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Free Alaska Statutory Power of Attorney Form - PDF Form Download

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Download and use this form in the State of Alaska to grant someone else rights to make decisions on your behalf.

Alaska Statutory Power of Attorney Form


Text Version of this Form

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Power of Attorney

This packet contains the Alaska form for a Power of
Attorney. Alaska Legal Services Corporation provides this
as a service to you and does not take responsibility for how
you fill it out. The law allows you to fill out this form on your
own. This packet contains general information to assist you.
However, if you have questions, please contact an attorney.
The Alaska Bar Association (272-0352 or 1-800-770-9999
outside Anchorage) can provide you with a list of attorneys.
If you cannot afford an attorney or if you are 60 years or
older, Alaska Legal Services may be able to assist you.
Please call: Anchorage, 272-9431 or (888) 478-2572;
Bethel, 543-2237 or (800) 478-2230; Dillingham, 842-1452
or (888) 391-1475; Fairbanks, 452-5181 or (800) 478-5401;
Juneau, 586-6425 or (800) 789-6426; Ketchikan, 225-6420;
Kotzebue, 442-3500 or (877) 622-9797; and Nome, 443-
2230 or (888) 495-6663.

This booklet is provided by Alaska Legal Services Corporation, a statewide private
nonprofit organization. Nothing contained in this publication is to be considered as the
rendering of legal advice for specific cases and readers are responsible for obtaining
such advice from an attorney.

Alaska Legal Services Corporation, 1016 West Sixth Avenue, Suite 200, Anchorage,
Alaska 99501, Telephone toll-free 888-478-2572 (in Anchorage, 272-9431)

February 2005

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DIRECTIONS

What is a Power of Attorney?

You make a variety of decisions every day. If you sign a Power of Attorney, you give another
person (your agent) the right to make decisions for you and you give them the authority to carry the
decisions out. The form provided here is based upon the Alaska Statutes (AS 13.26.332-335) and it
can be tailored to meet your specific needs. For instance, you can grant your agent broad powers to
do almost anything you could do for yourself (general power of attorney) or you can pick and choose
the powers you want to give an agent (specific power of attorney). You can choose to appoint an
agent immediately or you can make the appointment effective only if you become disabled. You can
limit the time your agent will have power to act on your behalf or you can make the appointment
“durable,” which means your agent will have powers even if you become disabled. You can also
state that the appointment will be revoked upon your incapacity.

Please note, Alaska now has a separate law addressing health care advance directives.
Issues addressed include the designation of a health care agent, end-of-life treatment decisions
(living wills), mental health care treatment options, and organ donation (see AS 13.52). There is a
separate pamphlet and form titled the Alaska Advance Health Care Directive that should be used for
all health care related issues.

Section 1. Naming your agent.

It is critically important that you thoroughly trust the person you name in your Power of
Attorney. The authority you give as the “principal” can have a major impact on you. For instance,
your agent may sell your house, withdraw money from your accounts, or place you in a nursing home.
Unlike a guardian or conservator, a person acting with a Power of Attorney does not have to answer
to a court. There will be no formal oversight of your agent regarding the decisions he or she makes.
In addition, it is very important to make sure the agent understands what your wishes are. Therefore,
it is highly recommended that you discuss your wishes and desires with the person you name in your
Power of Attorney. However, as long as you are competent, you do have the right to revoke a Power
of Attorney.

Section 2. Choosing which powers to grant on Power of Attorney form.

You do not have to give your agent authority for all of the powers listed in Section 2 of the Power of
Attorney form. You can limit which powers you give by crossing out any undesired provisions AND
putting your initials on the line in front of it. Any power (A-O) that is not crossed out and initialed will
be granted to your agent. You can find more detailed information about what powers each provision
grants by asking an attorney or reading Alaska Statute Section 13.26.344.

Section 3.

You can name more than one person to act on your behalf. If you name more than one agent in
Section 1, you must mark the first or second statement in Section 3. Mark the first statement if you
want to allow each agent to make decisions without getting approval from the other. If you want both
agents to act together, jointly, mark the second sentence.

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Section 4.

Sections 4, 5, and 6 let you decide when and for how long you want the Power of Attorney to be
effective. If you mark the first sentence in Section 4, the document will become effective immediately
and the person you named as your agent will have the power to act on your behalf. Some people do
not want this. Instead, you may want to designate an agent only in the event you cannot act on your
own behalf. Marking the second sentence makes the appointment of an agent effective only
when you become incapacitated.

Section 5.

If you choose to make your Power of Attorney effective immediately, then in Section 5 you must
decide whether it will be “durable.” A durable power of attorney remains effective in the event you
become incapacitated. If you want your agent to continue to have authority under such
circumstances, mark the first sentence in Section 5. If not, mark the second sentence in Section 5.

Section 6.

This section allows you to pick a date on which the Power of Attorney will no longer be valid. If you
want to appoint someone as your agent to accomplish a specific task or only for a limited period of
time, you should complete this section. Do not complete this section if you want your power of
attorney to be “durable” or to become effective only if you become disabled.

Section 7.

You can revoke the Power of Attorney for any reason at any time, provided you are mentally
competent to do so. To revoke your Power of Attorney, destroy the original and either (1) complete
a new Power of Attorney , if you wish to name another person, OR (2) create a Notice of Revocation
by writing a brief notarized statement revoking the old Power of Attorney. The new Power of
Attorney , or the Notice of Revocation, needs to be distributed in the same manner as you distributed
the old Power of Attorney. To be safe, you may want to send the Notice of Revocation directly to the
agent via first class mail, return receipt requested. You may also wish to record the Notice of
Revocation with a state Recorder’s office.

Section 8.

This section is optional. If you have executed an advanced health care directive, you may want to
indicate this fact by marking the appropriate statement.

