Power of Attorney Prep Sheet Power of Attorney Prep Sheet POA Worksheet Review & Download 1. Principal (You) The person granting the power. Full Legal Name Street Address City, State, ZIP Phone Number 2. Primary Agent (Attorney-in-Fact) The person you are giving power to. Must be a trusted individual. Full Legal Name Relationship Street Address City, State, ZIP Phone Number 3. Successor Agent (Optional) This person will act if your Primary Agent is unable or unwilling. Full Legal Name Relationship Street Address City, State, ZIP Phone Number 4. Granted Powers Select all powers you wish to grant. (Note: Health care decisions are typically in a separate "Health Care POA"). 5. Effective Date & Durability When does this POA start? Immediately upon signing Only upon my verified incapacitation Is this POA "Durable"? Yes (Stays in effect if I am incapacitated) No (Terminates if I become incapacitated) Generate Prep Sheet Download PDF Previous Next