Free Michigan Power of Attorney (POA) Forms

MICHIGAN POWER OF ATTORNEY

I, __________, am of sound mind, and I voluntarily make this designation.

I designate __________, my __________, living at __________, __________, __________, MI __________, to act for me as my agent, with the powers set forth in this document. If my first choice cannot serve or cannot continue to serve, I designate __________, my __________, living at __________, __________, MI __________ to act for me as my agent. I have discussed this appointment with the individual or individuals I have designated.

EFFECTIVE DATE
(You must choose one paragraph by writing your initials on the line)

[       ] ____________ My agent has the powers set forth in this document immediately upon my signing it. These powers shall not be affected by any mental or physical disability I may have in the future.

OR

[       ] ____________ My agent shall only have the powers set forth in this document when it is determined I am unable to manage my property and financial affairs effectively. That determination shall be made by my attending physician, who shall put it in writing.

POWERS

My agent shall exercise powers in my best interests and for my welfare, as a fiduciary. My agent shall have the following powers:

BANKING – To receive funds, deposit funds in any financial institution, and make withdrawals by check or otherwise to pay for goods, services, and any other personal and business expenses for my benefit. To effect her or his powers, my agent has power to sign a power of attorney drafted by the institution, and shall have access to my safe deposit box.

GOVERNMENT BENEFITS – To apply for and receive any government benefits for which I may be eligible or become eligible, including but not limited to, Social Security, Medicare and Medicaid.

INVESTMENTS – To invest and reinvest my funds, and to withdraw funds to the extent needed to pay for my needs.

RETIREMENT PLAN – To contribute to, select payment option of, roll-over, and receive benefits of any retirement plan or IRA, except my agent shall not have power to change the beneficiary of any plan or IRA.

TAXES – To complete and sign any local, state and federal tax returns, pay any taxes and assessments due and receive credits and refunds, to sign any IRS documents necessary to effectuate these powers.

INSURANCE – To purchase, pay premiums and make claims on life, health, automobile and homeowners’ insurance, except my agent shall not have the power to cash in or change the beneficiary of any life insurance policy.

REAL ESTATE – To purchase, sell, lease, repair, improve, mortgage, and make mortgage and utility payments upon real property. A legal description is attached.

PERSONAL PROPERTY – To hold personal property for safekeeping, and to buy and sell personal property, including motor vehicles.

LEGAL ADVICE AND PROCEEDINGS – To obtain and pay for legal advice, to initiate or defend legal and administrative proceedings on my behalf, including actions against third parties who refuse without cause to honor this document.

ESTATE PLAN – My agent has no authority to make or amend a will on my behalf, and has no power to make gifts on my behalf except to my spouse. My agent has access to my will; in exercising powers, my agent shall take into account my estate plan as known to the agent.

SPECIAL INSTRUCTIONS

On the following lines are any special instructions limiting or extending the powers I give to my agent.

______________________________________________________________________________

______________________________________________________________________________

OTHER PROVISIONS

No person in Michigan or in any other state who relies upon representations of my agent under this durable power of attorney shall be liable to me or my estate without actual knowledge my agent did not have power to act.

My agent shall not incur any liability to me under this power except for a breach of fiduciary duty.

My agent is entitled to reimbursement for reasonable expenses incurred in exercising powers, and to reasonable compensation for services as agent.

I can amend or revoke this power of attorney through a writing delivered to my agent. Revocation is not effective as to a third party until the third party learns of it.

Photocopies of this document can be relied upon as though they were originals.

SIGNATURE OF PRINCIPAL AND ACKNOWLEDGMENT OF PRINCIPAL
I sign this document voluntarily, and I understand its purpose.

 

Your Signature____________________________________  Date________________________

Your Name Printed: __________

Your Address: __________, __________, __________, MI __________

Your Telephone Number: __________

STATEMENT AND SIGNATURE OF WITNESSES

We sign below as witnesses. This declaration was signed in our presence. The declarant appears to be of sound mind, and to be making this designation voluntarily, without duress, fraud, or undue influence. Neither of us is an agent named in this document.

 

WITNESS: ___________________________________________ (Signature of witness)

PRINT NAME:____________________________________________________________________

ADDRESS:_________________________________________________________________________

 

WITNESS: ____________________________________________ (Signature of witness)

PRINT NAME:____________________________________________________________________

ADDRESS:_________________________________________________________________________

SIGNATURE OF NOTARY

Sworn to and signed by __________ (Name of Principal)

this _____________________ month _______day of 20____.

 

_________________________________________________ (Signature of notary public)

County____________________________________

My commission expires ______________________

 

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:

 

(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; and

(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 this power of attorney state otherwise, you must also:

(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; and 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:

 

(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; or

(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.

 

Liability of Agent

The meaning of the authority granted to you is defined in the Uniform Durable Power of Attorney Act, Michigan Compiled Laws, Section 700.5501. If you violate the Uniform Durable Power of Attorney Act, Michigan Compiled Laws, Section 700.5501, 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.

 

AGENT’S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT’S AUTHORITY

 

State of Michigan

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 authority 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; and

(4) __________________________________________________________________

___________________________________________ (Insert other relevant statements)

 

SIGNATURE AND ACKNOWLEDGMENT AGENT

 

Agent’s Signature__________________________________  Date________________________

Agent’s Name Printed: __________

Agent’s Address: __________, __________, __________, MI __________

Agent’s Telephone Number: __________

 

This document was acknowledged before me on

_________________________ (Date), by __________ (Name of Agent).

 

Signature of Notary _________________________

 

(Seal, if any)

 

My commission expires: _________________________

This document prepared by: __________