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Public Act 096-1195 | ||||
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AN ACT concerning civil law.
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Be it enacted by the People of the State of Illinois, | ||||
represented in the General Assembly:
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Section 5. The Illinois Power of Attorney Act is amended by | ||||
changing Sections 2-1, 2-3, 2-5, 2-7, 2-8, 2-10, 2-11, 3-3, | ||||
3-4, 4-4, 4-10, and 4-12 and by adding Sections 2-10.3, 2-10.5, | ||||
2-10.6, 3-3.6, 3-5, and 4-5.1 as follows:
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(755 ILCS 45/2-1) (from Ch. 110 1/2, par. 802-1)
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Sec. 2-1. Purpose. The General Assembly recognizes that | ||||
each
individual has the right to appoint an agent to make deal | ||||
with property , financial, or make
personal , and health care | ||||
decisions for the individual but that this right
cannot be | ||||
fully effective unless the principal may empower the agent to | ||||
act
throughout the principal's lifetime, including during | ||||
periods of
disability, and have confidence be sure that third | ||||
parties will honor the agent's authority
at all times.
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The General Assembly finds that in the light of modern | ||||
financial needs
and advances in medical science, the statutory | ||||
recognition of this right of
delegation in Illinois needs to be | ||||
restated , which will to , among other things, expand the
its | ||||
application and the permissible scope of the agent's authority, | ||||
clarify
the power of the individual to authorize an agent to | ||||
make financial and
care decisions for the individual and better |
protect health care personnel
and other third parties who rely | ||
in good faith on the agent so that
reliance will be assured. | ||
Nothing in this Act shall be deemed to
authorize or encourage | ||
euthanasia, suicide or any action or course of
action that | ||
violates the criminal law of this State or the United States.
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Similarly, nothing in this Act shall be deemed to authorize or | ||
encourage
any violation of a civil right expressed in the | ||
Constitution, statutes,
case law and administrative rulings of | ||
this State (including, without
limitation, the right of | ||
conscience respected and protected by the Health
Care Right of | ||
Conscience Act, as now or hereafter amended) or the
United | ||
States or any action or course of action that violates the | ||
public policy
expressed in the Constitution, statutes, case law | ||
and administrative rulings of
this State or the United States.
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(Source: P.A. 90-655, eff. 7-30-98.)
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(755 ILCS 45/2-3) (from Ch. 110 1/2, par. 802-3)
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Sec. 2-3. Definitions. As used in this Act:
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(a) "Agency" means the written power of attorney or other | ||
instrument of
agency governing the relationship between the | ||
principal and agent or the
relationship, itself, as appropriate | ||
to the context, and includes agencies
dealing with personal or | ||
health care as well as property. An agency is
subject to this | ||
Act to the extent it may be controlled by the principal,
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excluding agencies and powers for the benefit of the agent.
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(b) "Agent" means the attorney-in-fact or other person |
designated to act
for the principal in the agency.
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(c) "Disabled person" has the same meaning as in the | ||
"Probate Act of
1975", as now or hereafter amended. To be under | ||
a "disability" or
"disabled" means to be a disabled person.
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(c-5) "Incapacitated", when used to describe a principal, | ||
means that the principal is under a legal disability as defined | ||
in Section 11a-2 of the Probate Act of 1975. A principal shall | ||
also be considered incapacitated if: (i) a physician licensed | ||
to practice medicine in all of its branches has examined the | ||
principal and has determined that the principal lacks decision | ||
making capacity; (ii) that physician has made a written record | ||
of this determination and has signed the written record within | ||
90 days after the examination; and (iii) the written record has | ||
been delivered to the agent. The agent may rely conclusively on | ||
the written record. | ||
(d) "Person" means an individual, corporation, trust, | ||
partnership or
other entity, as appropriate to the agency.
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(e) "Principal" means an individual (including, without | ||
limitation, an
individual acting as trustee, representative or | ||
other fiduciary) who signs
a power of attorney or other | ||
instrument of agency granting powers to an agent.
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(Source: P.A. 85-701.)
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(755 ILCS 45/2-5) (from Ch. 110 1/2, par. 802-5)
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Sec. 2-5. Duration of agency - amendment and revocation. | ||
Unless the
agency states an earlier termination date, the |
agency continues until the
death of the principal, | ||
notwithstanding any lapse of time, the principal's
disability | ||
or incapacity or appointment of a guardian for the principal
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after the agency is signed. Every agency may be amended or | ||
revoked by the
principal , if the principal has the capacity to | ||
do so, at any time and in any manner communicated to the agent | ||
or to any
other person related to the subject matter of the | ||
agency, except that
revocation and amendment of health care | ||
agencies are governed by Section 4-6
of this Act except to the | ||
extent the terms of the agencies are inconsistent
with that | ||
Section. The execution of a power of attorney does not revoke a | ||
power of attorney previously executed by the principal unless | ||
the subsequent power of attorney provides that the previous | ||
power of attorney is revoked or that all other powers of | ||
attorney are revoked.
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(Source: P.A. 86-736.)
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(755 ILCS 45/2-7) (from Ch. 110 1/2, par. 802-7)
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Sec. 2-7. Duty - standard of care - record-keeping - | ||
exoneration. | ||
(a) The agent shall be under
no duty to exercise the powers | ||
granted by the agency or to assume control
of or responsibility | ||
for any of the principal's property, care or affairs,
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regardless of the principal's physical or mental condition. | ||
Whenever a
power is exercised, the agent shall use due care to | ||
act in good faith for the benefit of
the principal using due |
care, competence, and diligence in accordance with the terms of | ||
the agency and shall be
liable for negligent exercise. An agent | ||
who acts with due care for the
benefit of the principal shall | ||
not be liable or limited merely because the
agent also benefits | ||
from the act, has individual or conflicting interests
in | ||
relation to the property, care or affairs of the principal or | ||
acts in a
different manner with respect to the agency and the | ||
agent's individual
interests. The agent shall keep a record of | ||
all receipts, disbursements,
and significant actions taken | ||
under the agency.
The agent shall not be
affected by any | ||
amendment or termination
of the agency until the agent has | ||
actual knowledge thereof. The agent
shall not be liable for any | ||
loss due to error of judgment nor for the act
or default of any | ||
other person.
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(b) An agent that has accepted appointment must act in | ||
accordance with the principal's expectations to the extent | ||
actually known to the agent and otherwise in the principal's | ||
best interests. | ||
(c) An agent shall keep a record of all receipts, | ||
disbursements, and significant actions taken under the | ||
authority of the agency and shall provide a copy of this record | ||
when requested to do so by: | ||
(1) the principal, a guardian, another fiduciary | ||
acting on behalf of the principal, and, after the death of | ||
the principal, the personal representative or successors | ||
in interest of the principal's estate; |
(2) a representative of a provider agency, as defined | ||
in Section 2 of the Elder Abuse and Neglect Act, acting in | ||
the course of an assessment of a complaint of elder abuse | ||
or neglect under that Act; | ||
(3) a representative of the Office of the State Long | ||
Term Care Ombudsman, acting in the course of an | ||
investigation of a complaint of financial exploitation of a | ||
nursing home resident under Section 4.04 of the Illinois | ||
Act on the Aging; | ||
(4) a representative of the Office of Inspector General | ||
for the Department of Human Services, acting in the course | ||
of an assessment of a complaint of financial exploitation | ||
of an adult with disabilities pursuant to Section 35 of the | ||
Abuse of Adults with Disabilities Intervention Act; or | ||
(5) a court under Section 2-10 of this Act. | ||
(d) If the agent fails to provide his or her record of all | ||
receipts, disbursements, and significant actions within 21 | ||
days after a request under subsection (c), the elder abuse | ||
provider agency or the State Long Term Care Ombudsman may | ||
petition the court for an order requiring the agent to produce | ||
his or her record of receipts, disbursements, and significant | ||
actions. If the court finds that the agent's failure to provide | ||
his or her record in a timely manner to the elder abuse | ||
provider agency or the State Long Term Care Ombudsman was | ||
without good cause, the court may assess reasonable costs and | ||
attorney's fees against the agent, and order such other relief |
as is appropriate. | ||
(e) An agent is not required to disclose receipts, | ||
disbursements, or other significant actions conducted on | ||
behalf of the principal except as otherwise provided in the | ||
power of attorney or as required under subsection (c). | ||
(f) An agent that violates this Act is liable to the | ||
principal or the principal's successors in interest for the | ||
amount required (i) to restore the value of the principal's | ||
property to what it would have been had the violation not | ||
occurred, and (ii) to reimburse the principal or the | ||
principal's successors in interest for the attorney's fees and | ||
costs paid on the agent's behalf. This subsection does not | ||
limit any other applicable legal or equitable remedies. | ||
(Source: P.A. 86-736.)
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(755 ILCS 45/2-8) (from Ch. 110 1/2, par. 802-8)
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Sec. 2-8. Reliance on
document purporting to establish an
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agency. | ||
(a) Any person who acts in good faith
reliance on a copy of
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a document purporting to establish an agency will be fully | ||
protected and
released to
the same extent as though the reliant | ||
had dealt directly with the
named
principal
as a | ||
fully-competent person. The
named
agent shall furnish an | ||
affidavit or Agent's Certification and Acceptance of Authority | ||
to the
reliant on demand stating that the instrument relied on | ||
is a true copy of
the agency and that, to the best of the
named
|
agent's knowledge, the named principal is
alive and the | ||
relevant powers of the
named
agent have not been altered or
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terminated; but good faith reliance on
a document purporting to | ||
establish an agency will protect the reliant
without the | ||
affidavit or Agent's Certification and Acceptance of | ||
Authority . | ||
(b) Upon request, the named agent in a power of attorney | ||
shall furnish an Agent's Certification and Acceptance of | ||
Authority to the reliant in substantially the following form: | ||
AGENT'S CERTIFICATION AND ACCEPTANCE OF AUTHORITY | ||
I, .......... (insert name of agent), certify that the | ||
attached is a true copy of a power of attorney naming the | ||
undersigned as agent or successor agent for ............. | ||
(insert name of principal). | ||
I certify that to the best of my knowledge the principal | ||
had the capacity to execute the power of attorney, is alive, | ||
and has not revoked the power of attorney; that my powers as | ||
agent have not been altered or terminated; and that the power | ||
of attorney remains in full force and effect. | ||
I accept appointment as agent under this power of attorney. | ||
This certification and acceptance is made under penalty of | ||
perjury.* | ||
Dated: ............ | ||
....................... |
(Agent's Signature) | ||
....................... | ||
(Print Agent's Name) | ||
....................... | ||
(Agent's Address) | ||
*(NOTE: Perjury is defined in Section 32-2 of the Criminal | ||
Code of 1961, and is a Class 3 felony.) | ||
(c) Any person dealing with an agent
named in a copy of a | ||
document purporting to establish an agency
may presume, in
the | ||
absence of actual knowledge to the contrary, that the
document | ||
purporting to establish the
agency was
validly executed,
that | ||
the agency was validly established,
that the named principal | ||
was competent at the time
of execution, and that, at the time | ||
of reliance, the
named
principal is alive,
the agency
was | ||
validly established
and has not terminated or been amended, the | ||
relevant powers of the
named
agent were properly and validly | ||
granted and have not terminated or
been amended, and the acts | ||
of the
named
agent conform to the standards of this Act.
