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1 | AN ACT concerning civil law.
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2 | Be it enacted by the People of the State of Illinois, | ||||||
3 | represented in the General Assembly:
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4 | Section 5. The Illinois Power of Attorney Act is amended by | ||||||
5 | changing Sections 2-1, 2-3, 2-5, 2-7, 2-8, 2-10, 2-11, 3-3, | ||||||
6 | 3-4, 4-4, 4-10, and 4-12 and by adding Sections 2-10.3, 2-10.5, | ||||||
7 | 2-10.6, 3-3.6, 3-5, and 4-5.1 as follows:
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8 | (755 ILCS 45/2-1) (from Ch. 110 1/2, par. 802-1)
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9 | Sec. 2-1. Purpose. The General Assembly recognizes that | ||||||
10 | each
individual has the right to appoint an agent to make deal | ||||||
11 | with property , financial, or make
personal , and health care | ||||||
12 | decisions for the individual but that this right
cannot be | ||||||
13 | fully effective unless the principal may empower the agent to | ||||||
14 | act
throughout the principal's lifetime, including during | ||||||
15 | periods of
disability, and have confidence be sure that third | ||||||
16 | parties will honor the agent's authority
at all times.
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17 | The General Assembly finds that in the light of modern | ||||||
18 | financial needs
and advances in medical science, the statutory | ||||||
19 | recognition of this right of
delegation in Illinois needs to be | ||||||
20 | restated , which will to , among other things, expand the
its | ||||||
21 | application and the permissible scope of the agent's authority, | ||||||
22 | clarify
the power of the individual to authorize an agent to | ||||||
23 | make financial and
care decisions for the individual and better |
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1 | protect health care personnel
and other third parties who rely | ||||||
2 | in good faith on the agent so that
reliance will be assured. | ||||||
3 | Nothing in this Act shall be deemed to
authorize or encourage | ||||||
4 | euthanasia, suicide or any action or course of
action that | ||||||
5 | violates the criminal law of this State or the United States.
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6 | Similarly, nothing in this Act shall be deemed to authorize or | ||||||
7 | encourage
any violation of a civil right expressed in the | ||||||
8 | Constitution, statutes,
case law and administrative rulings of | ||||||
9 | this State (including, without
limitation, the right of | ||||||
10 | conscience respected and protected by the Health
Care Right of | ||||||
11 | Conscience Act, as now or hereafter amended) or the
United | ||||||
12 | States or any action or course of action that violates the | ||||||
13 | public policy
expressed in the Constitution, statutes, case law | ||||||
14 | and administrative rulings of
this State or the United States.
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15 | (Source: P.A. 90-655, eff. 7-30-98.)
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16 | (755 ILCS 45/2-3) (from Ch. 110 1/2, par. 802-3)
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17 | Sec. 2-3. Definitions. As used in this Act:
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18 | (a) "Agency" means the written power of attorney or other | ||||||
19 | instrument of
agency governing the relationship between the | ||||||
20 | principal and agent or the
relationship, itself, as appropriate | ||||||
21 | to the context, and includes agencies
dealing with personal or | ||||||
22 | health care as well as property. An agency is
subject to this | ||||||
23 | Act to the extent it may be controlled by the principal,
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24 | excluding agencies and powers for the benefit of the agent.
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25 | (b) "Agent" means the attorney-in-fact or other person |
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1 | designated to act
for the principal in the agency.
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2 | (c) "Disabled person" has the same meaning as in the | ||||||
3 | "Probate Act of
1975", as now or hereafter amended. To be under | ||||||
4 | a "disability" or
"disabled" means to be a disabled person.
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5 | (c-5) "Incapacitated", when used to describe a principal, | ||||||
6 | means that the principal is under a legal disability as defined | ||||||
7 | in Section 11a-2 of the Probate Act of 1975. A principal shall | ||||||
8 | also be considered incapacitated if: (i) a physician licensed | ||||||
9 | to practice medicine in all of its branches has examined the | ||||||
10 | principal and has determined that the principal lacks decision | ||||||
11 | making capacity; (ii) that physician has made a written record | ||||||
12 | of this determination and has signed the written record within | ||||||
13 | 90 days after the examination; and (iii) the written record has | ||||||
14 | been delivered to the agent. The agent may rely conclusively on | ||||||
15 | the written record. | ||||||
16 | (d) "Person" means an individual, corporation, trust, | ||||||
17 | partnership or
other entity, as appropriate to the agency.
