Connecticut Durable Power of Attorney
This Durable Power of Attorney is executed in accordance with the laws of the State of Connecticut, specifically under Connecticut General Statutes § 1-42 to § 1-56.
Principal Information:
- Name: ___________________________
- Address: _________________________
- City, State, Zip Code: ____________
- Date of Birth: ____________________
Agent Information:
- Name: ___________________________
- Address: _________________________
- City, State, Zip Code: ____________
- Phone Number: ____________________
Durable Power of Attorney Grant:
I, the undersigned Principal, hereby appoint the above-named Agent to act on my behalf in all matters relating to my financial affairs. This Durable Power of Attorney shall not be affected by my subsequent disability or incapacity.
Effective Date:
This Durable Power of Attorney shall become effective immediately upon execution, unless otherwise specified below:
Effective Date: _____________________
Limitations:
Please specify any limitations on the powers granted to the Agent:
Limitations: ________________________
Signature:
By signing below, I affirm that I am of sound mind and that I understand the powers I am granting to my Agent.
Principal's Signature: _______________________
Date: ____________________________________
Witnesses:
Two witnesses are required for this Durable Power of Attorney. The witnesses must not be named as Agents or alternate Agents.
- Witness Name: ______________________
- Witness Signature: ___________________
- Date: _______________________________
- Witness Name: ______________________
- Witness Signature: ___________________
- Date: _______________________________
Notarization:
This document should be notarized to ensure its validity.
State of Connecticut, County of _______________
Subscribed and sworn before me this ____ day of ____________, 20__.
Notary Public Signature: _____________________
My Commission Expires: ______________________