Alaska Power of Attorney Form
I, __________________________________ residing in __________________, Alaska, do
hereby appoint __________________________________ of __________________, _________.
as my agent (also known as “Attorney-in-Fact”) to act for me in any lawful way with respect to
the following matters:
If you designate more than one agent above, by default they must act together unless you initial the statement below.
[___] My agents may act separately.
If every agent that is listed above is unable or unwilling to serve, I hereby appoint as my successor agent(s):
If you designate more than one successor agent above, by default they must act together unless you initial the statement below.
[___] My successor agents may act separately.
I hereby revoke any and all powers of attorney that previously have been signed by me.
My attorney-in-fact may act on my behalf for the following purpose(s):
[____] Real Estate Transactions
[____] Stock and Bond Transactions
[____] Commodity and Option Transactions
[____] Tangible Personal Property Transactions
[____] Banking and Other Financial Institution Transactions
[____] Business Operating Transactions
[____] Insurance and Annuity Transactions
[____] Estate, Trust and Other Beneficiary Transactions
[____] Claims and Litigation
[____] Personal and Family Maintenance
[____] Benefits from Social Security, Medicare, Medicaid or Other Government Programs
[____] Retirement Plan Transactions
[____] Tax Matters, including any transactions with the Internal Revenue Service
[____] Decisions Regarding Lifesaving and Life Prolonging Medical Treatment.
[____] Decisions Relating to Medical Treatment, Surgical Treatment, Nursing Care, Medication, Hospitalization, Institutionalization in a nursing home or other facility and home health care.
[____] Transfer of Property or Income as a Gift to the Principal’s Spouse for the purpose of qualifying the principal for governmental medical assistance.
[____] All OF THE ABOVE POWERS, INCLUDING FINANCIAL AND HEALTH CARE DECISIONS.
I do hereby grant my attorney in fact complete authority to act in any reasonable manner that is necessary to execute the above mentioned powers that are granted.
This power of attorney shall become effective immediately unless specified otherwise in the special instructions.
Signature And Acknowledgment
This power of attorney shall continue until I revoke it or it is terminated by my death.
I agree that any third party who is given a copy of this power of attorney may act relying on it. I also agree that revocation of this power of attorney is effective as to a third party only upon receipt of actual notice by the third party. I agree to indemnify the third party for any loss that may be suffered while carrying out this power of attorney.
This contract shall be governed by the laws of the State of Alaska in __________ County and any applicable Federal Law.
Signature of Principle
By accepting this appointment and acting under it, I the attorney-in-fact ("Agent") do hereby assume the legal responsibilities of an agent.
Signature of Attorney-in-Fact
Signature of Successor
WITNESS #1) _________________________________
WITNESS #2) _________________________________
TRANSLATION CLAUSE (If Needed)
I certify that I have translated the provisions of the foregoing Power of Attorney from the English
language to the ___________________________________________ language to the best of my ability.
Signature of Translator