Arizona Limited Power of Attorney Form is a legal instrument signed by the principal to grant powers to attorney in fact to carry out financial transactions. However, this power of attorney does not confer the powers to take health care/medical decisions on behalf of the signing principal.
Furthermore, this limited power of attorney is revocable upon the execution of a new power of attorney and/or execution of Power of Attorney Revocation Form. Notarization of the power of attorney or signatures by two adult witnesses are mandatory for its legal standing. The principal may decide to appoint a successor attorney in fact, as per the provision in the document. Arizona Limited Power of Attorney Form has 14 sections and 2 pages for witness signatures and notarization. Filling all details as and when required is mandatory for the legal standing of the instrument.
Commence by entering the name of signing principal, followed by street address, city, and state in section V. Continue by furnishing name, street address, city, and state of the attorney in fact in the respective fields of section VI. The next line of the power of attorney requires typing the name of the state and the detailed description of the exact powers under the process of granting.
Proceed to section VII and furnish the information of successor attorney in fact if any. Provide name, street address, city, and state name in the respective spaces. Continue by inserting the state name and detailed description of the powers to grant in the blank space offered. Furnishing detailed description is very necessary to quantify the scope and limitations of the power of attorney.
Arizona Limited Power of Attorney Form
Enter the name of the principal in section XII followed by the day, month, and signature. Continue by furnishing the name of the attorney in fact, followed by the signature in acceptance and then insert the date in section XIII of the document. Section XIV seeks inputs like the name and signature of a successor attorney in fact and then date in acceptance of the grant of power of attorney.
Signatures of two adult and neutral witnesses are required on the next page of the power of attorney. Continue by providing the names and signatures in the respective fields. Signatures of witnesses are crucial to the legal standing of the document when not notarized.
The last page of the power of attorney is reserved for notarization. Inputs from the Notary Public of Arizona State required like the name of the state and county, name of the signing principal, name of the notary public, and date followed by the seal and signature. Continue by providing the name of the state and county, and date of expiry of the commission.
The next two sections are Acknowledgement and Acceptance of Appointment for attorney in fact and successor attorney in fact and inputs required are names, signatures, and date in the respective spaces.
Text Version of the Form
———————– Page 1———————–
-OFFICIAL-
LIMITED POWER OF ATTORNEY FORMI. NOTICE – This legal document grants you (Hereinafter referred to as the
“Principal”) the right to transfer limited financial powers to someone else
(Hereinafter referred to as the “Attorney-in-Fact”), limited financial powers
are described as: any specific financial act legal under law. The Principal’s
transfer of limited financial powers to the Attorney-in-Fact are granted upon
authorization of this agreement, and ONLY remains in effect until the
completion of said act, unless the Principal becomes incapacitated
(incapacitation is described in Paragraph II). This agreement does not authorize
the Attorney-in-Fact to make medical decisions for the Principal. The Principal
continues to retain every right to all their financial decision making power and
may revoke this Limited Power of Attorney Form at anytime. The Principal
may include restrictions or requests pertaining to the financial decision making
power of the Attorney-in-Fact. It is the intent of the Attorney-in-Fact to act in
the Principal’s wishes put forth, or, to make financial decisions that fit the
Principal’s best interest. All parties authorizing this agreement must be at least
18 years of age and acting under no false pressures or outside influences. Upon
authorization of this Limited Power of Attorney Form, it will revoke any
previously valid Limited Power of Attorney Form.II. INCAPACITATION – The powers granted to the Attorney-in-Fact by the
Principal in this Limited Power of Attorney Form DO NOT stay in effect upon
incapacitation by the Principal, incapacitation is describes as: A medical
physician stating verbally or in writing that the Principal can no longer make
decisions for them self.III. REVOCATION – The Principal has the right to revoke this Limited Power of
Attorney Form at anytime. Any revocation will be effective if the Principal:
A. Authorizes a new Limited Power of Attorney Form.
B. Authorizes a Power of Attorney Revocation Form.IV. WITNESS & NOTARY – This document is not valid as a Limited Power of
Attorney unless it is acknowledged before a notary public or is signed by at
least two adult witnesses who are present when the Principal signs or
acknowledges the Principal’s signature. It is recommended to have this
Limited Power of Attorney Form notarized.———————– Page 2———————–
V. PRINCIPAL – I, ______________________, residing at
Name of Principal____________________________________________________________________
Street Address of PrincipalCity of ______________________, State of ______________________, appoint
City of Principal State of Principalthe following as my Attorney-in-Fact, whom I trust with a specific financial act
or acts immediately upon the authorization of this form, and I grant the power
to act as if I were personally present toVI. ATTORNEY-IN-FACT – ______________________, residing at
Name of Attorney-in-Fact__________________________________________________________________
Street Address of Attorney-in-FactCity of ______________________, State of ______________________ grant
City of Attorney-in-Fact State of Attorney-in-Factthe Attorney-in-Fact the legal authority for a specific financial act on my
behalf that can be any power legal under law in the State of_________________________. The Specific financial act I grant my Attorney-in-
State
Fact is:____________________________________________________________________
A Detailed Description of Exact Powers grantedVII. SUCCESSOR ATTORNEY-IN-FACT (Optional) – If the Attorney-in-Fact named
above cannot or is unwilling to serve, then I appoint ______________________,
Name of Successor Attorney-in-Fact
residing at:____________________________________________________________________
Street Address of Successor Attorney-in-FactCity of ______________________, State of ______________________ grant
City of Successor Attorney-in-Fact State of Successor Attorney-in-Fact
the Attorney-in-Fact the legal authority for a specific financial act on my
behalf that can be any power legal under law in the State of_________________________. The Specific financial act I grant my Successor
StateAttorney-in-Fact is:
____________________________________________________________________
A Detailed Description of Exact Powers granted———————– Page 3———————–
VIII. TERMS & CONDITIONS – Upon authorization by all parties, the Attorney-in-
Fact accepts their designation to act in the Principal’s best interests for all
financial decisions legal under law.IX. THIRD PARTIES – I, the Principal, agree that any third party receiving a
copy via: physical copy, email, or fax that I, the Principal, will indemnify and
hold harmless any and all claims that may be put forth in reference to this
Limited Power of Attorney Form.X. COMPENSATION – The Attorney-in-Fact agrees not to be compensated for
acting in the presence of the Principal. The Attorney-in-Fact may be, but not
entitled to, reimbursement for all: food, travel, and lodging expenses for
acting in the presence of the Principal.XI. DISCLOSURE – I intend for my attorney-in-fact under this Power of Attorney
to be treated, as I would be with respect to my rights regarding the use and
disclosure of my individually identifiable health information or other medical
records. This release authority applies to any information governed by the
Health Insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC
1320d and 45 CFR 160-164XII. PRINCIPAL’S SIGNATURE – I, _________________________, the
Printed Name of PrincipalPrincipal, sign my name to this power of attorney this ________ day of
Day_________________________ and, being first duly sworn, do declare to the
Month
undersigned authority that I sign and execute this instrument as my power of
attorney and that I sign it willingly, or willingly direct another to sign for me,
that I execute it as my free and voluntary act for the purposes expressed in the
power of attorney and that I am eighteen years of age or older, of sound mind
and under no constraint or undue influence._________________________
Signature of Principal———————– Page 4———————–
XIII. ATTORNEY-IN-FACT’S SIGNATURE – I, ___________________________
Name of Attorney-in-Facthave read the attached power of attorney and am the person identified as the
attorney-in-fact for the principal. I hereby acknowledge and accept my
appointment as Attorney-in-Fact and that when I act as agent I shall exercise
the powers for the benefit of the principal; I shall keep the assets of the
principal separate from my assets; I shall exercise reasonable caution and
prudence; and I shall keep a full and accurate record of all actions, receipts
and disbursements on behalf of the principal.________________________________ __________________________________
Signature of Attorney-in-Fact DateXIV. SUCCESSOR ATTORNEY-IN-FACT’S SIGNATURE (Optional) –
I, ______________________________ have read the attached power of
Name of successor Attorney-in-Fact
attorney and am the person identified as the successor attorney-in-fact for the
principal. I hereby acknowledge and accept my appointment as Successor
Attorney-in-Fact and that, in the absence of a specific provision to the contrary
in the power of attorney, when I act as agent I shall exercise the powers for
the benefit of the principal; I shall keep the assets of the principal separate
from my assets; I shall exercise reasonable caution and prudence; and I shall
keep a full and accurate record of all actions, receipts, and disbursements on
behalf of the principal._________________________________ _________________________________
Signature of Successor Attorney-in-Fact Date———————– Page 5———————–
Witness Attestation
I, ______________________, the first witness, and I ______________________
Printed Name of First Witness Printed Name of Second Witnessthe second witness, sign my name to the foregoing power of attorney being
first duly sworn and do not declare to the undersigned authority that the
principal signs and executed this instrument as him or her, and that I, in the
presence and hearing of the principal, sign this power of attorney as witness to
the principal’s signing and that to the best of my knowledge the principal is
eighteen years of age or older, of sound mind and under no constraint or undue
influence.______________________________ ______________________________
Signature of First Witness Signature of Second Witness!
———————– Page 6———————–
Notary Acknowledgement (Must be completed by Notary)
State of ___________ County of ______________________________ Subscribed,
Sworn and acknowledged before me by ______________________________, the
Principal, and subscribed and sworn to before me by ______________________,
witness, this ______________________ day of ________________________.______________________________
Notary SignatureNotary Public
In and for the County of ______________________________
State of ______________________________
My commission expires: ______________________________ SealAcknowledgement and Acceptance of Appointment as Attorney-in-Fact
I, ______________________________ have read the attached power of attorney
Name of Attorney-in-Factand am the person identified as the attorney-in-fact for the principal. I hereby
acknowledge that accept my appointment as Attorney-in-Fact and that when I
act as agent I shall exercise the powers for the benefit of the principal; I shall
keep the assets of the principal separate from my assets; I shall exercise
reasonable caution and prudence; and I shall keep a full and accurate of all
actions, receipts and disbursements on behalf of the principal.______________________________ ______________________________
Signature of Attorney-in-Fact DateAcceptance of Appointment as successor Attorney-in-Fact
I, ______________________________ have read the attached power of
Name of successor Attorney-in-Fact
attorney and am the person identified as the successor attorney-in-fact for the
principal. I hereby acknowledge that I accept my appointment as Successor
Attorney-in-Fact and that, in the absence of a specific provision to the contrary
in the power of attorney, when I act as agent I shall exercise the powers for
the benefit of the principal; I shall keep the assets of the principal separate
from my assets; I shall exercise reasonable caution and prudence; and I shall
keep a full and accurate record of all actions, receipts, and disbursements on
behalf of the principal.______________________________ ______________________________
Signature of Successor Attorney-in-Fact Date