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18 | (e) "Principal" means an individual (including, without | ||||||
19 | limitation, an
individual acting as trustee, representative or | ||||||
20 | other fiduciary) who signs
a power of attorney or other | ||||||
21 | instrument of agency granting powers to an agent.
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22 | (Source: P.A. 85-701.)
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23 | (755 ILCS 45/2-5) (from Ch. 110 1/2, par. 802-5)
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24 | Sec. 2-5. Duration of agency - amendment and revocation. | ||||||
25 | Unless the
agency states an earlier termination date, the |
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1 | agency continues until the
death of the principal, | ||||||
2 | notwithstanding any lapse of time, the principal's
disability | ||||||
3 | or incapacity or appointment of a guardian for the principal
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4 | after the agency is signed. Every agency may be amended or | ||||||
5 | revoked by the
principal , if the principal has the capacity to | ||||||
6 | do so, at any time and in any manner communicated to the agent | ||||||
7 | or to any
other person related to the subject matter of the | ||||||
8 | agency, except that
revocation and amendment of health care | ||||||
9 | agencies are governed by Section 4-6
of this Act except to the | ||||||
10 | extent the terms of the agencies are inconsistent
with that | ||||||
11 | Section. The execution of a power of attorney does not revoke a | ||||||
12 | power of attorney previously executed by the principal unless | ||||||
13 | the subsequent power of attorney provides that the previous | ||||||
14 | power of attorney is revoked or that all other powers of | ||||||
15 | attorney are revoked.
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16 | (Source: P.A. 86-736.)
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17 | (755 ILCS 45/2-7) (from Ch. 110 1/2, par. 802-7)
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18 | Sec. 2-7. Duty - standard of care - record-keeping - | ||||||
19 | exoneration. | ||||||
20 | (a) The agent shall be under
no duty to exercise the powers | ||||||
21 | granted by the agency or to assume control
of or responsibility | ||||||
22 | for any of the principal's property, care or affairs,
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23 | regardless of the principal's physical or mental condition. | ||||||
24 | Whenever a
power is exercised, the agent shall use due care to | ||||||
25 | act in good faith for the benefit of
the principal using due |
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1 | care, competence, and diligence in accordance with the terms of | ||||||
2 | the agency and shall be
liable for negligent exercise. An agent | ||||||
3 | who acts with due care for the
benefit of the principal shall | ||||||
4 | not be liable or limited merely because the
agent also benefits | ||||||
5 | from the act, has individual or conflicting interests
in | ||||||
6 | relation to the property, care or affairs of the principal or | ||||||
7 | acts in a
different manner with respect to the agency and the | ||||||
8 | agent's individual
interests. The agent shall keep a record of | ||||||
9 | all receipts, disbursements,
and significant actions taken | ||||||
10 | under the agency.
The agent shall not be
affected by any | ||||||
11 | amendment or termination
of the agency until the agent has | ||||||
12 | actual knowledge thereof. The agent
shall not be liable for any | ||||||
13 | loss due to error of judgment nor for the act
or default of any | ||||||
14 | other person.
