(Your Signature)
....
(Your Social Security Number)
By signing as a witness, I am acknowledging the signature of the principal who signed in my presence and the presence of the other witness, and the fact that he or she has stated that this power of attorney reflects his or her wishes and is being executed voluntarily. I believe him or her to be of sound mind and capable of creating this power of attorney. I am not related to him or her by blood, marriage or adoption, and, to the best of my knowledge, I am not entitled to any portion of his or her estate under his or her will.
Witness Witness
Dated: .... Dated: ....
Signature: .... Signature: ....
Print Name: .... Print Name: ....
Address: .... Address: ....
State of ....
County of ....
This document was acknowledged before me on .... (date) by .... (name of principal).
....
(Signature of Notarial Officer)
(Seal, if any)
(Title)
[My commission is permanent or expires: .... ]
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES AND LIABILITIES OF AN AGENT.
....
(Name of Agent)
....
(Signature of Agent)
This document was drafted by .... (signature of person preparing the document).
243.10 Note
NOTE: Sub. (1) is shown as affected by two acts of the 1999 legislature and as merged by the revisor under s. 13.93 (2) (c).
243.10(2)
(2) Requirements. A Wisconsin basic power of attorney for finances and property is legally sufficient under this section if the wording of the form complies substantially with
sub. (1), the form is properly completed, the signature of the principal is acknowledged and the signature of the agent is obtained.
243.10(3)
(3) Copies. A copy of a completed Wisconsin basic power of attorney for finances and property form has the same force and effect as the original.
243.10(4)
(4) Durable power of attorney. A Wisconsin basic power of attorney for finances and property that is legally sufficient under this section is durable to the extent that durable powers are permitted under
s. 243.07 and the basic power of attorney for finances and property contains language provided under
s. 243.07 (1) (a) showing the intent of the principal that the power granted may be exercised notwithstanding later disability or incapacity.
243.10(5)
(5) Distribution of forms. The department of health and family services shall prepare and provide copies of the Wisconsin basic power of attorney for finances and property form under
sub. (1) for distribution in quantities to financial institutions, health care professionals, hospitals, nursing homes, multipurpose senior centers, county clerks and local bar associations and individually to private persons. The department of health and family services may charge a reasonable fee for the cost of preparation and distribution of the forms.
243.10(6)
(6) Relation to power of attorney for health care. The execution of a Wisconsin basic power of attorney for finances and property under this section does not confer on the agent any of the powers or duties conferred on a health care agent by the power of attorney for health care under
ch. 155.
243.10(7)
(7) Amendment, revocation and invalidation of basic power of attorney for finances and property. 243.10(7)(a)(a) A principal may amend a Wisconsin basic power of attorney for finances and property only by revoking that power of attorney and completing a new basic power of attorney for finances and property.
243.10(7)(b)
(b) A principal may revoke a Wisconsin basic power of attorney for finances and property and invalidate it at any time by destroying it, by directing another person to destroy it in the principal's presence or by signing a written and dated statement expressing the principal's intent to revoke. If the agent under the Wisconsin basic power of attorney for finances and property is the principal's spouse and the marriage is annulled, or the agent and principal are divorced, after signing the document, the Wisconsin basic power of attorney for finances and property is invalid.
243.10(8)(a)(a) An interested party may petition the court assigned to exercise probate jurisdiction for the county where a principal is present or the county of the principal's legal residence to review whether the agent is performing his or her duties in accordance with the terms of the Wisconsin basic power of attorney for finances and property executed by the principal. If the court finds after a hearing that the agent has not been performing in accordance with the terms of the Wisconsin basic power of attorney for finances and property, the court may do any of the following:
243.10(8)(a)1.
1. Direct the agent to act in accordance with the terms of the principal's Wisconsin basic power of attorney for finances and property.
243.10(8)(a)2.
2. Require the agent to report to the court concerning performance of the agent's duties at periods of time established by the court.
243.10(8)(a)3.
3. Rescind all powers of the agent to act under the power of attorney for finances and property.
243.10(8)(b)
(b) If the principal has designated an alternate agent and if the powers of the first-designated agent are rescinded under
par. (a) 3., the alternate agent is the agent and is subject to
par. (a).
243.10 Annotation
Wisconsin's New Statutory Power of Attorney. Thedinga. Wis. Law. Sept. 1992.
