Uniform statutory form power of attorney: free to fill in and download in Word

Reviewed in October 2026

A uniform statutory form power of attorney is a financial power of attorney built on a fixed list of subjects. You initial each subject your agent may handle, such as banking, real estate or taxes. Many states publish their own version in their code, and this template follows the same structure.

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Statutory form power of attorney example, filled in with sample data — Example filled in with sample data

The full statutory form power of attorney

GENERAL DURABLE POWER OF ATTORNEY (STATUTORY-STYLE FORM)

IMPORTANT INFORMATION. This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property whether or not you are able to act for yourself. This power of attorney does not authorize the agent to make health care decisions for you.

1. Designation of agent

I, [principal full name], with address at [address], name [agent full name], with address at [address] and phone [phone], as my agent. If my agent is unable or unwilling to act, I name [successor agent name] as my successor agent.

2. Grant of general authority

I grant my agent general authority to act for me with respect to the following subjects. INITIAL each subject you want to include. To grant all of them, initial "All preceding subjects".

[ ] Real property [ ] Tangible personal property [ ] Stocks and bonds [ ] Commodities and options [ ] Banks and other financial institutions [ ] Operation of an entity or business [ ] Insurance and annuities [ ] Estates, trusts and other beneficial interests [ ] Claims and litigation [ ] Personal and family maintenance [ ] Benefits from governmental programs or civil or military service [ ] Retirement plans [ ] Taxes [ ] Digital assets [ ] All preceding subjects

3. Grant of specific authority

My agent may NOT do any of the following unless I initial it: [ ] create, amend or revoke a trust [ ] make a gift beyond [amount] per person per year [ ] create or change rights of survivorship [ ] create or change a beneficiary designation [ ] waive my right to be a beneficiary of a joint and survivor annuity.

4. Limitations

[Special instructions that limit or extend the authority granted.]

5. Effective date

This power of attorney is effective immediately unless I state otherwise here: [effective date or event].

6. Durability

This power of attorney is not affected by my later incapacity. It ends at my death, when I revoke it or when a termination event in clause 4 occurs.

7. Compensation

My agent is entitled to reimbursement of reasonable expenses and [reasonable compensation / no compensation].

8. Reliance

Any person may rely on a copy of this power of attorney as if it were the original, until that person receives actual notice that it was revoked.

9. Agent's duties

My agent will act in good faith, within the authority granted, loyally for my benefit, and will keep records of every transaction made for me.

Principal

Printed name: ______________

Date: ______________

state

county: ______________

date: ______________

principal name: ______________

Notary signature: ______________

Printed name: ______________

Seal: ______________

date: ______________

Agent

Date: ______________

What the template includes

Plain notice of what a power of attorney does
Agent and successor agent
Initials for each of fourteen financial subjects
Actions that need a separate initial, such as gifts and trusts
Special instructions
Effective date
Durable language that survives incapacity
Expenses and compensation
Reliance on copies
Agent duties and record keeping
Notary acknowledgment block and agent acceptance

What you fill in

Field	Example
Principal	Robert Hale
Agent	Susan Hale (daughter)
Successor agent	Mark Hale (son)
Subjects initialed	Banks, real property, taxes, retirement plans
Gifts	Not authorized
Effective	Immediately
Compensation	Expenses only
State	Pennsylvania

How it gets signed

1Download the statutory form power of attorney in Word and fill in the fields.
2Print it and read every power once more before you sign.
3Sign it on paper, before a notary or witnesses when your state asks for them.
4Give the original to your agent and keep a copy with your records.

Your state may ask that the power of attorney be acknowledged before a notary. Texas does, for example. When yours does, print the form and sign it in front of the notary, who completes the acknowledgment block.

What the law says

Powers of attorney are governed by state law. Many states publish a statutory form in their code, and banks accept it more readily than a custom document.

If your state has its own statutory form, keep its exact wording. This template follows the common structure of initials per subject and works as a starting point.

In Texas, for example, a durable power of attorney must be acknowledged before an officer who can take acknowledgments, under Estates Code 751.0021.

How the initials work

Each subject on the list carries a set of powers defined in the law of your state. An initial grants that whole set.

A subject left without an initial is not granted. The agent cannot act on it, even in an emergency.

Gifts, trusts and beneficiary changes are kept apart in clause 3. Those powers can move your property to other people, so they need their own initial.

Choosing an agent

Someone you trust with money and paperwork.
Someone who lives close enough to visit your bank.
Someone organized enough to keep records of each transaction.
A successor in case the first agent cannot act.

Durable, springing and limited

A durable power of attorney keeps working if you lose capacity. A springing one starts only at a date or event you name in clause 5.

A limited power of attorney covers one task, such as closing on a house. For that, initial only the subject the task needs.

Common mistakes

Initialing "All preceding subjects" without reading them. Each subject is broad. Grant only what your agent will need.

Skipping the successor. If your agent cannot act, the power of attorney stops being useful.

Using another state's form. Banks look for the wording of their own state. Check before you sign.

No copy for the bank. Give each bank a copy before the agent needs to act.

Before you sign

Power of attorney guide. Types, agents and when each one ends.
Wet signatures. When a document still needs ink and a notary.
Read every clause of the statutory form power of attorney with the other party before anyone signs. Change what does not fit your deal.

Other templates

Frequently asked questions

Does this power of attorney need a notary?

It depends on the state. Texas, for example, asks for it. When yours does, print the form and sign it in front of the notary, who completes the acknowledgment block.

Does this cover medical decisions?

No. Health care decisions need a separate health care power of attorney or advance directive.

Can I revoke it later?

Yes. Sign a written revocation and give a copy to your agent and to every bank that has the original.

Is a uniform statutory form the same in every state?

No. States that adopted a statutory form often changed parts of it. Use the wording of your own state.

Can I edit the clauses before printing it?

Yes. Download it in Word, change any clause that does not fit and print the final version.