No | ||
person relying on
a copy of a document purporting to establish | ||
an agency shall be required to see to the application
of any | ||
property delivered to or controlled by the
named
agent or to | ||
question the
authority of the
named
agent. | ||
(d) Each person to whom a direction by the named agent in
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accordance with the terms of the
copy of the document | ||
purporting to establish an
agency is communicated shall comply |
with
that direction, and any person who fails to comply | ||
arbitrarily or without
reasonable cause shall be subject to | ||
civil liability for any damages
resulting from noncompliance.
A | ||
health care provider who complies with Section 4-7 shall not be
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deemed to have acted arbitrarily or without reasonable cause.
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(Source: P.A. 90-21, eff. 6-20-97.)
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(755 ILCS 45/2-10) (from Ch. 110 1/2, par. 802-10)
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Sec. 2-10. Agency-court relationship. | ||
(a) Upon petition by any interested
person (including the | ||
agent), with such notice to interested persons as the
court | ||
directs and a finding by the court that the principal
lacks | ||
either the capacity to control or the capacity to revoke the | ||
agency , the court may construe a power of attorney, review the | ||
agent's conduct, and grant appropriate relief including | ||
compensatory damages. : (a) if | ||
(b) If the court finds
that the agent is not acting for the | ||
benefit of the principal in accordance
with the terms of the | ||
agency or that the agent's action or inaction has
caused or | ||
threatens substantial harm to the principal's person or | ||
property
in a manner not authorized or intended by the | ||
principal, the court may
order a guardian of the principal's | ||
person or estate to exercise any powers
of the principal under | ||
the agency, including the power to revoke the
agency, or may | ||
enter such other orders without appointment of a guardian as
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the court deems necessary to provide for the best interests of |
the
principal . | ||
(c) If ; or (b) if the court finds that the agency requires
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interpretation, the court may construe the agency and instruct | ||
the agent,
but the court may not amend the agency. | ||
(d) If the court finds that the agent has not acted for the | ||
benefit of the principal in accordance with the terms of the | ||
agency and the Illinois Power of Attorney Act, or that the | ||
agent's action caused or threatened substantial harm to the | ||
principal's person or property in a manner not authorized or | ||
intended by the principal, then the agent shall not be | ||
authorized to pay or be reimbursed from the estate of the | ||
principal the attorneys' fees and costs of the agent in | ||
defending a proceeding brought pursuant to this Section. | ||
(e) Upon a finding that the agent's action has caused | ||
substantial harm to the principal's person or property, the | ||
court may assess against the agent reasonable costs and | ||
attorney's fees to a prevailing party who is a provider agency | ||
as defined in Section 2 of the Elder Abuse and Neglect Act, a | ||
representative of the Office of the State Long Term Care | ||
Ombudsman, or a governmental agency having regulatory | ||
authority to protect the welfare of the principal. | ||
(f) As used in this Section, the term "interested person" | ||
includes (1) the principal or the agent; (2) a guardian of the | ||
person, guardian of the estate, or other fiduciary charged with | ||
management of the principal's property; (3) the principal's | ||
spouse, parent, or descendant; (4) a person who would be a |
presumptive heir-at-law of the principal; (5) a person named as | ||
a beneficiary to receive any property, benefit, or contractual | ||
right upon the principal's death, or as a beneficiary of a | ||
trust created by or for the principal; (6) a provider agency as | ||
defined in Section 2 of the Elder Abuse and Neglect Act, a | ||
representative of the Office of the State Long Term Care | ||
Ombudsman, or a governmental agency having regulatory | ||
authority to protect the welfare of the principal; and (7) the | ||
principal's caregiver or another person who demonstrates | ||
sufficient interest in the principal's welfare. | ||
(g) Absent court order directing a
guardian to exercise | ||
powers of the principal under the agency, a guardian
will have | ||
no power, duty or liability with respect to any property | ||
subject
to the agency or any personal or health care matters | ||
covered by the agency. | ||
(h)
Proceedings under this Section shall be commenced in | ||
the county where the
guardian was appointed or, if no Illinois | ||
guardian is acting, then in the
county where the agent or | ||
principal resides or where the principal owns real property or, | ||
if the agent does not reside in
Illinois, then in any county .
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(i) This Section shall not be construed to limit any other | ||
remedies available. | ||
(Source: P.A. 85-701.)
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(755 ILCS 45/2-10.3 new) | ||
Sec. 2-10.3. Successor agents. |
(a) A principal may designate one or more successor agents | ||
to act if an initial or predecessor agent resigns, dies, | ||
becomes incapacitated, is not qualified to serve, or declines | ||
to serve. A principal may grant authority to another person, | ||
designated by name, by office, or by function, including an | ||
initial or successor agent, to designate one or more successor | ||
agents. Unless a power of attorney otherwise provides, a | ||
successor agent has the same authority as that granted to an | ||
initial agent. | ||
(b) An agent is not liable for the actions of another | ||
agent, including a predecessor agent, unless the agent | ||
participates in or conceals a breach of fiduciary duty | ||
committed by the other agent. An agent who has knowledge of a | ||
breach or imminent breach of fiduciary duty by another agent | ||
must notify the principal and, if the principal is | ||
incapacitated, take whatever actions may be reasonably | ||
appropriate in the circumstances to safeguard the principal's | ||
best interest. | ||
(c) Any person who acts in good faith reliance on the | ||
representation of a successor agent regarding the | ||
unavailability of a predecessor agent will be fully protected | ||
and released to the same extent as though the reliant had dealt | ||
directly with the predecessor agent. Upon request, the | ||
successor agent shall furnish an affidavit or Successor Agent's | ||
Certification and Acceptance of Authority to the reliant, but | ||
good faith reliance on a document purporting to establish an |
agency will protect the reliant without the affidavit or | ||
Successor Agent's Certification and Acceptance of Authority. A | ||
Successor Agent's Certification and Acceptance of Authority | ||
shall be in substantially the following form: | ||
SUCCESSOR AGENT'S | ||
CERTIFICATION AND ACCEPTANCE OF AUTHORITY | ||
I certify that the attached is a true copy of a power of | ||
attorney naming the undersigned as agent or successor agent for | ||
.......... (insert name of principal). | ||
I certify that to the best of my knowledge the principal | ||
had the capacity to execute the power of attorney, is alive, | ||
and has not revoked the power of attorney; that my powers as | ||
agent have not been altered or terminated; and that the power | ||
of attorney remains in full force and effect. | ||
I certify that to the best of my knowledge .......... | ||
(insert name of unavailable agent) is unavailable due to | ||
................. (specify death, resignation, absence, | ||
illness, or other temporary incapacity). | ||
I accept appointment as agent under this power of attorney. | ||
This certification and acceptance is made under penalty of | ||
perjury.* | ||
Dated: ............ | ||
....................... | ||
(Agent's Signature) |
....................... | ||
(Print Agent's Name) | ||
....................... | ||
(Agent's Address) | ||
*(NOTE: Perjury is defined in Section 32-2 of the Criminal | ||
Code of 1961, and is a Class 3 felony.) | ||
(755 ILCS 45/2-10.5 new)
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Sec. 2-10.5. Co-agents. | ||
(a) Co-agents may not be named by a principal in a | ||
statutory short form power of attorney for property under | ||
Article III or a statutory short form power of attorney for | ||
health care under Article IV. In the event that co-agents are | ||
named in any other form of power of attorney, then the | ||
provisions of this Section shall govern the use and acceptance | ||
of co-agency designations. | ||
(b) Unless the power of attorney or this Section otherwise | ||
provides, authority granted to 2 or more co-agents is | ||
exercisable only by their majority consent. However, if prompt | ||
action is required to accomplish the purposes of the power of | ||
attorney or to avoid irreparable injury to the principal's | ||
interests and an agent is unavailable because of absence, | ||
illness, or other temporary incapacity, the other agent or | ||
agents may act for the principal. If a vacancy occurs in one or | ||
more of the designations of agent under a power of attorney, | ||
the remaining agent or agents may act for the principal. |
(c) An agent is not liable for the actions of another | ||
agent, including a co-agent or predecessor agent, unless the | ||
agent participates in or conceals a breach of fiduciary duty | ||
committed by the other agent. An agent who has knowledge of a | ||
breach or imminent breach of fiduciary duty by another agent | ||
must notify the principal and, if the principal is | ||
incapacitated, take whatever actions may be reasonably | ||
appropriate in the circumstances to safeguard the principal's | ||
best interest. | ||
(d) Any person who acts in good faith reliance on the | ||
representation of a co-agent regarding the unavailability of a | ||
predecessor agent or one or more co-agents, or the need for | ||
prompt action to accomplish the purposes of the power of | ||
attorney or to avoid irreparable injury to the principal's | ||
interests, will be fully protected and released to the same | ||
extent as though the reliant had dealt directly with all named | ||
agents. Upon request, the co-agent shall furnish an affidavit | ||
or Co-Agent's Certification and Acceptance of Authority to the | ||
reliant, but good faith reliance on a document purporting to | ||
establish an agency will protect the reliant without the | ||
affidavit or Co-Agent's Certification and Acceptance of | ||
Authority. A Co-Agent's Certification and Acceptance of | ||
Authority shall be in substantially the following form: | ||
CO-AGENT'S | ||
CERTIFICATION AND ACCEPTANCE OF AUTHORITY |
I certify that the attached is a true copy of a power of | ||
attorney naming the undersigned as agent or co-agent for | ||
.......... (insert name of principal). | ||
I certify that to the best of my knowledge the principal | ||
had the capacity to execute the power of attorney, is alive, | ||
and has not revoked the power of attorney; that my powers as | ||
agent have not been altered or terminated; and that the power | ||
of attorney remains in full force and effect. | ||
I certify that to the best of my knowledge .......... | ||
(insert name of unavailable agent) is unavailable due to | ||
................. (specify death, resignation, absence, | ||
illness, or other temporary incapacity). | ||
I certify that prompt action is required to accomplish the | ||
purposes of the power of attorney or to avoid irreparable | ||
injury to the principal's interests. | ||
I accept appointment as agent under this power of attorney. | ||
This certification and acceptance is made under penalty of | ||
perjury.* | ||
Dated: ............ | ||
....................... | ||
(Agent's Signature) | ||
....................... | ||
(Print Agent's Name) | ||
....................... | ||
(Agent's Address) |
*(NOTE: Perjury is defined in Section 32-2 of the Criminal | ||
Code of 1961, and is a Class 3 felony.) | ||
(755 ILCS 45/2-10.6 new)
| ||
Sec. 2-10.6. Power of attorney executed in another state or | ||
country; pre-existing powers of attorney. | ||
(a) A power of attorney executed in another state or | ||
country is valid and enforceable in this State if its creation | ||
complied when executed with: | ||
(1) the law of the state or country in which the power | ||
of attorney was executed; | ||
(2) the law of this State; | ||
(3) the law of the state or country where the principal | ||
is domiciled, has a place of abode or business, or is a | ||
national; or | ||
(4) the law of the state or country where the agent is | ||
domiciled or has a place of business. | ||
(b) A power of attorney executed in this State before the | ||
effective date of this amendatory Act of the 96th General | ||
Assembly is valid and enforceable in this State if its creation | ||
complied with the law of this State as it existed at the time | ||
of execution.
| ||
(755 ILCS 45/2-11) (from Ch. 110 1/2, par. 802-11)
| ||
Sec. 2-11. Saving clause. This Act does not in any way
| ||
invalidate any agency executed or any act of any agent done, or
|
affect any claim, right or remedy that accrued, prior to
| ||
September 22, 1987.
