Please complete as much of this Form as possible by printing your answers.
Make sure that you have completed the General
Information for Wills and Powers of Attorney Form.
Name:
___________________________ Date:
___________________
PROPERTY POWER of ATTORNEY
(With this document, you give authority to another person to handle your
financial and property matters.)
Have you previously given such a Power of Attorney to anyone?
No _______ Yes _______
If Yes, details
_______________________________________________________
___________________________________________________________________
If Yes, do you want it cancelled? Yes ______ No _________
Who do you want to give Power of
Attorney to for your finances and property matters?
(You should name at least two people, unless you are naming a trust company -
in which case you do not need to name anyone else. One of your Attorneys can be
your spouse. At least one of them should be younger than you are. You can name
up to four people. All of your Attorneys must be at least 18 years old.)
Name, address, relationship to you and telephone number for each person you
name as your Attorney:
1.
__________________________________________________________________
2.
__________________________________________________________________
3.
__________________________________________________________________
4.
__________________________________________________________________
Is it alright for any one of your attorneys to be able to act by her/himself
on your behalf?
Yes _____ No ______
If No, why not?
_______________________________________________________
____________________________________________________________________
____________________________________________________________________
If No, how many of the above are needed to make the decisions and sign the
cheques, for example?
Any two _____ All _____ Other ______
Are your Attorneys able to make:
loans to any of your
relatives
No ______ Yes ______
loans to any of your
friends
No ______ Yes ______
gifts to any of your
relatives
No ______ Yes ______
gifts to any of your
friends
No ______ Yes ______
gifts to charities on your
behalf
No ______ Yes ______
Other comments (if any) about loans and gifts:
__________________________
_________________________________________________________________
_________________________________________________________________
Are there any restrictions or special instructions that you want to include
in your Property Power of Attorney?
No _______ Yes _______
If Yes, details
______________________________________________________
__________________________________________________________________
__________________________________________________________________
PERSONAL CARE POWER of ATTORNEY
(With this document, you give authority to another person to make decisions
for you concerning your "personal care" if you are unable to make
those decisions yourself. "Personal care" includes medical treatment,
nutrition, accommodation, clothing and hygiene.)
Have you previously given such a Power of Attorney to anyone?
No _______ Yes
_______
If Yes, details
_______________________________________________________
___________________________________________________________________
If Yes, do you want it cancelled? Yes ______ No _________
Who do you want to be the ones to make decisions about your personal care if
you are not able to decide?
(You should name at least two people. One of your Attorneys can be - and
probably should be - your spouse. Do not name a trust company. At least one of
the Attorneys should be younger than you are. You can name as many people as you
want. All of your Attorneys must be at least 18 years old. None of your
Attorneys can be your doctor, nurse, landlord, social worker or homemaker -
unless they are related to you.)
Name, address, relationship to you and telephone number for each person you
name as your Attorney:
1.
__________________________________________________________________
2.
__________________________________________________________________
3.
__________________________________________________________________
4.
__________________________________________________________________
5.
__________________________________________________________________
6.
__________________________________________________________________
Is it alright for any one of your attorneys to be able to make decisions by
her/himself on your behalf?
Yes _____ No ______
If No, why not?
_______________________________________________________
_____________________________________________________________________
_____________________________________________________________________
If No, how many of the above are needed to make personal care decisions on
your behalf?
Any two _____ All _____ Other ______
If your Doctor believes that the only way that you can be kept alive for
other than a brief period of time is to be on a life support system, do you want
your Attorney(s) to consent to having you be on such a life support system? No
______ Yes _______
If Yes, details
_________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Are there any restrictions or special instructions that you want to include
in your Personal Care Power of Attorney? No _______ Yes _______
If Yes, details
_________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Name and Address of your Doctor
____________________________________________________________________
____________________________________________________________________
This is NOT A POWER of ATTORNEY. These are INSTRUCTIONS ONLY. When you have
completed this Form as much as you can, please mail this Form (together with the
General Information Form) to your Lawyer, or take them to your FIRST Interview
with your Lawyer.
What you have printed in these Instructions will NOT become part of your
Powers of Attorney until they have been prepared by your Lawyer AND you have
signed your Powers of Attorney.
Your Lawyer will review these Instructions and include in your Powers of
Attorney the appropriate powers to be given to your Attorney(s).
_________________________________
Signature of person completing this form
