New Jersey Durable Power of Attorney Template
This Durable Power of Attorney ("Document") is created pursuant to the New Jersey Durable Power of Attorney Act. It grants the person(s) named below authority to act on the principal's behalf even in the event the principal becomes disabled or incapacitated.
Section 1: Principal Information
Principal's Full Name: ________________________________
Principal's Physical Address: ________________________________, ___________________, NJ, ___________
Principal's Telephone Number: ________________________________
Section 2: Agent(s) Information
Primary Agent's Full Name: ________________________________
Primary Agent's Physical Address: ________________________________, ___________________, NJ, ___________
Primary Agent's Telephone Number: ________________________________
If applicable, Alternate Agent's Full Name: ________________________________
If applicable, Alternate Agent's Physical Address: ________________________________, ___________________, NJ, ___________
If applicable, Alternate Agent's Telephone Number: ________________________________
Section 3: Powers Granted
Select the powers being granted to the agent by initialing next to each applicable power. If necessary, additional powers may be added under "Other".
- _____ Banking and financial transactions
- _____ Real estate transactions
- _____ Personal and family maintenance
- _____ Tax matters
- _____ Government benefits
- _____ Estate, trust, and beneficiary transactions
- _____ Legal claims and litigation
- _____ Health care, including medical and mental health decisions
- _____ Other: _______________________________________________________________
Section 4: Special Instructions
Any special instructions limiting or extending the powers granted to the agent should be mentioned here.
______________________________________________________________________________
______________________________________________________________________________
Section 5: Effective Date and Signature
This Document becomes effective immediately unless a future date is specified here: ___________.
By signing below, the principal acknowledges understanding and voluntarily granting the powers specified in this Document.
Principal's Signature: ________________________________ Date: ___________
Agent's Signature: ________________________________ Date: ___________
If applicable, Alternate Agent's Signature: ________________________________ Date: ___________
Section 6: Acknowledgement by Notary Public
This section must be completed by a Notary Public to validate the Durable Power of Attorney.
State of New Jersey, County of _______________:
Subscribed and sworn before me this ____ day of _______________, 20_____.
Notary Public's Signature: ___________________________________
Notary Public's Printed Name: _________________________________
My commission expires: _______________