| ||
This amendatory Act of the 96th General Assembly does not | ||
in any way invalidate any agency executed or any act of any | ||
agent done, or affect any claim, right, or remedy that accrued | ||
prior to the effective date of this amendatory Act of the 96th | ||
General Assembly. | ||
(Source: P.A. 86-736.)
| ||
(755 ILCS 45/3-3) (from Ch. 110 1/2, par. 803-3)
| ||
Sec. 3-3. Statutory short form power of attorney for | ||
property. | ||
(a) The
following form prescribed in this Section may be | ||
known as "statutory property power" and may be used
to grant an | ||
agent powers with respect to property and financial matters.
| ||
The "statutory property power" consists of the following: (1) | ||
Notice to the Individual Signing the Illinois Statutory Short | ||
Form Power of Attorney for Property; (2) Illinois Statutory | ||
Short Form Power of Attorney for Property; and (3) Notice to | ||
Agent. When a power of attorney in substantially the following | ||
form prescribed in this Section is used,
including all 3 items | ||
above, with item (1), the Notice to Individual Signing the | ||
Illinois Statutory Short Form Power of Attorney for Property, | ||
on a separate sheet (coversheet) in 14-point type the "notice" | ||
paragraph at the beginning in capital letters and
the notarized | ||
form of acknowledgment at the end, it shall have the meaning
|
and effect prescribed in this Act. | ||
(b) A power of attorney shall also be deemed to be in | ||
substantially the same format as the statutory form if the | ||
explanatory language throughout the form (the language | ||
following the designation "NOTE:") is distinguished in some way | ||
from the legal paragraphs in the form, such as the use of | ||
boldface or other difference in typeface and font or point | ||
size, even if the "Notice" paragraphs at the beginning are not | ||
on a separate sheet of paper or are not in 14-point type, or if | ||
the principal's initials do not appear in the acknowledgement | ||
at the end of the "Notice" paragraphs. | ||
The validity of a power of attorney as
meeting the | ||
requirements of a statutory property power shall not be
| ||
affected by the fact that one or more of the categories of | ||
optional powers
listed in the form are struck out or the form | ||
includes specific
limitations on or additions to the agent's | ||
powers, as permitted by the
form. Nothing in this Article shall | ||
invalidate or bar use by the
principal of any other or | ||
different form of power of attorney for property.
Nonstatutory | ||
property powers (i) must be executed by the principal , (ii) | ||
must and
designate the agent and the agent's powers , (iii) must | ||
be signed by at least one witness to the principal's signature, | ||
and (iv) must indicate that the principal has acknowledged his | ||
or her signature before a notary public. However, nonstatutory | ||
property powers , but they need not be acknowledged
or
conform | ||
in any other respect to the statutory property power.
|
(c) The Notice to the Individual Signing the Illinois | ||
Statutory Short Form Power of Attorney for Property shall be | ||
substantially as follows: | ||
"NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS | ||
STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY. | ||
PLEASE READ THIS NOTICE CAREFULLY. The form that you will | ||
be signing is a legal document. It is governed by the Illinois | ||
Power of Attorney Act. If there is anything about this form | ||
that you do not understand, you should ask a lawyer to explain | ||
it to you. | ||
The purpose of this Power of Attorney is to give your | ||
designated "agent" broad powers to handle your financial | ||
affairs, which may include the power to pledge, sell, or | ||
dispose of any of your real or personal property, even without | ||
your consent or any advance notice to you. When using the | ||
Statutory Short Form, you may name successor agents, but you | ||
may not name co-agents. | ||
This form does not impose a duty upon your agent to handle | ||
your financial affairs, so it is important that you select an | ||
agent who will agree to do this for you. It is also important | ||
to select an agent whom you trust, since you are giving that | ||
agent control over your financial assets and property. Any | ||
agent who does act for you has a duty to act in good faith for | ||
your benefit and to use due care, competence, and diligence. He |
or she must also act in accordance with the law and with the | ||
directions in this form. Your agent must keep a record of all | ||
receipts, disbursements, and significant actions taken as your | ||
agent. | ||
Unless you specifically limit the period of time that this | ||
Power of Attorney will be in effect, your agent may exercise | ||
the powers given to him or her throughout your lifetime, both | ||
before and after you become incapacitated. A court, however, | ||
can take away the powers of your agent if it finds that the | ||
agent is not acting properly. You may also revoke this Power of | ||
Attorney if you wish. | ||
This Power
of Attorney does not authorize your agent to | ||
appear in court for you as an attorney-at-law or otherwise to | ||
engage in the practice of law unless he or she is a licensed | ||
attorney who is authorized to practice law in Illinois. | ||
The powers you give your agent are explained more fully in | ||
Section 3-4 of the Illinois Power of Attorney Act. This form is | ||
a part of that law. The "NOTE" paragraphs throughout this form | ||
are instructions. | ||
You are not required to sign this Power of Attorney, but it | ||
will not take effect without your signature. You should not | ||
sign this Power of Attorney if you do not understand everything | ||
in it, and what your agent will be able to do if you do sign it. | ||
Please place your initials on the following line indicating | ||
that you have read this Notice: |
..................... | ||
Principal's initials" | ||
(d) The Illinois Statutory Short Form Power of Attorney for | ||
Property shall be substantially as follows: | ||
"ILLINOIS STATUTORY SHORT FORM | ||
POWER OF ATTORNEY FOR PROPERTY
| ||
(NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE | ||
THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE | ||
YOUR PROPERTY, WHICH MAY
INCLUDE POWERS TO PLEDGE, SELL OR | ||
OTHERWISE DISPOSE OF ANY REAL OR PERSONAL
PROPERTY WITHOUT | ||
ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS FORM DOES
NOT | ||
IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS; BUT | ||
WHEN POWERS
ARE EXERCISED, YOUR AGENT WILL HAVE TO USE DUE CARE | ||
TO ACT FOR YOUR
BENEFIT AND IN ACCORDANCE WITH THIS FORM AND | ||
KEEP A RECORD OF RECEIPTS,
DISBURSEMENTS AND SIGNIFICANT | ||
ACTIONS TAKEN AS AGENT. A COURT CAN TAKE AWAY THE POWERS
OF | ||
YOUR AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY. YOU | ||
MAY NAME
SUCCESSOR AGENTS UNDER THIS FORM BUT NOT CO-AGENTS. | ||
UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THIS POWER IN THE | ||
MANNER PROVIDED BELOW, UNTIL YOU
REVOKE THIS POWER OR A COURT | ||
ACTING ON YOUR BEHALF TERMINATES IT, YOUR
AGENT MAY EXERCISE | ||
THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN
AFTER YOU | ||
BECOME DISABLED. THE POWERS YOU GIVE YOUR AGENT ARE EXPLAINED
|
MORE FULLY IN SECTION 3-4 OF THE ILLINOIS "STATUTORY SHORT FORM | ||
POWER OF
ATTORNEY FOR PROPERTY LAW" OF WHICH THIS FORM IS A | ||
PART
(SEE THE BACK OF THIS FORM). THAT LAW EXPRESSLY PERMITS | ||
THE USE OF ANY
DIFFERENT FORM OF POWER OF ATTORNEY YOU MAY | ||
DESIRE. IF THERE IS ANYTHING
ABOUT THIS FORM THAT YOU DO NOT | ||
UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN
IT TO YOU.)
| ||
POWER OF ATTORNEY made this .... day of ....... (month) | ||
...... (year)
| ||
1. I, ..............., (insert name and address of | ||
principal)
hereby revoke all prior powers of attorney for | ||
property executed by me and appoint:
| ||
.............................................................
| ||
(insert name and address of agent)
| ||
(NOTE: You may not name co-agents using this form.) | ||
as my attorney-in-fact (my "agent") to act for me and in my | ||
name (in any
way I could act in person) with respect to the | ||
following powers, as defined
in Section 3-4 of the "Statutory | ||
Short Form Power of Attorney for Property Law"
(including all | ||
amendments), but subject to any limitations on or additions
to | ||
the specified powers inserted in paragraph 2 or 3 below:
| ||
(NOTE: You must strike out any one or more of the following | ||
categories of
powers you do not want your agent to have. | ||
Failure to strike the title
of any category will cause the | ||
powers described in that category to be
granted to the agent. | ||
To strike out a category you must draw a line
through the title |
of that category.) (YOU MUST STRIKE OUT ANY ONE OR MORE OF THE | ||
FOLLOWING CATEGORIES OF
POWERS YOU DO NOT WANT YOUR AGENT TO | ||
HAVE. FAILURE TO STRIKE THE TITLE
OF ANY CATEGORY WILL CAUSE | ||
THE POWERS DESCRIBED IN THAT CATEGORY TO BE
GRANTED TO THE | ||
AGENT. TO STRIKE OUT A CATEGORY YOU MUST DRAW A LINE
THROUGH | ||
THE TITLE OF THAT CATEGORY.)
| ||
(a) Real estate transactions.
| ||
(b) Financial institution transactions.
| ||
(c) Stock and bond transactions.
| ||
(d) Tangible personal property transactions.
| ||
(e) Safe deposit box transactions.
| ||
(f) Insurance and annuity transactions.
| ||
(g) Retirement plan transactions.
| ||
(h) Social Security, employment and military service | ||
benefits.
| ||
(i) Tax matters.
| ||
(j) Claims and litigation.
| ||
(k) Commodity and option transactions.
| ||
(l) Business operations.
| ||
(m) Borrowing transactions.
| ||
(n) Estate transactions.
| ||
(o) All other property powers and transactions.
| ||
(NOTE: Limitations on and additions to the agent's powers may | ||
be included in this power of attorney if they are specifically | ||
described below.) (LIMITATIONS ON AND ADDITIONS TO THE AGENT'S | ||
POWERS MAY BE INCLUDED IN THIS
POWER OF ATTORNEY IF THEY ARE |
SPECIFICALLY DESCRIBED BELOW.)
| ||
2. The powers granted above shall not include the following | ||
powers or
shall be modified or limited in the following | ||
particulars : | ||
( NOTE: Here here you may
include any specific limitations you | ||
deem appropriate, such as a
prohibition or conditions on the | ||
sale of particular stock or real estate or
special rules on | ||
borrowing by the agent . ) :
| ||
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
3. In addition to the powers granted above, I grant my | ||
agent the
following powers : | ||
( NOTE: Here here you may add any other delegable powers | ||
including,
without limitation, power to make gifts, exercise | ||
powers of appointment,
name or change beneficiaries or joint | ||
tenants or revoke or amend any trust
specifically referred to | ||
below . ) :
| ||
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
(NOTE: Your agent will have authority to employ other persons |
as necessary to enable the agent to properly exercise the | ||
powers granted in this form, but your agent will have to make | ||
all discretionary decisions. If you want to give your agent the | ||
right to delegate discretionary decision-making powers to | ||
others, you should keep paragraph 4, otherwise it should be | ||
struck out.) (YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER | ||
PERSONS AS NECESSARY TO
ENABLE THE AGENT TO PROPERLY EXERCISE | ||
THE POWERS GRANTED IN THIS FORM, BUT
YOUR AGENT WILL HAVE TO | ||
MAKE ALL DISCRETIONARY DECISIONS. IF YOU WANT TO
GIVE YOUR | ||
AGENT THE RIGHT TO DELEGATE DISCRETIONARY DECISION-MAKING | ||
POWERS
TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE, OTHERWISE | ||
IT SHOULD BE STRUCK OUT.)
