Pennsylvania Power of Attorney Template
This document, known as a Power of Attorney, is created under the laws of the Commonwealth of Pennsylvania. It allows you, the Principal, to appoint an agent to manage your affairs. Please fill in the blanks where indicated.
Principal Information:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: ______________________________
Agent Information:
Name: ________________________________________
Address: ______________________________________
City, State, Zip: ______________________________
Effective Date: This Power of Attorney shall become effective on: ____________.
Durability: This Power of Attorney shall remain in effect even if I become incapacitated, unless revoked.
Powers Granted: I grant my agent the authority to act on my behalf in the following matters:
- Real estate transactions
- Banking transactions
- Employment decisions
- Healthcare decisions
- Tax matters
Limitations: The following limitations apply to the powers granted:
_______________________________________________
_______________________________________________
Signatures:
Principal's Signature: _________________________
Date: ________________________________________
Agent's Signature: ____________________________
Date: ________________________________________
Notary Public:
State of Pennsylvania
County of ____________________________________
On this __________ day of __________, 20___, before me, a notary public, personally appeared ____________________ (Principal) and ____________________ (Agent), known to me or satisfactorily proven to be the persons whose names are subscribed to this instrument, and acknowledged that they executed the same for the purposes therein contained.
Notary Public Signature: ______________________
My Commission Expires: ______________________