragraph 8.)
8.
If any agent named by me shall die, become incompetent, resign or refuse to accept the
office of agent, I name the following (each to act alone and successively, in the order named) as
successor(s) to such agent:
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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..............................................................
..............................................................
For purposes of this paragraph 8, a person shall be considered to be incompetent if and while the
person is a minor or an adjudicated incompetent or disabled person or the person is unable to give
prompt and intelligent consideration to business matters, as certified by a licensed physician.
(NOTE: If you wish to, you may name your agent as guardian of your estate if a court decides
that one should be appointed. To do this, retain paragraph 9, and the court will appoint your
agent if the court finds that this appointment will serve your best interests and welfare. Strike
out paragraph 9 if you do not want your agent to act as guardian.)
9.
If a guardian of my estate (my property) is to be appointed, I nominate the agent acting
under this power of attorney as such guardian, to serve without bond or security.
10. I am fully informed as to all the contents of this form and understand the full import of this
grant of powers to my agent.
(NOTE: This form does not authorize your agent to appear in court for you as an
attorney-at-law or otherwise to engage in the practice of law unless he or she is a licensed
attorney who is authorized to practice law in Illinois.)
11.
The Notice to Agent is incorporated by reference and included as part of this form.
Dated: .........................
Signed .............................................
(principal)
(NOTE: This power of attorney will not be effective unless it is signed by at least one witness
and your signature is notarized, using the form below. The notary may not also sign as a
witness.)
The undersigned witness certifies that ........................................................, known to me to be the
same person whose name is subscribed as principal to the foregoing power of attorney, appeared
before me and the notary public and acknowledged signing and delivering the instrument as the
free and voluntary act of the principal, for the uses and purposes therein set forth. I believe him
or her to be of sound mind and memory. The undersigned witness also certifies that the witness
is not: (a) the attending physician or mental health service provider or a relative of the physician
or provider; (b) an owner, operator, or relative of an owner or operator of a health care facility in
which the principal is a patient or resident; (c) a parent, sibling, descendant, or any spouse of
such parent, sibling, or descendant of either the principal or any agent or successor agent under
the foregoing power of attorney, whether such relationship is by blood, marriage, or adoption; or
(d) an agent or successor agent under the foregoing power of attorney.
Dated: .........................
........................................................................
(Witness)
(NOTE: Illinois requires only one witness, but other jurisdictions may require more than one
witness. If you wish to have a second witness, have him or her certify and sign here:)
(Second witness)
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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The undersigned witness certifies that ........................................................, known to me to be the
same person whose name is subscribed as principal to the foregoing power of attorney, appeared
before me and the notary public and acknowledged signing and delivering the instrument as the
free and voluntary act of the principal, for the uses and purposes therein set forth. I believe him
or her to be of sound mind and memory. The undersigned witness also certifies that the witness
is not: (a) the attending physician or mental health service provider or a relative of the physician
or provider; (b) an owner, operator, or relative of an owner or operator of a health care facility in
which the principal is a patient or resident; (c) a parent, sibling, descendant, or any spouse of
such parent, sibling, or descendant of either the principal or any agent or successor agent under
the foregoing power of attorney, whether such relationship is by blood, marriage, or adoption; or
(d) an agent or successor agent under the foregoing power of attorney.
Dated: .........................
...............................................................
(Witness)
State of ..........................)
) SS.
County of ......................)
The undersigned, a notary public in and for the above county and state, certifies that
......................................................, known to me to be the same person whose name is subscribed
as principal to the foregoing power of attorney, appeared before me and the witness(es)
............................................................... (and ............................................................) in person and
acknowledged signing and delivering the instrument as the free and voluntary act of the
principal, for the uses and purposes therein set forth (, and certified to the correctness of the
signature(s) of the agent(s)).
Dated: .........................
...............................................................
Notary Public
(NOTE: You may, but are not required to, request your agent and successor agents to provide
specimen signatures below. If you include specimen signatures in this power of attorney, you
must complete the certification opposite the signatures of the agents.)
Specimen signatures of
agent (and successors).
I certify that the signatures of my
agent (and successors) are correct.
........................................................
........................................................
(agent)
........................................................
(successor agent)
........................................................
(successor agent)
(principal)
........................................................
(principal)
........................................................
(principal)
(NOTE: The name, address, and phone number of the person preparing this form or who
assisted the principal in completing this form should be inserted below.)
Statutory Short Form Power of Attorney For Property
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Name ........................................................................
Address ....................................................................
..................................................................................
..................................................................................
Phone .......................................................................
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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(e) Notice to Agent. The following form may be known as “Notice to Agent” and shall be
supplied to an agent appointed under a power of attorney for property.
Statutory Short Form Power of Attorney For Property
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NOTICE TO AGENT
When you accept the authority granted under this power of attorney a special legal relationship,
known as agency, is created between you and the principal. Agency imposes upon you duties
that continue until you resign or the power of attorney is terminated or revoked.
As agent you must:
(1) do what you know the principal reasonably expects you to do with the principal’s
property;
(2) act in good faith for the best interest of the principal, using due care, competence, and
diligence;
(3) keep a complete and detailed record of all receipts, disbursements, and significant actions
conducted for the principal;
(4) attempt to preserve the principal’s estate plan, to the extent actually known by the agent,
if preserving the plan is consistent with the principal’s best interest; and
(5) cooperate with a person who has authority to make health care decisions for the principal
to carry out the principal’s reasonable expectations to the extent actually in the principal’s best
interest.
As agent you must not do any of the following:
(1) act so as to create a conflict of interest that is inconsistent with the other principles in this
Notice to Agent;
(2) do any act beyond the authority granted in this power of attorney;
(3) commingle the principal’s funds with your funds;
(4) borrow funds or other property from the principal, unless otherwise authorized;
(5) continue 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, such as the death of the
principal, your legal separation from the principal, or the dissolution of your marriage to the
principal.
If you have special skills or expertise, you must use those special skills and expertise when
acting for the principal. You must 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:
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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“(Principal’s Name) by (Your Name) as Agent”
The meaning of the powers granted to you is contained in Section 3-4 of the Illinois Power of
Attorney Act, which is incorporated by reference into the body of the power of attorney for
property document.
If you violate your duties as agent or act outside the authority granted to you, you may be liable
for any damages, including attorney’s fees and costs, caused by your violation.
If there is anything about this document or your duties that you do not understand, you should
seek legal advice from an attorney.
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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(f) The requirement of the signature of a witness in addition to the principal and the
notary, imposed by Public Act 91-790, applies only to instruments executed on or after
June 9, 2000 (the effective date of that Public Act).
(NOTE: This amendatory Act of the 96th General Assembly deletes provisions that
referred to the one required witness as an “additional witness”, and it also provides for
the signature of an optional “second witness”.)
(Source: P.A. 96-1195, eff. 7-1-11.)
Statutory Short Form Power of Attorney For Property
effective July 1, 2011
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