| ||
4. My agent shall have the right by written instrument to | ||
delegate any
or all of the foregoing powers involving | ||
discretionary decision-making to
any person or persons whom my | ||
agent may select, but such delegation may be
amended or revoked | ||
by any agent (including any successor) named by me who
is | ||
acting under this power of attorney at the time of reference.
| ||
(NOTE: Your agent will be entitled to reimbursement for all | ||
reasonable expenses incurred in acting under this power of | ||
attorney. Strike out paragraph 5 if you do not want your agent | ||
to also be entitled to reasonable compensation for services as | ||
agent.) (YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL | ||
REASONABLE EXPENSES
INCURRED IN ACTING UNDER THIS POWER OF | ||
ATTORNEY. STRIKE OUT THE NEXT
SENTENCE IF YOU DO NOT WANT YOUR | ||
AGENT TO ALSO BE ENTITLED TO REASONABLE
COMPENSATION FOR |
SERVICES AS AGENT.)
| ||
5. My agent shall be entitled to reasonable compensation | ||
for services
rendered as agent under this power of attorney.
| ||
(NOTE: This power of attorney may be amended or revoked by you | ||
at any time and in any manner. Absent amendment or revocation, | ||
the authority granted in this power of attorney will become | ||
effective at the time this power is signed and will continue | ||
until your death, unless a limitation on the beginning date or | ||
duration is made by initialing and completing one or both of | ||
paragraphs 6 and 7:) (THIS POWER OF ATTORNEY MAY BE AMENDED OR | ||
REVOKED BY YOU AT ANY TIME AND IN
ANY MANNER. ABSENT AMENDMENT | ||
OR REVOCATION, THE AUTHORITY GRANTED IN THIS
POWER OF ATTORNEY | ||
WILL BECOME EFFECTIVE AT THE TIME THIS POWER IS SIGNED
AND WILL | ||
CONTINUE UNTIL YOUR DEATH UNLESS A LIMITATION ON THE BEGINNING
| ||
DATE OR DURATION IS MADE BY INITIALING AND COMPLETING EITHER | ||
(OR BOTH) OF
THE FOLLOWING:)
| ||
6. ( ) This power of attorney shall become effective on
| ||
.............................................................
| ||
( NOTE: Insert insert a future date or event during your | ||
lifetime, such as a court
determination of your disability or a | ||
written determination by your physician that you are | ||
incapacitated , when you want this power to first take effect . )
| ||
7. ( ) This power of attorney shall terminate on
| ||
.............................................................
| ||
( NOTE: Insert insert a future date or event, such as a court | ||
determination that you are not under a legal disability or a |
written determination by your physician that you are not | ||
incapacitated, if of your
disability, when you want this power | ||
to terminate prior to your death . )
| ||
(NOTE: If you wish to name one or more successor agents, insert | ||
the name and address of each successor agent in paragraph 8.) | ||
(IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND | ||
ADDRESS(ES)
OF SUCH SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)
| ||
8. If any agent named by me shall die, become incompetent, | ||
resign
or refuse to accept the office of agent, I name the | ||
following
(each to act alone and successively,
in the order | ||
named) as successor(s) to such agent:
| ||
.............................................................
| ||
.............................................................
| ||
For purposes of this paragraph 8, a person shall be considered | ||
to be
incompetent if and while the person is a minor or an | ||
adjudicated
incompetent or disabled person or the person is | ||
unable to give prompt and
intelligent consideration to business | ||
matters, as certified by a licensed physician.
| ||
(NOTE: If you wish to, you may name your agent as guardian of | ||
your estate if a court decides that one should be appointed. To | ||
do this, retain paragraph 9, and the court will appoint your | ||
agent if the court finds that this appointment will serve your | ||
best interests and welfare. Strike out paragraph 9 if you do | ||
not want your agent to act as guardian.) (IF YOU WISH TO NAME | ||
YOUR AGENT AS
GUARDIAN OF YOUR ESTATE, IN THE EVENT A COURT | ||
DECIDES THAT ONE
SHOULD BE APPOINTED, YOU
MAY, BUT ARE NOT |
REQUIRED TO, DO SO BY RETAINING THE FOLLOWING PARAGRAPH.
THE | ||
COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH | ||
APPOINTMENT WILL SERVE YOUR
BEST INTERESTS AND WELFARE. STRIKE | ||
OUT PARAGRAPH 9 IF YOU DO NOT WANT
YOUR AGENT TO ACT AS | ||
GUARDIAN.)
| ||
9. If a guardian of my estate (my property) is to be | ||
appointed, I
nominate the agent acting under this power of | ||
attorney as such guardian,
to serve without bond or security.
| ||
10. I am fully informed as to all the contents of this form | ||
and
understand the full import of this grant of powers to my | ||
agent.
| ||
(NOTE: This form does not authorize your agent to appear in | ||
court for you as an attorney-at-law or otherwise to engage in | ||
the practice of law unless he or she is a licensed attorney who | ||
is authorized to practice law in Illinois.) | ||
11. The Notice to Agent is incorporated by reference and | ||
included as part of this form. | ||
Dated: ................ | ||
Signed ..........................................
| ||
(principal)
| ||
(YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND | ||
SUCCESSOR
AGENTS TO PROVIDE SPECIMEN SIGNATURES BELOW. IF YOU | ||
INCLUDE SPECIMEN
SIGNATURES IN THIS POWER OF ATTORNEY, YOU MUST | ||
COMPLETE THE CERTIFICATION
OPPOSITE THE SIGNATURES OF THE | ||
AGENTS.)
| ||
Specimen signatures of I certify that the signatures
|
agent (and successors) of my agent (and successors)
| ||
are correct.
| ||
.......................... .............................
| ||
(agent) (principal)
| ||
.......................... .............................
| ||
(successor agent) (principal)
| ||
.......................... .............................
| ||
(successor agent) (principal)
| ||
(NOTE: This power of attorney will not be effective unless it | ||
is signed by at least one witness and your signature is | ||
notarized, using the form below. The notary may not also sign | ||
as a witness.) (THIS POWER OF ATTORNEY WILL NOT BE EFFECTIVE | ||
UNLESS IT IS NOTARIZED AND
SIGNED BY AT LEAST ONE ADDITIONAL | ||
WITNESS,
USING THE FORM BELOW.)
| ||
The undersigned witness certifies that ..............., known | ||
to me to be
the same person whose name is subscribed as | ||
principal to the foregoing power of
attorney, appeared before | ||
me and the notary public and acknowledged signing and
| ||
delivering the instrument as the free and voluntary act of the | ||
principal, for
the
uses and purposes therein set forth. I | ||
believe him or her to be of sound mind
and memory. The | ||
undersigned witness also certifies that the witness is not: (a) | ||
the attending physician or mental health service provider or a | ||
relative of the physician or provider; (b) an owner, operator, |
or relative of an owner or operator of a health care facility | ||
in which the principal is a patient or resident; (c) a parent, | ||
sibling, descendant, or any spouse of such parent, sibling, or | ||
descendant of either the principal or any agent or successor | ||
agent under the foregoing power of attorney, whether such | ||
relationship is by blood, marriage, or adoption; or (d) an | ||
agent or successor agent under the foregoing power of attorney.
| ||
Dated: ................
| ||
..............................
| ||
Witness | ||
(NOTE: Illinois requires only one witness, but other | ||
jurisdictions may require more than one witness. If you wish to | ||
have a second witness, have him or her certify and sign here:) | ||
(Second witness) The undersigned witness certifies that | ||
................, known to me to be the same person whose name | ||
is subscribed as principal to the foregoing power of attorney, | ||
appeared before me and the notary public and acknowledged | ||
signing and delivering the instrument as the free and voluntary | ||
act of the principal, for the uses and purposes therein set | ||
forth. I believe him or her to be of sound mind and memory. The | ||
undersigned witness also certifies that the witness is not: (a) | ||
the attending physician or mental health service provider or a | ||
relative of the physician or provider; (b) an owner, operator, | ||
or relative of an owner or operator of a health care facility |
in which the principal is a patient or resident; (c) a parent, | ||
sibling, descendant, or any spouse of such parent, sibling, or | ||
descendant of either the principal or any agent or successor | ||
agent under the foregoing power of attorney, whether such | ||
relationship is by blood, marriage, or adoption; or (d) an | ||
agent or successor agent under the foregoing power of attorney. | ||
Dated: ....................... | ||
.............................. | ||
Witness | ||
State of ............)
| ||
) SS.
| ||
County of ...........)
| ||
The undersigned, a notary public in and for the above | ||
county and state,
certifies that ......................., | ||
known to me to be the same person
whose name is subscribed as | ||
principal to the foregoing power of attorney,
appeared before | ||
me and the witness(es) ............. (and ..............) | ||
additional witness in person and acknowledged
signing and | ||
delivering the
instrument as the free and voluntary act of the | ||
principal, for the uses and
purposes therein set forth (, and | ||
certified to the correctness of the
signature(s) of the | ||
agent(s)).
| ||
Dated: ................ (SEAL)
| ||
..............................
| ||
Notary Public
|
My commission expires .................
| ||
(NOTE: You may, but are not required to, request your agent and | ||
successor agents to provide specimen signatures below. If you | ||
include specimen signatures in this power of attorney, you must | ||
complete the certification opposite the signatures of the | ||
agents.)
| ||
Specimen signatures of I certify that the signatures
| ||
agent (and successors) of my agent (and successors)
| ||
are genuine.
| ||
.......................... .............................
| ||
(agent) (principal)
| ||
.......................... .............................
| ||
(successor agent) (principal)
| ||
.......................... .............................
| ||
(successor agent) (principal) | ||
The undersigned witness certifies that ................, known | ||
to me to be
the same person whose name is subscribed as | ||
principal to the foregoing power of
attorney, appeared before | ||
me and the notary public and acknowledged signing and
| ||
delivering the instrument as the free and voluntary act of the | ||
principal, for
the
uses and purposes therein set forth. I | ||
believe him or her to be of sound mind
and memory.
| ||
Dated: ................ (SEAL)
|
..............................
| ||
Witness
| ||
(NOTE: The name, address, and phone number of the person | ||
preparing this form or who assisted the principal in completing | ||
this form should be inserted below.) (THE NAME AND ADDRESS OF | ||
THE PERSON PREPARING THIS FORM SHOULD BE
INSERTED
IF THE AGENT | ||
WILL HAVE POWER TO CONVEY ANY INTEREST IN REAL ESTATE.)