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15 | (b) An agent that has accepted appointment must act in | ||||||
16 | accordance with the principal's expectations to the extent | ||||||
17 | actually known to the agent and otherwise in the principal's | ||||||
18 | best interests. | ||||||
19 | (c) An agent shall keep a record of all receipts, | ||||||
20 | disbursements, and significant actions taken under the | ||||||
21 | authority of the agency and shall provide a copy of this record | ||||||
22 | when requested to do so by: | ||||||
23 | (1) the principal, a guardian, another fiduciary | ||||||
24 | acting on behalf of the principal, and, after the death of | ||||||
25 | the principal, the personal representative or successors | ||||||
26 | in interest of the principal's estate; |
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1 | (2) a representative of a provider agency, as defined | ||||||
2 | in Section 2 of the Elder Abuse and Neglect Act, acting in | ||||||
3 | the course of an assessment of a complaint of elder abuse | ||||||
4 | or neglect under that Act; | ||||||
5 | (3) a representative of the Office of the State Long | ||||||
6 | Term Care Ombudsman, acting in the course of an | ||||||
7 | investigation of a complaint of financial exploitation of a | ||||||
8 | nursing home resident under Section 4.04 of the Illinois | ||||||
9 | Act on the Aging; | ||||||
10 | (4) a representative of the Office of Inspector General | ||||||
11 | for the Department of Human Services, acting in the course | ||||||
12 | of an assessment of a complaint of financial exploitation | ||||||
13 | of an adult with disabilities pursuant to Section 35 of the | ||||||
14 | Abuse of Adults with Disabilities Intervention Act; or | ||||||
15 | (5) a court under Section 2-10 of this Act. | ||||||
16 | (d) If the agent fails to provide his or her record of all | ||||||
17 | receipts, disbursements, and significant actions within 21 | ||||||
18 | days after a request under subsection (c), the elder abuse | ||||||
19 | provider agency or the State Long Term Care Ombudsman may | ||||||
20 | petition the court for an order requiring the agent to produce | ||||||
21 | his or her record of receipts, disbursements, and significant | ||||||
22 | actions. If the court finds that the agent's failure to provide | ||||||
23 | his or her record in a timely manner to the elder abuse | ||||||
24 | provider agency or the State Long Term Care Ombudsman was | ||||||
25 | without good cause, the court may assess reasonable costs and | ||||||
26 | attorney's fees against the agent, and order such other relief |
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1 | as is appropriate. | ||||||
2 | (e) An agent is not required to disclose receipts, | ||||||
3 | disbursements, or other significant actions conducted on | ||||||
4 | behalf of the principal except as otherwise provided in the | ||||||
5 | power of attorney or as required under subsection (c). | ||||||
6 | (f) An agent that violates this Act is liable to the | ||||||
7 | principal or the principal's successors in interest for the | ||||||
8 | amount required (i) to restore the value of the principal's | ||||||
9 | property to what it would have been had the violation not | ||||||
10 | occurred, and (ii) to reimburse the principal or the | ||||||
11 | principal's successors in interest for the attorney's fees and | ||||||
12 | costs paid on the agent's behalf. This subsection does not | ||||||
13 | limit any other applicable legal or equitable remedies. | ||||||
14 | (Source: P.A. 86-736.)
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15 | (755 ILCS 45/2-8) (from Ch. 110 1/2, par. 802-8)
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16 | Sec. 2-8. Reliance on
document purporting to establish an
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17 | agency. | ||||||
18 | (a) Any person who acts in good faith
reliance on a copy of
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19 | a document purporting to establish an agency will be fully | ||||||
20 | protected and
released to
the same extent as though the reliant | ||||||
21 | had dealt directly with the
named
principal
as a | ||||||
22 | fully-competent person. The
named
agent shall furnish an | ||||||
23 | affidavit or Agent's Certification and Acceptance of Authority | ||||||
24 | to the
reliant on demand stating that the instrument relied on | ||||||
25 | is a true copy of
the agency and that, to the best of the
named
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1 | agent's knowledge, the named principal is
alive and the | ||||||
2 | relevant powers of the
named
agent have not been altered or
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3 | terminated; but good faith reliance on
a document purporting to | ||||||
4 | establish an agency will protect the reliant
without the | ||||||
5 | affidavit or Agent's Certification and Acceptance of | ||||||
6 | Authority . | ||||||
7 | (b) Upon request, the named agent in a power of attorney | ||||||
8 | shall furnish an Agent's Certification and Acceptance of | ||||||
9 | Authority to the reliant in substantially the following form: | ||||||
10 | AGENT'S CERTIFICATION AND ACCEPTANCE OF AUTHORITY | ||||||
11 | I, .......... (insert name of agent), certify that the | ||||||
12 | attached is a true copy of a power of attorney naming the | ||||||
13 | undersigned as agent or successor agent for ............. | ||||||
14 | (insert name of principal). | ||||||
15 | I certify that to the best of my knowledge the principal | ||||||
16 | had the capacity to execute the power of attorney, is alive, | ||||||
17 | and has not revoked the power of attorney; that my powers as | ||||||
18 | agent have not been altered or terminated; and that the power | ||||||
19 | of attorney remains in full force and effect. | ||||||
20 | I accept appointment as agent under this power of attorney. | ||||||
21 | This certification and acceptance is made under penalty of | ||||||
22 | perjury.* | ||||||
23 | Dated: ............ | ||||||
24 | ....................... |
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1 | (Agent's Signature) | ||||||
2 | ....................... | ||||||
3 | (Print Agent's Name) | ||||||
4 | ....................... | ||||||
5 | (Agent's Address) | ||||||
6 | *(NOTE: Perjury is defined in Section 32-2 of the Criminal | ||||||
7 | Code of 1961, and is a Class 3 felony.) | ||||||
8 | (c) Any person dealing with an agent
named in a copy of a | ||||||
9 | document purporting to establish an agency
may presume, in
the | ||||||
10 | absence of actual knowledge to the contrary, that the
document | ||||||
11 | purporting to establish the
agency was
validly executed,
that | ||||||
12 | the agency was validly established,
that the named principal | ||||||
13 | was competent at the time
of execution, and that, at the time | ||||||
14 | of reliance, the
named
principal is alive,
the agency
was | ||||||
15 | validly established
and has not terminated or been amended, the | ||||||
16 | relevant powers of the
named
agent were properly and validly | ||||||
17 | granted and have not terminated or
been amended, and the acts | ||||||
18 | of the
named
agent conform to the standards of this Act.
