Power of Attorney Request Worksheet (Pre-Attorney)
A planning worksheet to organize a power of attorney before you see an attorney or complete a state form — who your agent is, the type of POA, which powers to grant, when it takes effect, durability, and limits.
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POWER OF ATTORNEY -- PLANNING WORKSHEET *** THIS IS A PREPARATION WORKSHEET, NOT A POWER OF ATTORNEY. *** Use it to organize your wishes, then have an attorney prepare your POA or complete the form valid in your state and execute it as required (signing, and usually notarization and/or witnesses). This worksheet grants no authority to anyone. Principal (you): Sample Principal AGENT (attorney-in-fact) Agent: Sample Agent (spouse) — (555) 010-1212 Alternate: Backup Agent (sibling) — (555) 010-3434 TYPE OF POA Financial (durable) EFFECTIVE / DURABILITY Takes effect: Springing (on incapacity) Durability: Durable (survives incapacity) POWERS TO GRANT - Manage bank accounts and pay bills - File taxes and handle the IRS - Manage real estate (buy/sell/lease the home) - Manage investments and retirement accounts - Handle insurance and government benefits POWERS TO WITHHOLD / LIMITS - No authority to make gifts to the agent themselves - No changing of beneficiary designations without separate written consent SPECIAL INSTRUCTIONS / NOTES FOR THE ATTORNEY Agent should consult my financial advisor before selling investments. Provide an accounting to my alternate agent annually. NEXT STEPS [ ] Review with a licensed attorney (POA powers are significant) [ ] Complete the POA form valid in your state [ ] Sign and have notarized / witnessed as your state requires [ ] Give copies to your agent and relevant institutions (banks, etc.) [ ] Choose someone you trust completely -- an agent can act on your behalf (Worksheet only -- signing here does NOT create a power of attorney.)
About this template
A power of attorney (POA) lets you name an **agent** (also called an attorney-in-fact) to act on your behalf — typically for **financial/property** matters or for **healthcare** decisions. It is one of the most powerful documents you can sign, which is exactly why it pays to think it through before drafting: this worksheet helps you organize the decisions an attorney (or your state's form) will ask about, so the eventual POA matches what you actually intend. The choices that matter most are **who your agent is** — this person can act with real authority over your money or care, so it must be someone you trust completely, plus a named **alternate** in case the first cannot serve — and **what powers you grant** versus withhold (managing accounts, real estate, taxes, investments, benefits; and limits such as no self-gifting). Two technical choices shape how the POA behaves: **when it takes effect** — immediately on signing, or "springing" so it only activates if you become incapacitated — and **durability** — a **durable** POA stays in effect if you become incapacitated (usually the point of having one for incapacity planning), while a non-durable one ends at that moment. The essential caveat: **this worksheet is not a power of attorney and grants no authority to anyone.** A valid POA must be the form/document recognized in your state and **executed the way your state requires** — signed, and usually **notarized and/or witnessed** — and many financial institutions have their own acceptance requirements. Because the stakes are high and rules vary by state, **review your plan with a licensed attorney**, then give signed copies to your agent and the institutions that will rely on it. Choose your agent carefully and revisit the POA after major life changes.
When to use it
- Organizing your wishes before an attorney drafts a power of attorney.
- Deciding who your agent and alternate should be.
- Mapping out which powers to grant or withhold.
- Preparing for a meeting about financial or healthcare POA.
What to include
- Principal and agent (plus an alternate/successor agent).
- Type of POA (financial, healthcare, general, or limited).
- Powers to grant and powers to withhold/limits.
- When it takes effect and whether it is durable.
- Special instructions and next steps to make it legally valid.