| ||
Name: ....................... | ||
Address: .................... | ||
.............................. | ||
.............................. | ||
Phone: .................... | ||
This document was prepared by:
| ||
| ||
"
| ||
(e) Notice to Agent. The following form may be known as | ||
"Notice to Agent" and shall be supplied to an agent appointed | ||
under a power of attorney for property. | ||
"NOTICE TO AGENT | ||
When you accept the authority granted under this power of | ||
attorney a special legal relationship, known as agency, is | ||
created between you and the principal. Agency imposes upon you | ||
duties that continue until you resign or the power of attorney |
is terminated or revoked. | ||
As agent you must: | ||
(1) do what you know the principal reasonably expects | ||
you to do with the principal's property; | ||
(2) act in good faith for the best interest of the | ||
principal, using due care, competence, and diligence; | ||
(3) keep a complete and detailed record of all | ||
receipts, disbursements, and significant actions conducted | ||
for the principal; | ||
(4) attempt to preserve the principal's estate plan, to | ||
the extent actually known by the agent, if preserving the | ||
plan is consistent with the principal's best interest; and | ||
(5) cooperate with a person who has authority to make | ||
health care decisions for the principal to carry out the | ||
principal's reasonable expectations to the extent actually | ||
in the principal's best interest. | ||
As agent you must not do any of the following: | ||
(1) act so as to create a conflict of interest that is | ||
inconsistent with the other principles in this Notice to | ||
Agent; | ||
(2) do any act beyond the authority granted in this | ||
power of attorney; | ||
(3) commingle the principal's funds with your funds; | ||
(4) borrow funds or other property from the principal, | ||
unless otherwise authorized; | ||
(5) continue acting on behalf of the principal if you |
learn of any event that terminates this power of attorney | ||
or your authority under this power of attorney, such as the | ||
death of the principal, your legal separation from the | ||
principal, or the dissolution of your marriage to the | ||
principal. | ||
If you have special skills or expertise, you must use those | ||
special skills and expertise when acting for the principal. You | ||
must disclose your identity as an agent whenever you act for | ||
the principal by writing or printing the name of the principal | ||
and signing your own name "as Agent" in the following manner: | ||
"(Principal's Name) by (Your Name) as Agent" | ||
The meaning of the powers granted to you is contained in | ||
Section 3-4 of the Illinois Power of Attorney Act, which is | ||
incorporated by reference into the body of the power of | ||
attorney for property document. | ||
If you violate your duties as agent or act outside the | ||
authority granted to you, you may be liable for any damages, | ||
including attorney's fees and costs, caused by your violation. | ||
If there is anything about this document or your duties | ||
that you do not understand, you should seek legal advice from | ||
an attorney." | ||
(f) The requirement of the signature of a witness in | ||
addition to the principal and the notary, an additional
witness | ||
imposed by Public Act 91-790, this amendatory Act of the 91st | ||
General
Assembly applies only to instruments executed on or |
after June 9, 2000 ( the effective date of that Public Act). | ||
this amendatory Act of the 91st
General Assembly. | ||
(NOTE: This amendatory Act of the 96th General Assembly deletes | ||
provisions that referred to the one required witness as an | ||
"additional witness", and it also provides for the signature of | ||
an optional "second witness".)
| ||
(Source: P.A. 91-790, eff. 6-9-00 .)
| ||
(755 ILCS 45/3-3.6 new) | ||
Sec. 3-3.6. Limitations on who may witness property powers. | ||
(a) Every property power shall bear the signature of a | ||
witness to the signing of the agency and shall be notarized. | ||
None of the following may serve as a witness to the signing of | ||
a property power or as a notary public notarizing the property | ||
power: | ||
(1) the attending physician or mental health service | ||
provider of the principal, or a relative of the physician | ||
or provider; | ||
(2) an owner, operator, or relative of an owner or | ||
operator of a health care facility in which the principal | ||
is a patient or resident; | ||
(3) a parent, sibling, or descendant, or the spouse of | ||
a parent, sibling, or descendant, of either the principal | ||
or any agent or successor agent, regardless of whether the | ||
relationship is by blood, marriage, or adoption; | ||
(4) an agent or successor agent for property. |
(b) The prohibition on the operator of a health care | ||
facility from serving as a witness shall extend to directors | ||
and executive officers of an operator that is a corporate | ||
entity but not other employees of the operator.
| ||
(755 ILCS 45/3-4) (from Ch. 110 1/2, par. 803-4)
| ||
Sec. 3-4. Explanation of powers granted in the statutory | ||
short form power
of attorney for property. This Section defines | ||
each category of powers
listed in the statutory short form | ||
power of attorney for property and the
effect of granting | ||
powers to an agent , and is incorporated by reference into the | ||
statutory short form. Incorporation by reference does not | ||
require physical attachment of a copy of this Section 3-4 to | ||
the statutory short form power of attorney for property . When | ||
the title of any of the
following categories is retained (not | ||
struck out) in a statutory property
power form, the effect will | ||
be to grant the agent all of the principal's
rights, powers and | ||
discretions with respect to the types of property and
| ||
transactions covered by the retained category, subject to any | ||
limitations
on the granted powers that appear on the face of | ||
the form. The agent will
have authority to exercise each | ||
granted power for and in the name of the
principal with respect | ||
to all of the principal's interests in every type of
property | ||
or transaction covered by the granted power at the time of
| ||
exercise, whether the principal's interests are direct or | ||
indirect, whole
or fractional, legal, equitable or |
contractual, as a joint tenant or tenant
in common or held in | ||
any other form; but the agent will not have power under
any of | ||
the statutory categories (a) through (o) to make gifts of the
| ||
principal's property, to exercise powers to appoint to others | ||
or to change
any beneficiary whom the principal has designated | ||
to take the principal's
interests at death under any will, | ||
trust, joint tenancy, beneficiary form
or contractual | ||
arrangement. The agent will be under no duty to exercise
| ||
granted powers or to assume control of or responsibility for | ||
the
principal's property or affairs; but when granted powers | ||
are exercised, the
agent will be required to use due care to | ||
act in good faith for the benefit of
the principal using due | ||
care, competence, and diligence in accordance with the terms of | ||
the statutory property power
and will be liable for negligent | ||
exercise. The agent may act in person or
through others | ||
reasonably employed by the agent for that purpose and will
have | ||
authority to sign and deliver all instruments, negotiate and | ||
enter
into all agreements and do all other acts reasonably | ||
necessary to implement
the exercise of the powers granted to | ||
the agent.
| ||
(a) Real estate transactions. The agent is authorized to: | ||
buy,
sell, exchange, rent and lease real estate (which term | ||
includes, without
limitation, real estate subject to a land | ||
trust and all beneficial
interests in and powers of direction | ||
under any land trust); collect all
rent, sale proceeds and | ||
earnings from real estate; convey, assign and
accept title to |
real estate; grant easements, create conditions and release
| ||
rights of homestead with respect to real estate; create land | ||
trusts and
exercise all powers under land trusts; hold, | ||
possess, maintain, repair,
improve, subdivide, manage, operate | ||
and insure real estate; pay, contest,
protest and compromise | ||
real estate taxes and assessments; and, in general,
exercise | ||
all powers with respect to real estate which the principal | ||
could
if present and under no disability.
| ||
(b) Financial institution transactions. The agent is | ||
authorized to:
open, close, continue and control all accounts | ||
and deposits in any type of
financial institution (which term | ||
includes, without limitation, banks,
trust companies, savings | ||
and building and loan associations, credit unions
and brokerage | ||
firms); deposit in and withdraw from and write checks on any
| ||
financial institution account or deposit; and, in general, | ||
exercise all
powers with respect to financial institution | ||
transactions which the
principal could if present and under no | ||
disability. This authorization shall also apply to any Totten | ||
Trust, Payable on Death Account, or comparable trust account | ||
arrangement where the terms of such trust are contained | ||
entirely on the financial institution's signature card, | ||
insofar as an agent shall be permitted to withdraw income or | ||
principal from such account, unless this authorization is | ||
expressly limited or withheld under paragraph 2 of the form | ||
prescribed under Section 3-3. This authorization shall not | ||
apply to accounts titled in the name of any trust subject to |
the provisions of the Trusts and Trustees Act, for which | ||
specific reference to the trust and a specific grant of | ||
authority to the agent to withdraw income or principal from | ||
such trust is required pursuant to Section 2-9 of the Illinois | ||
Power of Attorney Act and subsection (n) of this Section.
| ||
(c) Stock and bond transactions. The agent is authorized | ||
to: buy
and sell all types of securities (which term includes, | ||
without limitation,
stocks, bonds, mutual funds and all other | ||
types of investment securities
and financial instruments); | ||
collect, hold and safekeep all dividends,
interest, earnings, | ||
proceeds of sale, distributions, shares, certificates
and | ||
other evidences of ownership paid or distributed with respect | ||
to
securities; exercise all voting rights with respect to | ||
securities in person
or by proxy, enter into voting trusts and | ||
consent to limitations on the
right to vote; and, in general, | ||
exercise all powers with respect to
securities which the | ||
principal could if present and under no disability.
| ||
(d) Tangible personal property transactions. The agent is
| ||
authorized to: buy and sell, lease, exchange, collect, possess | ||
and take
title to all tangible personal property; move, store, | ||
ship, restore,
maintain, repair, improve, manage, preserve, | ||
insure and safekeep tangible
personal property; and, in | ||
general, exercise all powers with respect to
tangible personal | ||
property which the principal could if present and under no | ||
disability.
| ||
(e) Safe deposit box transactions. The agent is authorized |
to:
open, continue and have access to all safe deposit boxes; | ||
sign, renew,
release or terminate any safe deposit contract; | ||
drill or surrender any safe
deposit box; and, in general, | ||
exercise all powers with respect to safe
deposit matters which | ||
the principal could if present and under no disability.
| ||
(f) Insurance and annuity transactions. The agent is | ||
authorized to:
procure, acquire, continue, renew, terminate or | ||
otherwise deal with any
type of insurance or annuity contract | ||
(which terms include, without
limitation, life, accident, | ||
health, disability, automobile casualty,
property or liability | ||
insurance); pay premiums or assessments on or
surrender and | ||
collect all distributions, proceeds or benefits payable under
| ||
any insurance or annuity contract; and, in general, exercise | ||
all powers
with respect to insurance and annuity contracts | ||
which the principal could
if present and under no disability.
| ||
(g) Retirement plan transactions. The agent is authorized | ||
to:
contribute to, withdraw from and deposit funds in any type | ||
of retirement
plan (which term includes, without limitation, | ||
any tax qualified or
nonqualified pension, profit sharing, | ||
stock bonus, employee savings and
other retirement plan, | ||
individual retirement account, deferred compensation
plan and | ||
any other type of employee benefit plan); select and change
| ||
payment options for the principal under any retirement plan; | ||
make rollover
contributions from any retirement plan to other | ||
retirement plans or
individual retirement accounts; exercise | ||
all investment powers available
under any type of self-directed |
retirement plan; and, in general, exercise
all powers with | ||
respect to retirement plans and retirement plan account
| ||
balances which the principal could if present and under no | ||
disability.
| ||
(h) Social Security, unemployment and military service | ||
benefits.
