Pennsylvania General Durable Power of Attorney Form - Free Download | Page 5
The Pennsylvania general durable power of attorney is an important legal document for a general purpose that gives the attorney-in-fact enduring authority, which will exist even if the grantor becomes incapacitated to make his/her own decisions.
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Pennsylvania General Durable Power of Attorney Form Page 5
Pennsylvania General Durable Power of Attorney Form
office of Agent, I name the following (each to act alone and successively, in the order named) as
successor(s) to such Agent:
________________________________________________________________________
________________________________________________________________________
Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF THE
COMMONWEALTH OF PENNSYLVANIA WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES.
IT WAS EXECUTED IN THE COMMONWEALTH OF PENNSYLVANIA AND IS INTENDED TO BE VALID IN
ALL JURISDICTIONS OF THE UNITED STATES OF AMERICA AND ALL FOREIGN NATIONS.
I am fully informed as to all the contents of this form and understand the full import of this grant of powers to
my Agent.
I agree that any third party who receives a copy of this document may act under it. Revocation of the power
of attorney is not effective as to a third party until the third party learns of the revocation. I agree to indemnify
the third party for any claims that arise against the third party because of reliance on this power of attorney.
Signed this _______ day of _______________, 20____
______________________________
[Your Signature]
STATEMENT OF WITNESS
On the date written above, the principal declared to me in my presence that this instrument is his general
durable power of attorney and that he or she had willingly signed or directed another to sign for him or her,
and that he or she executed it as his or her free and voluntary act for the purposes therein expressed.
_______________________________________ [Signature of Witness #1]
_______________________________________ [Printed or typed name of Witness #1]
_______________________________________ [Address of Witness #1, Line 1]
_______________________________________ [Address of Witness #1, Line 2]
_______________________________________ [Signature of Witness #2]
_______________________________________ [Printed or typed name of Witness #2]
_______________________________________ [Address of Witness #2, Line 1]
_______________________________________ [Address of Witness #2, Line 2]
A Note About Selecting Witnesses: The agent (attorney-in-fact) may not also serve as a
witness. Each witness must be present at the time that principal signs the Power of Attorney in
front of the notary. Each witness must be a mentally competent adult. Witnesses should ideally
reside close by, so that they will be easily accessible in the event they are one day needed to
affirm this document's validity.
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
COMMONWEALTH OF PENNSYLVANIA
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Pennsylvania General Durable Power of Attorney Form