Georgia Power of Attorney Template
This Power of Attorney document grants another individual the right to act on your behalf in accordance with the Uniform Power of Attorney Act, as adopted in Georgia. It is a legal form that needs to be completed accurately. Please provide all the requested information and review the document carefully before signing.
Principal Information
Full Name: ___________________________
Address: _____________________________
City: ________________________________
State: Georgia
ZIP Code: ____________________________
Phone Number: ________________________
Agent Information
Full Name: ___________________________
Address: _____________________________
City: ________________________________
State: ______________________________
ZIP Code: ____________________________
Phone Number: ________________________
Powers Granted
Please specify the powers you grant to your agent. These can include, but are not limited to, financial and health care decisions. If certain areas are to be excluded, please specify.
________________________________________________________________
________________________________________________________________
________________________________________________________________
Special Instructions
Please provide any special instructions or limitations you wish to impose on your agent's authority. If none, state "None".
________________________________________________________________
________________________________________________________________
Effective Date and Duration
This Power of Attorney will become effective on: __________________ (date).
Choose one of the following options regarding the duration:
- This document shall remain in effect until it is explicitly revoked by the principal, regardless of the principal’s physical or mental state.
- This document shall become effective upon the disability or incapacity of the principal and will remain in effect until the principal dies or revokes the power granted herein.
Please indicate chosen option: __________
Signature
By signing below, the principal acknowledges that they have read and understood the terms of this Power of Attorney and have willingly made the designations and grants of power contained herein.
Principal's Signature: _______________________ Date: _______________
Agent's Signature: _________________________ Date: _______________
Notarization
This document was acknowledged before me on (date) __________________ by (name of principal) ___________________.
Notary's Signature: ________________________
My commission expires: ____________________