The agent is authorized to: prepare, sign and file | ||
any claim or application
for Social Security, unemployment or | ||
military service benefits; sue for,
settle or abandon any | ||
claims to any benefit or assistance under any
federal, state, | ||
local or foreign statute or regulation; control, deposit to
any | ||
account, collect, receipt for, and take title to and hold all | ||
benefits
under any Social Security, unemployment, military | ||
service or other state,
federal, local or foreign statute or | ||
regulation; and, in general, exercise
all powers with respect | ||
to Social Security, unemployment, military service
and | ||
governmental benefits which the principal could if present and | ||
under no disability.
| ||
(i) Tax matters. The agent is authorized to: sign, verify | ||
and file
all the principal's federal, state and local income, | ||
gift, estate, property
and other tax returns, including joint | ||
returns and declarations of
estimated tax; pay all taxes; | ||
claim, sue for and receive all tax refunds;
examine and copy | ||
all the principal's tax returns and records; represent the
| ||
principal before any federal, state or local revenue agency or | ||
taxing body
and sign and deliver all tax powers of attorney on | ||
behalf of the principal
that may be necessary for such |
purposes; waive rights and sign all
documents on behalf of the | ||
principal as required to settle, pay and
determine all tax | ||
liabilities; and, in general, exercise all powers with
respect | ||
to tax matters which the principal could if present and under | ||
no disability.
| ||
(j) Claims and litigation. The agent is authorized to: | ||
institute,
prosecute, defend, abandon, compromise, arbitrate, | ||
settle and dispose of
any claim in favor of or against the | ||
principal or any property interests of
the principal; collect | ||
and receipt for any claim or settlement proceeds and
waive or | ||
release all rights of the principal; employ attorneys and | ||
others
and enter into contingency agreements and other | ||
contracts as necessary in
connection with litigation; and, in | ||
general, exercise all powers with
respect to claims and | ||
litigation which the principal could if present and
under no | ||
disability. The statutory short form power
of attorney for | ||
property does not authorize the agent to appear in court or any | ||
tribunal as an attorney-at-law for the principal or otherwise | ||
to engage in the practice of law without being a licensed | ||
attorney who is authorized to practice law in Illinois under | ||
applicable Illinois Supreme Court Rules.
| ||
(k) Commodity and option transactions. The agent is | ||
authorized to:
buy, sell, exchange, assign, convey, settle and | ||
exercise commodities
futures contracts and call and put options | ||
on stocks and stock indices
traded on a regulated options | ||
exchange and collect and receipt for all
proceeds of any such |
transactions; establish or continue option accounts
for the | ||
principal with any securities or futures broker; and, in | ||
general,
exercise all powers with respect to commodities and | ||
options which the
principal could if present and under no | ||
disability.
| ||
(l) Business operations. The agent is authorized to: | ||
organize or
continue and conduct any business (which term | ||
includes, without limitation,
any farming, manufacturing, | ||
service, mining, retailing or other type of
business operation) | ||
in any form, whether as a proprietorship, joint
venture, | ||
partnership, corporation, trust or other legal entity; | ||
operate,
buy, sell, expand, contract, terminate or liquidate | ||
any business; direct,
control, supervise, manage or | ||
participate in the operation of any business
and engage, | ||
compensate and discharge business managers, employees, agents,
| ||
attorneys, accountants and consultants; and, in general, | ||
exercise all
powers with respect to business interests and | ||
operations which the principal
could if present and under no | ||
disability.
| ||
(m) Borrowing transactions. The agent is authorized to: | ||
borrow
money; mortgage or pledge any real estate or tangible or | ||
intangible
personal property as security for such purposes; | ||
sign, renew, extend, pay
and satisfy any notes or other forms | ||
of obligation; and, in general,
exercise all powers with | ||
respect to secured and unsecured borrowing which
the principal | ||
could if present and under no disability.
|
(n) Estate transactions. The agent is authorized to: | ||
accept,
receipt for, exercise, release, reject, renounce, | ||
assign, disclaim, demand,
sue for, claim and recover any | ||
legacy, bequest, devise, gift or other
property interest or | ||
payment due or payable to or for the principal; assert
any | ||
interest in and exercise any power over any trust, estate or | ||
property
subject to fiduciary control; establish a revocable | ||
trust solely for the
benefit of the principal that terminates | ||
at the death of the principal and
is then distributable to the | ||
legal representative of the estate of the
principal; and, in | ||
general, exercise all powers with respect to estates and
trusts | ||
which the principal could if present and under no disability;
| ||
provided, however, that the agent may not make or change a will | ||
and may not
revoke or amend a trust revocable or amendable by | ||
the principal or require
the trustee of any trust for the | ||
benefit of the principal to pay income or
principal to the | ||
agent unless specific authority to that end is given, and
| ||
specific reference to the trust is made, in the statutory | ||
property power form.
| ||
(o) All other property powers and transactions. The agent | ||
is
authorized to: exercise all possible authority powers of the | ||
principal with respect
to all possible types of property and | ||
interests in property, except to the
extent limited in | ||
subsections (a) through (n) of this Section 3-4 and to the | ||
extent that the principal otherwise limits the generality of | ||
this category (o) by striking
out one or more of categories (a) |
through (n) or by specifying other
limitations in the statutory | ||
property power form.
| ||
(Source: P.A. 94-938, eff. 1-1-07.)
| ||
(755 ILCS 45/3-5 new) | ||
Sec. 3-5. Savings clause. This amendatory Act of the 96th | ||
General Assembly does not in any way invalidate any property | ||
power executed or any act of any agent done, or affect any | ||
claim, right, or remedy that accrued, prior to the effective | ||
date of this amendatory Act of the 96th General Assembly.
| ||
(755 ILCS 45/4-4) (from Ch. 110 1/2, par. 804-4)
| ||
Sec. 4-4. Definitions. As used in this Article:
| ||
(a) "Attending physician" means the physician who has | ||
primary
responsibility at the time of reference for the | ||
treatment and care of the patient.
| ||
(b) "Health care" means any care, treatment, service or | ||
procedure to
maintain, diagnose, treat or provide for the | ||
patient's physical or mental
health or personal care.
| ||
(c) "Health care agency" means an agency governing any type | ||
of health
care, anatomical gift, autopsy or disposition of | ||
remains for and on behalf
of a patient and refers to the power | ||
of attorney or other written
instrument defining the agency or | ||
the agency, itself, as appropriate to the context.
| ||
(d) "Health care provider" or "provider" means the | ||
attending physician
and any other person administering health |
care to the patient at the time
of reference who is licensed, | ||
certified, or otherwise authorized or
permitted by law to | ||
administer health care in the ordinary course of
business or | ||
the practice of a profession, including any person employed by
| ||
or acting for any such authorized person.
| ||
(e) "Patient" means the principal or, if the agency governs | ||
health care
for a minor child of the principal, then the child.
| ||
(f) "Incurable or irreversible condition" means an illness | ||
or injury (i) for which there is no reasonable prospect of cure | ||
or recovery, (ii) that ultimately will cause the patient's | ||
death even if life-sustaining treatment is initiated or | ||
continued, (iii) that imposes severe pain or otherwise imposes | ||
an inhumane burden on the patient, or (iv) for which initiating | ||
or continuing life-sustaining treatment, in light of the | ||
patient's medical condition, provides only minimal medical | ||
benefit. | ||
(g) "Permanent unconsciousness" means a condition that, to | ||
a high degree of medical certainty, (i) will last permanently, | ||
without improvement, (ii) in which thought, sensation, | ||
purposeful action, social interaction, and awareness of self | ||
and environment are absent, and (iii) for which initiating or | ||
continuing life-sustaining treatment, in light of the | ||
patient's medical condition, provides only minimal medical | ||
benefit. For the purposes of this definition, "medical benefit" | ||
means a chance to cure or reverse a condition. | ||
(h) "Terminal condition" means an illness or injury for |
which there is no reasonable prospect of cure or recovery, | ||
death is imminent, and the application of life-sustaining | ||
treatment would only prolong the dying process. | ||
(Source: P.A. 85-701.)
| ||
(755 ILCS 45/4-5.1 new) | ||
Sec. 4-5.1. Limitations on who may witness health care | ||
agencies. | ||
(a) Every health care agency shall bear the signature of a | ||
witness to the signing of the agency. None of the following may | ||
serve as a witness to the signing of a health care agency: | ||
(1) the attending physician or mental health service | ||
provider of the principal, or a relative of the physician | ||
or provider; | ||
(2) an owner, operator, or relative of an owner or | ||
operator of a health care facility in which the principal | ||
is a patient or resident; | ||
(3) a parent, sibling, or descendant, or the spouse of | ||
a parent, sibling, or descendant, of either the principal | ||
or any agent or successor agent, regardless of whether the | ||
relationship is by blood, marriage, or adoption; | ||
(4) an agent or successor agent for health care. | ||
(b) The prohibition on the operator of a health care | ||
facility from serving as a witness shall extend to directors | ||
and executive officers of an operator that is a corporate | ||
entity but not other employees of the operator.
|
(755 ILCS 45/4-10) (from Ch. 110 1/2, par. 804-10)
| ||
Sec. 4-10. Statutory short form power of attorney for | ||
health care.
| ||
(a) The following form prescribed in this Section | ||
(sometimes also referred to in this Act as the
"statutory | ||
health care power") may be used to grant an agent powers with
| ||
respect to the principal's own health care; but the statutory | ||
health care
power is not intended to be exclusive nor to cover | ||
delegation of a parent's
power to control the health care of a | ||
minor child, and no provision of this
Article shall be | ||
construed to invalidate or bar use by the principal of any
| ||
other or
different form of power of attorney for health care. | ||
Nonstatutory health
care powers must be
executed by the | ||
principal, designate the agent and the agent's powers, and
| ||
comply with Section 4-5 of this Article, but they need not be | ||
witnessed or
conform in any other respect to the statutory | ||
health care power. When a
power of attorney in substantially | ||
the
following form prescribed in this Section is used, | ||
including the "Notice to the Individual Signing the Illinois | ||
Statutory Short Form Power of Attorney for Health Care" (or | ||
"Notice" paragraphs) "notice" paragraph at the beginning of the | ||
form on a separate sheet in 14-point type
in capital letters , | ||
it shall have the meaning and effect prescribed in this
Act. A | ||
power of attorney for health care shall be deemed to be in | ||
substantially the same format as the statutory form if the |
explanatory language throughout the form (the language | ||
following the designation "NOTE:") is distinguished in some way | ||
from the legal paragraphs in the form, such as the use of | ||
boldface or other difference in typeface and font or point | ||
size, even if the "Notice" paragraphs at the beginning are not | ||
on a separate sheet of paper or are not in 14-point type, or if | ||
the principal's initials do not appear in the acknowledgement | ||
at the end of the "Notice" paragraphs. The statutory health | ||
care power may be included in or
combined with any
other form | ||
of power of attorney governing property or other matters.