No | ||||||
19 | person relying on
a copy of a document purporting to establish | ||||||
20 | an agency shall be required to see to the application
of any | ||||||
21 | property delivered to or controlled by the
named
agent or to | ||||||
22 | question the
authority of the
named
agent. | ||||||
23 | (d) Each person to whom a direction by the named agent in
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24 | accordance with the terms of the
copy of the document | ||||||
25 | purporting to establish an
agency is communicated shall comply |
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1 | with
that direction, and any person who fails to comply | ||||||
2 | arbitrarily or without
reasonable cause shall be subject to | ||||||
3 | civil liability for any damages
resulting from noncompliance.
A | ||||||
4 | health care provider who complies with Section 4-7 shall not be
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5 | deemed to have acted arbitrarily or without reasonable cause.
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6 | (Source: P.A. 90-21, eff. 6-20-97.)
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7 | (755 ILCS 45/2-10) (from Ch. 110 1/2, par. 802-10)
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8 | Sec. 2-10. Agency-court relationship. | ||||||
9 | (a) Upon petition by any interested
person (including the | ||||||
10 | agent), with such notice to interested persons as the
court | ||||||
11 | directs and a finding by the court that the principal
lacks | ||||||
12 | either the capacity to control or the capacity to revoke the | ||||||
13 | agency , the court may construe a power of attorney, review the | ||||||
14 | agent's conduct, and grant appropriate relief including | ||||||
15 | compensatory damages. : (a) if | ||||||
16 | (b) If the court finds
that the agent is not acting for the | ||||||
17 | benefit of the principal in accordance
with the terms of the | ||||||
18 | agency or that the agent's action or inaction has
caused or | ||||||
19 | threatens substantial harm to the principal's person or | ||||||
20 | property
in a manner not authorized or intended by the | ||||||
21 | principal, the court may
order a guardian of the principal's | ||||||
22 | person or estate to exercise any powers
of the principal under | ||||||
23 | the agency, including the power to revoke the
agency, or may | ||||||
24 | enter such other orders without appointment of a guardian as
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25 | the court deems necessary to provide for the best interests of |
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1 | the
principal . | ||||||
2 | (c) If ; or (b) if the court finds that the agency requires
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3 | interpretation, the court may construe the agency and instruct | ||||||
4 | the agent,
but the court may not amend the agency. | ||||||
5 | (d) If the court finds that the agent has not acted for the | ||||||
6 | benefit of the principal in accordance with the terms of the | ||||||
7 | agency and the Illinois Power of Attorney Act, or that the | ||||||
8 | agent's action caused or threatened substantial harm to the | ||||||
9 | principal's person or property in a manner not authorized or | ||||||
10 | intended by the principal, then the agent shall not be | ||||||
11 | authorized to pay or be reimbursed from the estate of the | ||||||
12 | principal the attorneys' fees and costs of the agent in | ||||||
13 | defending a proceeding brought pursuant to this Section. | ||||||
14 | (e) Upon a finding that the agent's action has caused | ||||||
15 | substantial harm to the principal's person or property, the | ||||||
16 | court may assess against the agent reasonable costs and | ||||||
17 | attorney's fees to a prevailing party who is a provider agency | ||||||
18 | as defined in Section 2 of the Elder Abuse and Neglect Act, a | ||||||
19 | representative of the Office of the State Long Term Care | ||||||
20 | Ombudsman, or a governmental agency having regulatory | ||||||
21 | authority to protect the welfare of the principal. | ||||||
22 | (f) As used in this Section, the term "interested person" | ||||||
