Massachusetts Power of Attorney
This Power of Attorney document ("Document") is created pursuant to the Massachusetts Uniform Probate Code, M.G.L. Chapter 190B, Article V, which allows an individual (the "Principal") to designate another person (the "Agent") to act on the Principal's behalf regarding financial, health, or legal matters.
Principal Information:
- Full Name: ___________________________
- Physical Address: ___________________________
- City: ____________________, State: MA, Zip Code: __________
- Contact Number: ___________________________
- Email Address (Optional): ___________________________
Agent Information:
- Full Name: ___________________________
- Physical Address: ___________________________
- City: ____________________, State: MA, Zip Code: __________
- Contact Number: ___________________________
- Email Address (Optional): ___________________________
This Power of Attorney shall become effective on ______________ and will remain in effect until ______________, unless it is revoked earlier by the Principal in writing.
The Agent is granted the authority to act on behalf of the Principal in the following areas (initial next to the powers being granted):
- ____ Banking and financial transactions
- ____ Real Estate transactions
- ____ Personal and family maintenance
- ____ Government benefits
- ____ Health care decision-making, including treatment and end-of-life decisions
- ____ Litigation and legal matters
The Principal reserves the right to revoke this Power of Attorney at any time by providing written notice to the Agent.
This Document shall be governed by the laws of the State of Massachusetts and is intended to comply fully with the Massachusetts Uniform Probate Code. Any disputes arising from this Document shall be resolved in the courts of the Commonwealth of Massachusetts.
In witness whereof, the Principal has executed this Power of Attorney on this day of month, year.
______________________________
Principal Signature
______________________________
Printed Name of Principal
State of Massachusetts, County of _________________
This document was acknowledged before me on _______________ (date) by ____________________ (name of Principal).
______________________________
Notary Public Signature
My Commission Expires: _______________