| ||
(b) The Illinois Statutory Short Form Power of Attorney for | ||
Health Care shall be substantially as follows: | ||
"NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS | ||
STATUTORY SHORT FORM POWER OF ATTORNEY FOR HEALTH CARE | ||
PLEASE READ THIS NOTICE CAREFULLY. The form that you will | ||
be signing is a legal document. It is governed by the Illinois | ||
Power of Attorney Act. If there is anything about this form | ||
that you do not understand, you should ask a lawyer to explain | ||
it to you. | ||
The purpose of this Power of Attorney is to give your | ||
designated "agent" broad powers to make health care decisions | ||
for you, including the power to require, consent to, or | ||
withdraw treatment for any physical or mental condition, and to | ||
admit you or discharge you from any hospital, home, or other |
institution. You may name successor agents under this form, but | ||
you may not name co-agents. | ||
This form does not impose a duty upon your agent to make | ||
such health care decisions, so it is important that you select | ||
an agent who will agree to do this for you and who will make | ||
those decisions as you would wish. It is also important to | ||
select an agent whom you trust, since you are giving that agent | ||
control over your medical decision-making, including | ||
end-of-life decisions. Any agent who does act for you has a | ||
duty to act in good faith for your benefit and to use due care, | ||
competence, and diligence. He or she must also act in | ||
accordance with the law and with the statements in this form. | ||
Your agent must keep a record of all significant actions taken | ||
as your agent. | ||
Unless you specifically limit the period of time that this | ||
Power of Attorney will be in effect, your agent may exercise | ||
the powers given to him or her throughout your lifetime, even | ||
after you become disabled. A court, however, can take away the | ||
powers of your agent if it finds that the agent is not acting | ||
properly. You may also revoke this Power of Attorney if you | ||
wish. | ||
The Powers you give your agent, your right to revoke those | ||
powers, and the penalties for violating the law are explained | ||
more fully in Sections 4-5, 4-6, and 4-10(b) of the Illinois | ||
Power of Attorney Act. This form is a part of that law. The | ||
"NOTE" paragraphs throughout this form are instructions. |
You are not required to sign this Power of Attorney, but it | ||
will not take effect without your signature. You should not | ||
sign it if you do not understand everything in it, and what | ||
your agent will be able to do if you do sign it. | ||
Please put your initials on the following line indicating | ||
that you have read this Notice: | ||
...................... | ||
(Principal's initials)" | ||
"ILLINOIS STATUTORY SHORT FORM | ||
POWER OF ATTORNEY FOR HEALTH CARE
| ||
(NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE | ||
THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO MAKE | ||
HEALTH CARE DECISIONS FOR YOU,
INCLUDING POWER TO REQUIRE, | ||
CONSENT TO OR WITHDRAW ANY TYPE OF PERSONAL
CARE OR MEDICAL | ||
TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND TO ADMIT
YOU | ||
TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME OR OTHER | ||
INSTITUTION. THIS
FORM DOES NOT IMPOSE A DUTY ON YOUR AGENT TO | ||
EXERCISE GRANTED POWERS; BUT
WHEN POWERS ARE EXERCISED, YOUR | ||
AGENT WILL HAVE TO USE
DUE CARE TO ACT FOR
YOUR BENEFIT AND IN | ||
ACCORDANCE WITH THIS FORM AND KEEP A RECORD OF
RECEIPTS, | ||
DISBURSEMENTS AND SIGNIFICANT ACTIONS TAKEN AS AGENT. A COURT
| ||
CAN TAKE AWAY THE
POWERS OF YOUR AGENT IF IT FINDS THE AGENT IS | ||
NOT ACTING PROPERLY. YOU MAY
NAME SUCCESSOR AGENTS UNDER THIS |
FORM
BUT NOT CO-AGENTS, AND NO HEALTH CARE PROVIDER MAY BE | ||
NAMED. UNLESS
YOU EXPRESSLY LIMIT THE DURATION OF THIS POWER
IN | ||
THE MANNER PROVIDED BELOW, UNTIL YOU REVOKE THIS POWER OR A | ||
COURT ACTING
ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY | ||
EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN | ||
AFTER YOU BECOME DISABLED. THE POWERS YOU
GIVE YOUR AGENT, YOUR | ||
RIGHT TO REVOKE THOSE POWERS AND THE PENALTIES FOR
VIOLATING | ||
THE LAW ARE EXPLAINED MORE FULLY IN SECTIONS 4-5, 4-6, 4-9 AND
| ||
4-10(b) OF THE ILLINOIS
"POWERS OF ATTORNEY FOR HEALTH CARE | ||
LAW"
OF WHICH THIS FORM IS A PART (SEE THE BACK OF THIS FORM). | ||
THAT LAW
EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM OF | ||
POWER OF ATTORNEY YOU
MAY DESIRE. IF THERE IS ANYTHING ABOUT | ||
THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER | ||
TO EXPLAIN IT TO YOU.)
| ||
POWER OF ATTORNEY made this .......................day of
| ||
................................
| ||
(month) (year)
| ||
1. I, ..................................................,
| ||
(insert name and address of principal)
hereby revoke all prior | ||
powers of attorney for health care executed by me and appoint:
| ||
............................................................
| ||
(insert name and address of agent)
| ||
(NOTE: You may not name co-agents using this form.) | ||
as my attorney-in-fact (my "agent") to act for me and in my | ||
name (in any
way I could act in person) to make any and all | ||
decisions for me concerning
my personal care, medical |
treatment, hospitalization and health care and to
require, | ||
withhold or withdraw any type of medical treatment or | ||
procedure,
even though my death may ensue. | ||
A. My agent shall have the same access to my
medical | ||
records that I have, including the right to disclose the | ||
contents
to others. My agent shall also have full power to
| ||
authorize an autopsy and direct the disposition of my remains. | ||
B.
Effective upon my death, my agent has the full power to | ||
make an anatomical
gift of the following (initial one) : | ||
(NOTE: Initial one. In the event none of the options are | ||
initialed, then it shall be concluded that you do not wish to | ||
grant your agent any such authority.)
| ||
.... Any organs, tissues, or eyes suitable for | ||
transplantation or used for
research or education.
| ||
.... Specific organs: ................................
| ||
.... I do not grant my agent authority to make any | ||
anatomical gifts. | ||
C. My agent shall also have full power to authorize an | ||
autopsy and direct the disposition of my remains. I intend for | ||
this power of attorney to be in substantial compliance with | ||
Section 10 of the Disposition of Remains Act. All decisions | ||
made by my agent with respect to the disposition of my remains, | ||
including cremation, shall be binding. I hereby direct any | ||
cemetery organization, business operating a crematory or | ||
columbarium or both, funeral director or embalmer, or funeral | ||
establishment who receives a copy of this document to act under |
it. | ||
D. I intend for the person named as my agent to be treated | ||
as I would be with respect to my rights regarding the use and | ||
disclosure of my individually identifiable health information | ||
or other medical records, including records or communications | ||
governed by the Mental Health and Developmental Disabilities | ||
Confidentiality Act. This release authority applies to any | ||
information governed by the Health Insurance Portability and | ||
Accountability Act of 1996 ("HIPAA") and regulations | ||
thereunder. I intend for the person named as my agent to serve | ||
as my "personal representative" as that term is defined under | ||
HIPAA and regulations thereunder. | ||
(i) The person named as my agent shall have the power to | ||
authorize the release of information governed by HIPAA to third | ||
parties. | ||
(ii) I authorize any physician, health care professional, | ||
dentist, health plan, hospital, clinic, laboratory, pharmacy | ||
or other covered health care provider, any insurance company | ||
and the Medical Informational Bureau, Inc., or any other health | ||
care clearinghouse that has provided treatment or services to | ||
me, or that has paid for or is seeking payment for me for such | ||
services to give, disclose, and release to the person named as | ||
my agent, without restriction, all of my individually | ||
identifiable health information and medical records, regarding | ||
any past, present, or future medical or mental health | ||
condition, including all information relating to the diagnosis |
and treatment of HIV/AIDS, sexually transmitted diseases, drug | ||
or alcohol abuse, and mental illness (including records or | ||
communications governed by the Mental Health and Developmental | ||
Disabilities Confidentiality Act). | ||
(iii) The authority given to the person named as my agent | ||
shall supersede any prior agreement that I may have with my | ||
health care providers to restrict access to, or disclosure of, | ||
my individually identifiable health information. The authority | ||
given to the person named as my agent has no expiration date | ||
and shall expire only in the event that I revoke the authority | ||
in writing and deliver it to my health care provider. The | ||
authority given to the person named as my agent to serve as my | ||
"personal representative" as defined under HIPAA and | ||
regulations thereunder and to access my individually | ||
identifiable health information or authorize the release of the | ||
same to third parties shall take effect immediately, even if I | ||
designate in Paragraph 3 of this document that this agency | ||
shall otherwise take effect at some future date. | ||
(NOTE: The above grant of power is intended to be as broad as | ||
possible so that your agent will have the authority to make any | ||
decision you could make to obtain or terminate any type of | ||
health care, including withdrawal of food and water and other | ||
life-sustaining measures, if your agent believes such action | ||
would be consistent with your intent and desires. If you wish | ||
to limit the scope of your agent's powers or prescribe special | ||
rules or limit the power to make an anatomical gift, authorize |
autopsy or dispose of remains, you may do so in the following | ||
paragraphs.) (THE ABOVE GRANT OF POWER IS INTENDED TO BE AS | ||
BROAD AS POSSIBLE SO THAT
YOUR AGENT WILL HAVE AUTHORITY TO | ||
MAKE ANY DECISION YOU COULD MAKE TO
OBTAIN OR TERMINATE ANY | ||
TYPE OF HEALTH CARE, INCLUDING WITHDRAWAL OF FOOD
AND WATER AND | ||
OTHER LIFE-SUSTAINING MEASURES, IF YOUR AGENT BELIEVES SUCH
| ||
ACTION WOULD BE CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU | ||
WISH TO
LIMIT THE SCOPE OF YOUR AGENT'S POWERS OR PRESCRIBE | ||
SPECIAL RULES OR LIMIT
THE POWER TO MAKE AN ANATOMICAL GIFT, | ||
AUTHORIZE AUTOPSY OR DISPOSE OF
REMAINS, YOU MAY DO SO IN THE | ||
FOLLOWING PARAGRAPHS.)
| ||
2. The powers granted above shall not include the following | ||
powers or
shall be subject to the following rules or | ||
limitations : | ||
(NOTE: Here (here you may include
any specific limitations you | ||
deem appropriate, such as: your own
definition of when | ||
life-sustaining measures should be withheld; a direction
to | ||
continue food and fluids or life-sustaining treatment in
all | ||
events; or instructions to refuse
any specific types of | ||
treatment that are inconsistent with your religious
beliefs or | ||
unacceptable to you for any other reason, such as blood
| ||
transfusion, electro-convulsive therapy, amputation, | ||
psychosurgery,
voluntary admission to a mental institution, | ||
etc.) :
| ||
.............................................................
| ||
.............................................................
|
.............................................................
| ||
.............................................................
| ||
.............................................................
| ||
(NOTE: The subject of life-sustaining treatment is of | ||
particular importance. For your convenience in dealing with | ||
that subject, some general statements concerning the | ||
withholding or removal of life-sustaining treatment are set | ||
forth below. If you agree with one of these statements, you may | ||
initial that statement; but do not initial more than one. These | ||
statements serve as guidance for your agent, who shall give | ||
careful consideration to the statement you initial when | ||
engaging in health care decision-making on your behalf.) (THE | ||
SUBJECT OF LIFE-SUSTAINING TREATMENT IS OF PARTICULAR | ||
IMPORTANCE. FOR
YOUR CONVENIENCE IN DEALING WITH THAT SUBJECT, | ||
SOME GENERAL STATEMENTS
CONCERNING THE WITHHOLDING OR REMOVAL | ||
OF LIFE-SUSTAINING TREATMENT ARE SET
FORTH BELOW. IF YOU AGREE | ||
WITH ONE OF THESE STATEMENTS, YOU MAY
INITIAL THAT STATEMENT; | ||
BUT DO NOT INITIAL MORE THAN ONE):
| ||
I do not want my life to be prolonged nor do I want | ||
life-sustaining
treatment to be provided or continued if my | ||
agent believes the burdens of
the treatment outweigh the | ||
expected benefits. I want my agent to consider
the relief of | ||
suffering, the expense involved and the quality as well as
the | ||
possible extension of my life in making decisions concerning
| ||
life-sustaining treatment.
| ||
Initialed ...........................
|
I want my life to be prolonged and I want life-sustaining | ||
treatment to be
provided or continued , unless I am in a coma | ||
which my attending physician
believes to be irreversible , in | ||
the opinion of my attending physician, in accordance with | ||
reasonable medical
standards at the time of reference , in a | ||
state of "permanent unconsciousness" or suffer from an | ||
"incurable or irreversible condition" or "terminal condition", | ||
as those terms are defined in Section 4-4 of the Illinois Power | ||
of Attorney Act . If and when I am in any one of these states or | ||
conditions, I have suffered
irreversible coma, I want | ||
life-sustaining treatment to be withheld or
discontinued.