23 | includes (1) the principal or the agent; (2) a guardian of the | ||||||
24 | person, guardian of the estate, or other fiduciary charged with | ||||||
25 | management of the principal's property; (3) the principal's | ||||||
26 | spouse, parent, or descendant; (4) a person who would be a |
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1 | presumptive heir-at-law of the principal; (5) a person named as | ||||||
2 | a beneficiary to receive any property, benefit, or contractual | ||||||
3 | right upon the principal's death, or as a beneficiary of a | ||||||
4 | trust created by or for the principal; (6) a provider agency as | ||||||
5 | defined in Section 2 of the Elder Abuse and Neglect Act, a | ||||||
6 | representative of the Office of the State Long Term Care | ||||||
7 | Ombudsman, or a governmental agency having regulatory | ||||||
8 | authority to protect the welfare of the principal; and (7) the | ||||||
9 | principal's caregiver or another person who demonstrates | ||||||
10 | sufficient interest in the principal's welfare. | ||||||
11 | (g) Absent court order directing a
guardian to exercise | ||||||
12 | powers of the principal under the agency, a guardian
will have | ||||||
13 | no power, duty or liability with respect to any property | ||||||
14 | subject
to the agency or any personal or health care matters | ||||||
15 | covered by the agency. | ||||||
16 | (h)
Proceedings under this Section shall be commenced in | ||||||
17 | the county where the
guardian was appointed or, if no Illinois | ||||||
18 | guardian is acting, then in the
county where the agent or | ||||||
19 | principal resides or where the principal owns real property or, | ||||||
20 | if the agent does not reside in
Illinois, then in any county .
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21 | (i) This Section shall not be construed to limit any other | ||||||
22 | remedies available. | ||||||
23 | (Source: P.A. 85-701.)
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24 | (755 ILCS 45/2-10.3 new) | ||||||
25 | Sec. 2-10.3. Successor agents. |
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1 | (a) A principal may designate one or more successor agents | ||||||
2 | to act if an initial or predecessor agent resigns, dies, | ||||||
3 | becomes incapacitated, is not qualified to serve, or declines | ||||||
4 | to serve. A principal may grant authority to another person, | ||||||
5 | designated by name, by office, or by function, including an | ||||||
6 | initial or successor agent, to designate one or more successor | ||||||
7 | agents. Unless a power of attorney otherwise provides, a | ||||||
8 | successor agent has the same authority as that granted to an | ||||||
9 | initial agent. | ||||||
10 | (b) An agent is not liable for the actions of another | ||||||
11 | agent, including a predecessor agent, unless the agent | ||||||
12 | participates in or conceals a breach of fiduciary duty | ||||||
13 | committed by the other agent. An agent who has knowledge of a | ||||||
14 | breach or imminent breach of fiduciary duty by another agent | ||||||
15 | must notify the principal and, if the principal is | ||||||
16 | incapacitated, take whatever actions may be reasonably | ||||||
17 | appropriate in the circumstances to safeguard the principal's | ||||||
18 | best interest. | ||||||
19 | (c) Any person who acts in good faith reliance on the | ||||||
20 | representation of a successor agent regarding the | ||||||
21 | unavailability of a predecessor agent will be fully protected | ||||||
22 | and released to the same extent as though the reliant had dealt | ||||||
23 | directly with the predecessor agent. Upon request, the | ||||||
24 | successor agent shall furnish an affidavit or Successor Agent's | ||||||
25 | Certification and Acceptance of Authority to the reliant, but | ||||||
26 | good faith reliance on a document purporting to establish an |
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1 | agency will protect the reliant without the affidavit or | ||||||
2 | Successor Agent's Certification and Acceptance of Authority. A | ||||||
3 | Successor Agent's Certification and Acceptance of Authority | ||||||
