iLEAD LAW GROUP
艾利德律师事务所
(718) 939-9000 [email protected]
Manhattan: 99 Park Ave, Ste 830, New York, NY 10016  |  Queens: 136-20 38th Ave, Ste 9J, Flushing, NY 11354  |  NJ: 560 Sylvan Ave, Ste 3160, Englewood Cliffs, NJ 07632
Durable Power of Attorney Information Form
Please complete all applicable sections. This form will be used to prepare your Power of Attorney document.
Important: A Durable Power of Attorney allows you to designate an agent to manage your financial and legal affairs on your behalf. "Durable" means it remains effective even if you become incapacitated. This form gathers necessary information for your attorney to draft the document.
I. Principal Information (You)
Full Legal Name:
Date of Birth:
Address:
City:
State:
ZIP:
Phone:
Email:
II. Agent Information (Primary)
Full Legal Name:
Relationship to Principal:
Address:
City:
State:
ZIP:
Phone:
Email:
III. Alternate Agent

This person will serve as your agent if the primary agent is unable or unwilling to act.

Full Legal Name:
Relationship to Principal:
Address:
City:
State:
ZIP:
Phone:
Email:
IV. Scope of Authority

Please check all powers you wish to grant to your agent:

Real estate transactions
Banking operations
Investment management
Tax matters
Insurance matters
Government benefits
Business operations
Gift-making powers
All financial matters
V. Limitations on Agent's Authority

Please describe any specific limitations you wish to place on your agent's powers:

VI. Effective Date

When should this Power of Attorney take effect?

Immediately effective — The agent may act on your behalf as soon as the document is signed and notarized.
Effective upon incapacity (Springing) — The agent may only act if you become mentally incapacitated, as determined by your physician.
Note: New York law generally favors immediately effective powers of attorney. A "springing" power may cause delays if the agent needs to prove your incapacity before institutions will honor the document. Your attorney can advise you on the best option for your situation.
VII. Special Instructions

Please provide any additional instructions or preferences for your agent:

I certify that the information provided above is true and accurate to the best of my knowledge. I understand this form is used for information-gathering purposes only and does not constitute an executed Power of Attorney.

Signature (Principal)
Printed Name
Date
CONFIDENTIALITY NOTICE: This form contains privileged and confidential information intended solely for the use of iLEAD LAW GROUP. Completion of this form does not create an attorney-client relationship. This form is for informational purposes only and does not constitute legal advice. This form is NOT a Power of Attorney document. A formal Power of Attorney must be prepared, signed, and notarized in accordance with applicable state law. Please bring this completed form to your consultation appointment.