Indiana Power of Attorney Template
This Power of Attorney form is designed for use in the State of Indiana, in accordance with Indiana Code § 30-5-1-1, et seq. It allows you to designate an individual to act on your behalf in financial and legal matters.
Principal Information:
Name: ___________________________________
Address: ___________________________________
City, State, Zip: ___________________________
Date of Birth: ______________________________
Agent Information:
Name: ___________________________________
Address: ___________________________________
City, State, Zip: ___________________________
Relationship to Principal: ___________________
Effective Date:
This Power of Attorney shall become effective on: _______________________.
Limitations:
The powers granted to the Agent include, but are not limited to:
- Managing bank accounts
- Buying or selling real estate
- Investment decisions
- Payment of bills and expenses
- Filing tax returns
Optional: Additional powers granted:_____________________________________________________.
If so desired, the Principal may specify any limitations to the powers granted. For example: _______________________.
Signature of Principal:
_____________________________
Date: _____________
Witness Information:
This Power of Attorney must be witnessed by one individual:
Name: ___________________________________
Address: ___________________________________
City, State, Zip: ___________________________
Signature of Witness:
_____________________________
Date: _____________
Notary Public:
This document must be notarized:
State of Indiana
County of ____________________________
Subscribed and sworn to before me on this ___ day of ____________, 20__.
_____________________________
Notary Public Signature
My Commission Expires: ________________
It is advisable for the Principal to review this document fully and consider consulting with a legal professional before executing this Power of Attorney.