4 | shall be in substantially the following form: | ||||||
5 | SUCCESSOR AGENT'S | ||||||
6 | CERTIFICATION AND ACCEPTANCE OF AUTHORITY | ||||||
7 | I certify that the attached is a true copy of a power of | ||||||
8 | attorney naming the undersigned as agent or successor agent for | ||||||
9 | .......... (insert name of principal). | ||||||
10 | I certify that to the best of my knowledge the principal | ||||||
11 | had the capacity to execute the power of attorney, is alive, | ||||||
12 | and has not revoked the power of attorney; that my powers as | ||||||
13 | agent have not been altered or terminated; and that the power | ||||||
14 | of attorney remains in full force and effect. | ||||||
15 | I certify that to the best of my knowledge .......... | ||||||
16 | (insert name of unavailable agent) is unavailable due to | ||||||
17 | ................. (specify death, resignation, absence, | ||||||
18 | illness, or other temporary incapacity). | ||||||
19 | I accept appointment as agent under this power of attorney. | ||||||
20 | This certification and acceptance is made under penalty of | ||||||
21 | perjury.* | ||||||
22 | Dated: ............ | ||||||
23 | ....................... | ||||||
24 | (Agent's Signature) |
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| |||||||
1 | ....................... | ||||||
2 | (Print Agent's Name) | ||||||
3 | ....................... | ||||||
4 | (Agent's Address) | ||||||
5 | *(NOTE: Perjury is defined in Section 32-2 of the Criminal | ||||||
6 | Code of 1961, and is a Class 3 felony.) | ||||||
7 | (755 ILCS 45/2-10.5 new)
| ||||||
8 | Sec. 2-10.5. Co-agents. | ||||||
9 | (a) Co-agents may not be named by a principal in a | ||||||
10 | statutory short form power of attorney for property under | ||||||
11 | Article III or a statutory short form power of attorney for | ||||||
12 | health care under Article IV. In the event that co-agents are | ||||||
13 | named in any other form of power of attorney, then the | ||||||
14 | provisions of this Section shall govern the use and acceptance | ||||||
15 | of co-agency designations. | ||||||
16 | (b) Unless the power of attorney or this Section otherwise | ||||||
17 | provides, authority granted to 2 or more co-agents is | ||||||
18 | exercisable only by their majority consent. However, if prompt | ||||||
19 | action is required to accomplish the purposes of the power of | ||||||
20 | attorney or to avoid irreparable injury to the principal's | ||||||
21 | interests and an agent is unavailable because of absence, | ||||||
22 | illness, or other temporary incapacity, the other agent or | ||||||
23 | agents may act for the principal. If a vacancy occurs in one or | ||||||
24 | more of the designations of agent under a power of attorney, | ||||||
25 | the remaining agent or agents may act for the principal. |
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1 | (c) An agent is not liable for the actions of another | ||||||
2 | agent, including a co-agent or predecessor agent, unless the | ||||||
3 | agent participates in or conceals a breach of fiduciary duty | ||||||
4 | committed by the other agent. An agent who has knowledge of a | ||||||
5 | breach or imminent breach of fiduciary duty by another agent | ||||||
6 | must notify the principal and, if the principal is | ||||||
7 | incapacitated, take whatever actions may be reasonably | ||||||
8 | appropriate in the circumstances to safeguard the principal's | ||||||
9 | best interest. | ||||||
10 | (d) Any person who acts in good faith reliance on the | ||||||
11 | representation of a co-agent regarding the unavailability of a | ||||||
12 | predecessor agent or one or more co-agents, or the need for | ||||||
13 | prompt action to accomplish the purposes of the power of | ||||||
14 | attorney or to avoid irreparable injury to the principal's | ||||||
15 | interests, will be fully protected and released to the same | ||||||
16 | extent as though the reliant had dealt directly with all named | ||||||
17 | agents. Upon request, the co-agent shall furnish an affidavit | ||||||
18 | or Co-Agent's Certification and Acceptance of Authority to the | ||||||
