Florida Durable Power of Attorney
This Durable Power of Attorney is executed in accordance with the laws of the State of Florida, specifically under Florida Statutes Chapter 709.
Principal: This document is made by:
Name: ____________________________
Address: ____________________________
City, State, ZIP: ____________________________
Date of Birth: ____________________________
Agent: I appoint the following individual as my agent:
Name: ____________________________
Address: ____________________________
City, State, ZIP: ____________________________
Phone Number: ____________________________
Effective Date: This Durable Power of Attorney shall become effective immediately upon execution unless otherwise specified below:
Effective Date: ____________________________
Powers Granted: My agent shall have the authority to act on my behalf in all matters except for the following:
- ____________________________
- ____________________________
- ____________________________
Durability: This Durable Power of Attorney shall not be affected by my disability or incapacity and shall remain in effect until revoked by me in writing.
Revocation: I reserve the right to revoke this Power of Attorney at any time.
Signatures:
In Witness Whereof, I have hereunto set my hand this _____ day of _______________, 20____.
Principal’s Signature: ____________________________
Witnesses: I declare that the principal appeared to be of sound mind and that this Power of Attorney was executed in our presence.
Witness 1 Signature: ____________________________
Name: ____________________________
Address: ____________________________
Witness 2 Signature: ____________________________
Name: ____________________________
Address: ____________________________
Notary Public:
State of Florida
County of ____________________________
Subscribed and sworn to before me this _____ day of _______________, 20____.
Notary Public Signature: ____________________________
My Commission Expires: ____________________________