| ||
Initialed ...........................
| ||
I want my life to be prolonged to the greatest extent | ||
possible in accordance with reasonable medical standards | ||
without
regard to my condition, the chances I have for recovery | ||
or the cost of the
procedures.
| ||
Initialed ...........................
| ||
(NOTE: This power of attorney may be amended or revoked by you | ||
in the manner provided in Section 4-6 of the Illinois Power of | ||
Attorney Act. Your agent can act immediately, unless you | ||
specify otherwise; but you cannot specify otherwise with | ||
respect to your "personal representative" under subparagraph | ||
D(iii).) (THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY | ||
YOU IN THE MANNER
PROVIDED IN SECTION 4-6 OF THE ILLINOIS | ||
"POWERS OF ATTORNEY FOR HEALTH CARE
LAW" (SEE THE BACK OF THIS | ||
FORM). ABSENT AMENDMENT OR
REVOCATION, THE AUTHORITY GRANTED IN |
THIS
POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE TIME THIS | ||
POWER IS SIGNED
AND WILL CONTINUE UNTIL YOUR DEATH, AND BEYOND | ||
IF ANATOMICAL GIFT, AUTOPSY
OR DISPOSITION OF REMAINS IS | ||
AUTHORIZED, UNLESS A LIMITATION ON THE
BEGINNING DATE OR | ||
DURATION IS MADE BY INITIALING AND COMPLETING EITHER OR
BOTH OF | ||
THE FOLLOWING:)
| ||
3. ( ) This power of attorney shall become effective on
| ||
.............................................................
| ||
.............................................................
| ||
( NOTE: Insert insert a future date or event during your | ||
lifetime, such as a court
determination of your disability or a | ||
written determination by your physician that you are | ||
incapacitated , when you want this power to first take
effect . )
| ||
(NOTE: If you do not amend or revoke this power, or if you do | ||
not specify a specific ending date in paragraph 4, it will | ||
remain in effect until your death; except that your agent will | ||
still have the authority to donate your organs, authorize an | ||
autopsy, and dispose of your remains after your death, if you | ||
grant that authority to your agent.) | ||
4. ( ) This power of attorney shall terminate on
.......
| ||
.............................................................
| ||
( NOTE: Insert insert a future date or event, such as a court | ||
determination that you are not under a legal disability or a | ||
written determination by your physician that you are not | ||
incapacitated, if of your
disability, when you want this power | ||
to terminate prior to your death . )
|
(NOTE: You cannot use this form to name co-agents. If you wish | ||
to name successor agents, insert the names and addresses of the | ||
successors in paragraph 5.) (IF YOU WISH TO NAME SUCCESSOR | ||
AGENTS, INSERT THE NAMES AND ADDRESSES OF
SUCH SUCCESSORS IN | ||
THE FOLLOWING PARAGRAPH.)
| ||
5. If any agent named by me shall die, become incompetent, | ||
resign,
refuse to accept the office of agent or be unavailable, | ||
I name
the following (each to act alone
and successively, in | ||
the order named) as successors to such agent:
| ||
.............................................................
| ||
.............................................................
| ||
For purposes of this paragraph 5, a person shall be considered | ||
to be
incompetent if and while the person is a minor , or an | ||
adjudicated
incompetent or disabled person , or the person is | ||
unable to give prompt and
intelligent consideration to health | ||
care matters, as certified by a licensed physician.
| ||
(NOTE: If you wish to, you may name your agent as guardian of | ||
your person if a court decides that one should be appointed. To | ||
do this, retain paragraph 6, and the court will appoint your | ||
agent if the court finds that this appointment will serve your | ||
best interests and welfare. Strike out paragraph 6 if you do | ||
not want your agent to act as guardian.) (IF YOU WISH TO NAME | ||
YOUR AGENT AS GUARDIAN OF YOUR PERSON,
IN THE EVENT A COURT | ||
DECIDES
THAT ONE SHOULD BE APPOINTED, YOU MAY, BUT ARE NOT | ||
REQUIRED TO, DO SO BY
RETAINING THE FOLLOWING
PARAGRAPH. THE | ||
COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH
|
APPOINTMENT WILL SERVE YOUR BEST INTERESTS AND WELFARE. STRIKE | ||
OUT
PARAGRAPH 6 IF YOU DO NOT WANT YOUR AGENT TO ACT AS | ||
GUARDIAN.)
| ||
6. If a guardian of my person is to be appointed, I | ||
nominate the agent
acting under this power of attorney as such
| ||
guardian, to serve without bond or security.
| ||
7. I am fully informed as to all the contents of this form | ||
and
understand the full import of this grant of powers to my | ||
agent.
| ||
Dated: .......... | ||
Signed ..............................
| ||
( principal's signature or mark principal )
| ||
The principal has had an opportunity to review read the | ||
above form and has
signed the form or acknowledged his or her | ||
signature or mark on the form in my presence. The undersigned | ||
witness certifies that the witness is not: (a) the attending | ||
physician or mental health service provider or a relative of | ||
the physician or provider; (b) an owner, operator, or relative | ||
of an owner or operator of a health care facility in which the | ||
principal is a patient or resident; (c) a parent, sibling, | ||
descendant, or any spouse of such parent, sibling, or | ||
descendant of either the principal or any agent or successor | ||
agent under the foregoing power of attorney, whether such | ||
relationship is by blood, marriage, or adoption; or (d) an | ||
agent or successor agent under the foregoing power of attorney.
|
....................... | ||
(Witness Signature) | ||
....................... | ||
(Print Witness Name) | ||
....................... | ||
(Street Address) | ||
....................... | ||
(City, State, ZIP) | ||
.......................... Residing at......................
| ||
(witness)
| ||
(NOTE: You may, but are not required to, request your agent and | ||
successor agents to provide specimen signatures below. If you | ||
include specimen signatures in this power of attorney, you must | ||
complete the certification opposite the signatures of the | ||
agents.) (YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT | ||
AND SUCCESSOR AGENTS
TO PROVIDE SPECIMEN SIGNATURES BELOW. IF | ||
YOU INCLUDE SPECIMEN SIGNATURES
IN THIS POWER OF ATTORNEY, YOU | ||
MUST COMPLETE THE CERTIFICATION OPPOSITE THE
SIGNATURES OF THE | ||
AGENTS.)
| ||
Specimen signatures of I certify that the signatures of my
| ||
agent (and successors). agent (and successors) are correct.
| ||
....................... ...................................
| ||
(agent) (principal)
| ||
....................... ...................................
| ||
(successor agent) (principal)
| ||
....................... ...................................
|
(successor agent) (principal)"
| ||
(NOTE: The name, address, and phone number of the person | ||
preparing this form or who assisted the principal in completing | ||
this form is optional.) | ||
......................... | ||
(name of preparer) | ||
......................... | ||
......................... | ||
(address) | ||
......................... | ||
(phone) | ||
(c) (b) The statutory short form power of attorney for | ||
health care (the
"statutory health care power") authorizes the | ||
agent to make any and all
health care decisions on behalf of | ||
the principal which the principal could
make if present and | ||
under no disability, subject to any limitations on the
granted | ||
powers that appear on the face of the form, to be exercised in | ||
such
manner as the agent deems consistent with the intent and | ||
desires of the
principal. The agent will be under no duty to | ||
exercise granted powers or
to assume control of or | ||
responsibility for the principal's health care;
but when | ||
granted powers are exercised, the agent will be required to use
| ||
due care to act for the benefit of the principal in accordance | ||
with the
terms of the statutory health care power and will be | ||
liable
for negligent exercise. The agent may act in person or |
through others
reasonably employed by the agent for that | ||
purpose
but may not delegate authority to make health care | ||
decisions. The agent
may sign and deliver all instruments, | ||
negotiate and enter into all
agreements and do all other acts | ||
reasonably necessary to implement the
exercise of the powers | ||
granted to the agent. Without limiting the
generality of the | ||
foregoing, the statutory health care power shall include
the | ||
following powers, subject to any limitations appearing on the | ||
face of the form:
| ||
(1) The agent is authorized to give consent to and | ||
authorize or refuse,
or to withhold or withdraw consent to, | ||
any and all types of medical care,
treatment or procedures | ||
relating to the physical or mental health of the
principal, | ||
including any medication program, surgical procedures,
| ||
life-sustaining treatment or provision of food and fluids | ||
for the principal.
| ||
(2) The agent is authorized to admit the principal to | ||
or discharge the
principal from any and all types of | ||
hospitals, institutions, homes,
residential or nursing | ||
facilities, treatment centers and other health care
| ||
institutions providing personal care or treatment for any | ||
type of physical
or mental condition. The agent shall have | ||
the same right to visit the
principal in the hospital or | ||
other institution as is granted to a spouse or
adult child | ||
of the principal, any rule of the institution to the | ||
contrary
notwithstanding.
|
(3) The agent is authorized to contract for any and all | ||
types of health
care services and facilities in the name of | ||
and on behalf of the principal
and to bind the principal to | ||
pay for all such services and facilities,
and to have and | ||
exercise those powers over the principal's property as are
| ||
authorized under the statutory property power, to the | ||
extent the agent
deems necessary to pay health care costs; | ||
and
the agent shall not be personally liable for any | ||
services or care contracted
for on behalf of the principal.
| ||
(4) At the principal's expense and subject to | ||
reasonable rules of the
health care provider to prevent | ||
disruption of the principal's health care,
the agent shall | ||
have the same right the principal has to examine and copy
| ||
and consent to disclosure of all the principal's medical | ||
records that the agent deems
relevant to the exercise of | ||
the agent's powers, whether the records
relate to mental | ||
health or any other medical condition and whether they are | ||
in
the possession of or maintained by any physician, | ||
psychiatrist,
psychologist, therapist, hospital, nursing | ||
home or other health care
provider.
| ||
(5) The agent is authorized: to direct that an autopsy | ||
be made pursuant
to Section 2 of "An Act in relation to | ||
autopsy of dead bodies", approved
August 13, 1965, | ||
including all amendments;
to make a disposition of any
part | ||
or all of the principal's body pursuant to the Illinois | ||
Anatomical Gift
Act, as now or hereafter amended; and to |
direct the disposition of the
principal's remains.
| ||
(Source: P.A. 93-794, eff. 7-22-04.)
| ||
(755 ILCS 45/4-12) (from Ch. 110 1/2, par. 804-12)
| ||
Sec. 4-12. Saving clause. This Act does not in any way
| ||
invalidate any health care agency executed or any act of any
| ||
agent done, or affect any claim, right or
remedy that accrued, | ||
prior to September 22, 1987.
| ||
This amendatory Act of the 96th General Assembly does not | ||
in any way invalidate any health care agency executed or any | ||
act of any agent done, or affect any claim, right, or remedy | ||
that accrued, prior to the effective date of this amendatory | ||
Act of the 96th General Assembly. | ||
(Source: P.A. 86-736.)
| ||
(755 ILCS 45/2-7.5 rep.) | ||
Section 10. The Illinois Power of Attorney Act is amended | ||
by repealing Section 2-7.5. | ||
Section 99. Effective date. This Act takes effect July 1, | ||
2011. |