19 | reliant, but good faith reliance on a document purporting to | ||||||
20 | establish an agency will protect the reliant without the | ||||||
21 | affidavit or Co-Agent's Certification and Acceptance of | ||||||
22 | Authority. A Co-Agent's Certification and Acceptance of | ||||||
23 | Authority shall be in substantially the following form: | ||||||
24 | CO-AGENT'S | ||||||
25 | CERTIFICATION AND ACCEPTANCE OF AUTHORITY |
| |||||||
| |||||||
1 | I certify that the attached is a true copy of a power of | ||||||
2 | attorney naming the undersigned as agent or co-agent for | ||||||
3 | .......... (insert name of principal). | ||||||
4 | I certify that to the best of my knowledge the principal | ||||||
5 | had the capacity to execute the power of attorney, is alive, | ||||||
6 | and has not revoked the power of attorney; that my powers as | ||||||
7 | agent have not been altered or terminated; and that the power | ||||||
8 | of attorney remains in full force and effect. | ||||||
9 | I certify that to the best of my knowledge .......... | ||||||
10 | (insert name of unavailable agent) is unavailable due to | ||||||
11 | ................. (specify death, resignation, absence, | ||||||
12 | illness, or other temporary incapacity). | ||||||
13 | I certify that prompt action is required to accomplish the | ||||||
14 | purposes of the power of attorney or to avoid irreparable | ||||||
15 | injury to the principal's interests. | ||||||
16 | I accept appointment as agent under this power of attorney. | ||||||
17 | This certification and acceptance is made under penalty of | ||||||
18 | perjury.* | ||||||
19 | Dated: ............ | ||||||
20 | ....................... | ||||||
21 | (Agent's Signature) | ||||||
22 | ....................... | ||||||
23 | (Print Agent's Name) | ||||||
24 | ....................... | ||||||
25 | (Agent's Address) |
| |||||||
| |||||||
1 | *(NOTE: Perjury is defined in Section 32-2 of the Criminal | ||||||
2 | Code of 1961, and is a Class 3 felony.) | ||||||
3 | (755 ILCS 45/2-10.6 new)
| ||||||
4 | Sec. 2-10.6. Power of attorney executed in another state or | ||||||
5 | country; pre-existing powers of attorney. | ||||||
6 | (a) A power of attorney executed in another state or | ||||||
7 | country is valid and enforceable in this State if its creation | ||||||
8 | complied when executed with: | ||||||
9 | (1) the law of the state or country in which the power | ||||||
10 | of attorney was executed; | ||||||
11 | (2) the law of this State; | ||||||
12 | (3) the law of the state or country where the principal | ||||||
13 | is domiciled, has a place of abode or business, or is a | ||||||
14 | national; or | ||||||
15 | (4) the law of the state or country where the agent is | ||||||
16 | domiciled or has a place of business. | ||||||
17 | (b) A power of attorney executed in this State before the | ||||||
18 | effective date of this amendatory Act of the 96th General | ||||||
19 | Assembly is valid and enforceable in this State if its creation | ||||||
20 | complied with the law of this State as it existed at the time | ||||||
21 | of execution.
| ||||||
22 | (755 ILCS 45/2-11) (from Ch. 110 1/2, par. 802-11)
| ||||||
23 | Sec. 2-11. Saving clause. This Act does not in any way
| ||||||
24 | invalidate any agency executed or any act of any agent done, or
|
| |||||||
| |||||||
1 | affect any claim, right or remedy that accrued, prior to
| ||||||
2 | September 22, 1987.
| ||||||
3 | This amendatory Act of the 96th General Assembly does not | ||||||
4 | in any way invalidate any agency executed or any act of any | ||||||
5 | agent done, or affect any claim, right, or remedy that accrued | ||||||
6 | prior to the effective date of this amendatory Act of the 96th | ||||||
7 | General Assembly. | ||||||
8 | (Source: P.A. 86-736.)
| ||||||
9 | (755 ILCS 45/3-3) (from Ch. 110 1/2, par. 803-3)
| ||||||
10 | Sec. 3-3. Statutory short form power of attorney for | ||||||
11 | property. | ||||||
12 | (a) The
following form prescribed in this Section may be | ||||||
13 | known as "statutory property power" and may be used
to grant an | ||||||
14 | agent powers with respect to property and financial matters.
