Indiana Power of Attorney Template
This Power of Attorney ("POA") document is established according to the Indiana Power of Attorney Act, allowing an individual to designate another person as their attorney-in-fact with specific powers to act on their behalf. Please fill in all required information accurately to ensure the validity of this document.
Principal Information
Full Name: _______________________________________________
Address: __________________________________________________
City, State, Zip: ___________________________, IN __________
Phone Number: _____________________________________________
Attorney-in-Fact Information
Full Name: _______________________________________________
Address: __________________________________________________
City, State, Zip: ___________________________, IN __________
Phone Number: _____________________________________________
Powers Granted
Select the powers you wish to grant by placing a checkmark beside each applicable category. If granting full authority, check the first option only.
- ____ Full Authority
- ____ Financial Decisions
- ____ Real Estate Transactions
- ____ Personal Property Transactions
- ____ Healthcare Decisions
- ____ Legal Decisions
Term of Power of Attorney
Effective Date: ________________
Termination Date (if applicable): ________________
If no termination date is provided, this Power of Attorney will remain in effect indefinitely or until revoked by the Principal.
Signatures
By signing below, the Principal and the Attorney-in-Fact agree to the terms and conditions of this Power of Attorney document.
Principal's Signature: ____________________________________ Date: ________________
Attorney-in-Fact's Signature: ______________________________ Date: ________________
Witnesses (Optional)
While not required in Indiana, having witnesses can provide additional validity in certain situations.
Witness 1 Signature: ____________________________________ Date: ________________
Witness 2 Signature: ____________________________________ Date: ________________
This document was created on __________________ (date), and conforms to the laws of the State of Indiana regarding powers of attorney.