Illinois Durable Power of Attorney
This Durable Power of Attorney is executed in accordance with the Illinois Power of Attorney Act (755 ILCS 45). It grants designated agents the authority to act on behalf of the principal as specified herein.
Principal Information:
- Full Name: _______________
- Address: _______________
- City, State, Zip Code: _______________
- Date of Birth: _______________
Agent Information:
- Full Name of Agent: _______________
- Address: _______________
- City, State, Zip Code: _______________
- Relationship to Principal: _______________
Durability Clause:
This Durable Power of Attorney shall not be affected by the subsequent incapacity of the principal.
Powers Granted:
The principal grants the agent the authority to make decisions regarding:
- Healthcare decisions
- Financial transactions
- Real estate transactions
- Legal matters
- Other matters specifically detailed: _______________
Effective Date:
This Power of Attorney shall become effective immediately upon execution unless a different effective date is specified here: _______________.
Signatures:
In witness whereof, the principal has executed this Durable Power of Attorney on this __ day of __________, 20___.
Principal’s Signature: ________________________
Agent’s Signature: ________________________
Witness:
Two witnesses must sign below, neither of whom shall be the agent named above.
Witness 1 Signature: ________________________
Witness 1 Printed Name: ________________________
Witness 2 Signature: ________________________
Witness 2 Printed Name: ________________________