Section 9.

This section is optional. It’s possible that the person you name as your agent will not be able to
perform his or her duties. For instance, your agent may move out of state, die, or otherwise become
incapable of performing. To address this possibility, you may want to name a replacement just in
case.

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Signatures

Finally, the Power of Attorney must be signed in front of a notary and sealed by him or her.
Once you have completed the Power of Attorney, you should give the original to whomever you
named as the power of attorney, distribute copies to important people (doctor, banker, etc.), and keep
a copy for yourself. If you later revoke the Power of Attorney, you should distribute the revocation in
the same manner as you distributed the original.

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POWER OF ATTORNEY

The powers granted from the principal to the agent or agents in the following document are very broad.
They may include the power to dispose, sell, convey, and encumber your real and personal property, and the
power to make your health care decisions. Accordingly, the following document should only be used after
careful consideration. If you have any questions about this document, you should seek competent advice. You
may revoke this power of attorney at any time.

Section 1. Pursuant to A.S.13.26.338 – 13.26.353,

I, _____________________________________, of ______________________________________, do hereby appoint
(Name of principal) (Address of principal)

_____________________________________________________________________________________________ as
(Name and address of agent or agents)

my attorney(s)-in-fact to act as I have checked below in my name, place and stead in any way which I myself could do, if I
were personally present, with respect to the following matters, as each of them is defined in AS 13.26.344, to the full
extent that I am permitted by law to act through an agent:

Section 2. The agent or agents you have appointed will have all the powers listed below UNLESS you draw a line
through a category; AND initial the space before that category.

_____ (A) Real estate transactions
_____ (B) Transactions involving tangible personal property, chattels, and goods
_____ (C) Bonds, shares, and commodities transactions
_____ (D) Banking transactions
_____ (E) Business operating transactions
_____ (F) Insurance transactions
_____ (G) Estate transactions
_____ (H) Gift transactions
_____ (I) Claims and litigation
_____ (J) Personal relationships and affairs
_____ (K) Benefits from government programs and military service
_____ (L) (repealed)
_____ (M) Records, reports, and statements
_____ (N) Delegation
_____ (O) All other matters, including those specified as follows:
________________________________________________________________________________________________
________________________________________________________________________________________________

Section 3. If you have appointed more than one agent, check one of the following:

_____ Each agent may exercise the powers conferred separately, without the consent of any other agent.
_____ All agents shall exercise the powers conferred jointly, with the consent of all other agents.

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DURABLE POWER OF ATTORNEY OPTIONS

(Sections 4, 5 and 6 allow you to choose whether or not you want this to be a durable power of attorney and when you
want it to go into effect.)

Section 4. To indicate when this document shall become effective, check one of the following:
_____ This document shall become effective upon the date of my signature.
_____ This document shall become effective upon the date of my disability and shall not otherwise be affected by my
disability.

Section 5. If you have indicated that this document shall become effective on the date of your signature check
one of the following:
_____ This document shall not be affected by my subsequent disability.
_____ This document shall be revoked by my subsequent disability.

If you want this to be a durable power of attorney, do not limit the term of this document in Section 6.
Section 6. If you have indicated that this document shall become effective upon the date of your signature and
want to limit the term of this document, complete the following:
This document shall only continue in effect for _____________(____) years from the date of my signature.

Section 7. Notice of revocation of the powers granted in this document.

You may revoke one or more of the powers granted in this document. Unless otherwise provided in this
document, you may revoke a specific power granted in this power of attorney by completing a special power of attorney
that includes the specific power in this document that you want to revoke. Unless otherwise provided in this document,
you may revoke all the powers granted in this power of attorney by completing a subsequent power of attorney.

Additional Provisions

Section 8. If you have given an agent authority regarding health care services, complete the following:

_____ I have executed a separate declaration under AS 13.52 known as an “Alaska Advance Health Care Directive.”

_____ I have not executed an “Alaska Advance Health Care Directive.”

Section 9. You may designate an alternate attorney-in-fact. Any alternate you designate will be able to exercise
the same powers as the agent(s) you named at the beginning of this document. If you wish to designate an
alternate or alternates, complete the following:

If the agent(s) named at the beginning of this document is unable or unwilling to serve or continue to serve, then I
appoint the following agent to serve with the same powers:

First alternate or successor attorney-in-fact ______________________________________________________________
(Name and address of alternate)

Second alternate or successor attorney-in-fact ___________________________________________________________
(Name and address of alternate)

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Section 10. Notice to Third Parties

A third party who relies on the reasonable representations of an attorney-in-fact as to a matter relating to a power
granted by a properly executed statutory power of attorney does not incur any liability to the principal or to the principals
heirs, assigns, or estate as a result of permitting the attorney-in-fact to exercise the authority granted by the power of
attorney. A third party who fails to honor a properly executed statutory form power of attorney may be liable to the
principal, the attorney-in-fact, the principal’s heirs, assigns, or estate for civil penalty, plus damages, costs, and fees
associated with the failure to comply with the statutory form power of attorney. If the power of attorney is one which
becomes effective upon the disability of the principal, the disability of the principal is established by an affidavit, as
required by law.

In Witness Whereof, I have hereunto signed my name this ________ day of ______________________, 20____.

______________________________________
(Signature of principal)

STATE OF ALASKA )
) ss.
__ JUDICIAL DISTRICT )

Acknowledged before me at_______________________________________on the_____day of_______________, 20__.

________________________________________________________________________________________________
Signature of officer or notary. Serial number, if any; date commission expires.

TRANSLATION CLAUSE (if needed)

I certify that I have translated the provisions of the foregoing Power of Attorney from the English
language to the ____________________________ language to the best of my ability.

__________________________________________
Translator

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