Illinois Power of Attorney
This Power of Attorney is created in accordance with the laws of the State of Illinois.
Principal Information:
- Name: ___________________________
- Address: _________________________
- City: ____________________________
- State: ___________________________
- Zip Code: ________________________
- Date of Birth: _____________________
Agent Information:
- Name: ___________________________
- Address: _________________________
- City: ____________________________
- State: ___________________________
- Zip Code: ________________________
- Phone Number: ____________________
Effective Date:
- The authority granted under this Power of Attorney shall become effective on: ____________.
Scope of Authority:
- The Agent is granted the authority to act on behalf of the Principal in the following matters:
- Financial transactions.
- Real estate decisions.
- Health care decisions.
This document must be signed by the Principal and notarized to be valid.
Principal's Signature: __________________________ Date: ____________
Notary Public:
State of Illinois
County of ____________________
Subscribed and sworn to before me this ____ day of __________, 20__.
Notary Signature: __________________________
My Commission Expires: ____________________