Financial Power of Attorney

CONNECTICUT DURABLE FINANCIAL POWER OF ATTORNEY

This instrument is intended to operate under the Connecticut Uniform Power of Attorney Act, Conn. Gen. Stat. §§ 1-350 through 1-353b.

1. Principal and Agent

I, [PRINCIPAL NAME], of [PRINCIPAL ADDRESS], appoint:

[AGENT NAME]

Address: [AGENT ADDRESS]

Telephone: [AGENT TELEPHONE]

Email: [AGENT EMAIL]

as my agent.

If that person does not serve or ceases to serve, I appoint:

[SUCCESSOR AGENT NAME]

Address: [SUCCESSOR AGENT ADDRESS]

Telephone: [SUCCESSOR AGENT TELEPHONE]

Email: [SUCCESSOR AGENT EMAIL]

as successor agent.

2. Effective Date

Choose one:

☐ This power of attorney is effective when executed.

☐ This power of attorney becomes effective on: [DATE].

☐ This power of attorney becomes effective upon this future event or contingency: [DESCRIBE EVENT AND WHO MAY DETERMINE THAT IT OCCURRED].

If no choice is made, this power of attorney is effective when executed under Conn. Gen. Stat. § 1-350h.

3. Durability

This power of attorney is not terminated by my later incapacity. Connecticut law also makes a power of attorney created under the Act durable unless the instrument expressly provides otherwise. See Conn. Gen. Stat. § 1-350b.

4. General Authority

Initial each subject for which authority is granted. Each initialed subject incorporates the general authority described in the cited Connecticut statute, subject to this instrument's limitations and Conn. Gen. Stat. §§ 1-351, 1-351a, and 1-351b.

If no subject is initialed, no general authority is granted by this section.

5. Gifts and Other Authority Requiring an Express Grant

No authority described in Conn. Gen. Stat. § 1-351(a), including gift authority, is granted unless the Special Instructions expressly grant that authority. Any express gift authority must be read with Conn. Gen. Stat. § 1-351p and any narrower limit written below.

6. Special Instructions and Limitations

The following instructions add to or limit the authority granted above:

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

Unless expressly authorized above, my agent may not delegate authority granted by this instrument.

7. Agent Standards and Records

In addition to duties imposed by Conn. Gen. Stat. § 1-350m and duties that this instrument cannot alter, my agent shall:

• follow my lawful instructions and the limitations in this instrument;
• act loyally, in good faith, and for my benefit;
• keep complete records of receipts, disbursements, and transactions;
• keep my property reasonably separate from the agent's property; and
• provide records to me or to a person or court legally entitled to request them.

The agent is not entitled to compensation unless stated here: [COMPENSATION TERMS]. The agent may be reimbursed for reasonable expenses properly incurred for my benefit.

8. Nomination of Conservator

If a court decides that a conservator should be appointed for me, I nominate:

Conservator of the estate: [NAME AND ADDRESS]

Conservator of the person: [NAME AND ADDRESS]

This nomination does not itself appoint a conservator.

9. Prior Powers; Revocation; Termination

Choose one:

☐ I revoke every prior financial power of attorney executed by me.

☐ I revoke only the following prior power or authority: [IDENTIFY].

☐ I do not revoke prior powers of attorney except to the extent they conflict with this instrument.

This power of attorney and the agent's authority also terminate as provided by Conn. Gen. Stat. § 1-350i.

10. Judicial Review

Conn. Gen. Stat. § 1-350o permits specified persons to ask a court, in accordance with Conn. Gen. Stat. § 45a-175(d), to construe a power of attorney, review an agent's conduct, and grant appropriate relief. Nothing in this instrument limits a court's statutory authority.

11. Reliance and Copies

A copy of this instrument may be relied on to the extent permitted by law. An acknowledgment may affect acceptance and reliance under Conn. Gen. Stat. § 1-350r.

12. Principal's Signature

Connecticut law requires a power of attorney to be dated, signed by the principal or by another individual directed by the principal in the principal's conscious physical presence, and witnessed by two witnesses. See Conn. Gen. Stat. § 1-350d.

I sign this power of attorney voluntarily and intend to grant only the authority stated in it.

Date: [__/__/____]

Principal's signature: ______________________________________

Printed name: [PRINCIPAL NAME]

13. Witnesses

Witness 1

I witnessed the principal sign or direct the signing of this power of attorney.

Signature: ______________________________________

Printed name: [WITNESS 1 NAME]

Address: [WITNESS 1 ADDRESS]

Date: [__/__/____]

Witness 2

I witnessed the principal sign or direct the signing of this power of attorney.

Signature: ______________________________________

Printed name: [WITNESS 2 NAME]

Address: [WITNESS 2 ADDRESS]

Date: [__/__/____]

14. Acknowledgment

State of Connecticut

County of [COUNTY]

On [DATE], before me, the undersigned officer, personally appeared [PRINCIPAL NAME], known to me or satisfactorily proven to be the person whose name is subscribed to this instrument, and acknowledged executing it for its stated purposes.

Signature of notary public, commissioner of the Superior Court, or other authorized officer:

______________________________________

Printed name and title: [NAME AND TITLE]

My commission expires: [DATE, IF APPLICABLE]

15. Optional Agent Acknowledgment

I, [AGENT NAME], acknowledge that I have received this instrument and understand that acting as agent subjects me to the instrument and applicable Connecticut law, including Conn. Gen. Stat. § 1-350m.

Agent's signature: ______________________________________

Date: [__/__/____]

Sources and References

• Connecticut General Assembly, current Chapter 15c: https://www.cga.ct.gov/current/pub/chap_015c.htm
• Connecticut General Assembly, current Probate Court procedures, including Conn. Gen. Stat. § 45a-175: https://www.cga.ct.gov/current/pub/chap_801b.htm