Illinois Power of Attorney
This document is created in accordance with the Illinois Power of Attorney Act. It allows you to appoint someone to make decisions on your behalf. Please fill in the required information below.
Principal Information:
- Name: _______________________________
- Address: _______________________________
- City, State, ZIP: _______________________________
- Date of Birth: _______________________________
Agent Information:
- Name: _______________________________
- Address: _______________________________
- City, State, ZIP: _______________________________
- Phone Number: _______________________________
Powers Granted:
- To make decisions regarding my health care.
- To manage my financial affairs.
- To handle my property and any related transactions.
Effective Date: This Power of Attorney shall become effective immediately upon execution unless otherwise indicated.
Signature of Principal: ___________________________
Date: ___________________________
Witness Statement:
- I, _______________________________ (witness), verify that the above-named Principal appeared to be of sound mind and not under duress at the time of signing.
Signature of Witness: ___________________________
Date: ___________________________
This document must be signed in the presence of at least one witness who is not named in this document.