| ||||||
15 | The "statutory property power" consists of the following: (1) | ||||||
16 | Notice to the Individual Signing the Illinois Statutory Short | ||||||
17 | Form Power of Attorney for Property; (2) Illinois Statutory | ||||||
18 | Short Form Power of Attorney for Property; and (3) Notice to | ||||||
19 | Agent. When a power of attorney in substantially the following | ||||||
20 | form prescribed in this Section is used,
including all 3 items | ||||||
21 | above, with item (1), the Notice to Individual Signing the | ||||||
22 | Illinois Statutory Short Form Power of Attorney for Property, | ||||||
23 | on a separate sheet (coversheet) in 14-point type the "notice" | ||||||
24 | paragraph at the beginning in capital letters and
the notarized | ||||||
25 | form of acknowledgment at the end, it shall have the meaning
|
| |||||||
| |||||||
1 | and effect prescribed in this Act. | ||||||
2 | (b) A power of attorney shall also be deemed to be in | ||||||
3 | substantially the same format as the statutory form if the | ||||||
4 | explanatory language throughout the form (the language | ||||||
5 | following the designation "NOTE:") is distinguished in some way | ||||||
6 | from the legal paragraphs in the form, such as the use of | ||||||
7 | boldface or other difference in typeface and font or point | ||||||
8 | size, even if the "Notice" paragraphs at the beginning are not | ||||||
9 | on a separate sheet of paper or are not in 14-point type, or if | ||||||
10 | the principal's initials do not appear in the acknowledgement | ||||||
11 | at the end of the "Notice" paragraphs. | ||||||
12 | The validity of a power of attorney as
meeting the | ||||||
13 | requirements of a statutory property power shall not be
| ||||||
14 | affected by the fact that one or more of the categories of | ||||||
15 | optional powers
listed in the form are struck out or the form | ||||||
16 | includes specific
limitations on or additions to the agent's | ||||||
17 | powers, as permitted by the
form. Nothing in this Article shall | ||||||
18 | invalidate or bar use by the
principal of any other or | ||||||
19 | different form of power of attorney for property.
Nonstatutory | ||||||
20 | property powers (i) must be executed by the principal , (ii) | ||||||
21 | must and
designate the agent and the agent's powers , (iii) must | ||||||
22 | be signed by at least one witness to the principal's signature, | ||||||
23 | and (iv) must indicate that the principal has acknowledged his | ||||||
24 | or her signature before a notary public. However, nonstatutory | ||||||
25 | property powers , but they need not be acknowledged
or
conform | ||||||
26 | in any other respect to the statutory property power.
|
| |||||||
| |||||||
1 | (c) The Notice to the Individual Signing the Illinois | ||||||
2 | Statutory Short Form Power of Attorney for Property shall be | ||||||
3 | substantially as follows: | ||||||
4 | "NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS | ||||||
5 | STATUTORY SHORT FORM POWER OF ATTORNEY FOR PROPERTY. | ||||||
6 | PLEASE READ THIS NOTICE CAREFULLY. The form that you will | ||||||
7 | be signing is a legal document. It is governed by the Illinois | ||||||
8 | Power of Attorney Act. If there is anything about this form | ||||||
9 | that you do not understand, you should ask a lawyer to explain | ||||||
10 | it to you. | ||||||
11 | The purpose of this Power of Attorney is to give your | ||||||
12 | designated "agent" broad powers to handle your financial | ||||||
13 | affairs, which may include the power to pledge, sell, or | ||||||
14 | dispose of any of your real or personal property, even without | ||||||
15 | your consent or any advance notice to you. When using the | ||||||
16 | Statutory Short Form, you may name successor agents, but you | ||||||
17 | may not name co-agents. | ||||||
18 | This form does not impose a duty upon your agent to handle | ||||||
19 | your financial affairs, so it is important that you select an | ||||||
20 | agent who will agree to do this for you. It is also important | ||||||
21 | to select an agent whom you trust, since you are giving that | ||||||
22 | agent control over your financial assets and property. Any | ||||||
23 | agent who does act for you has a duty to act in good faith for | ||||||
24 | your benefit and to use due care, competence, and diligence. He |
| |||||||
| |||||||
1 | or she must also act in accordance with the law and with the | ||||||
2 | directions in this form. Your agent must keep a record of all | ||||||
3 | receipts, disbursements, and significant actions taken as your | ||||||
4 | agent. | ||||||
5 | Unless you specifically limit the period of time that this | ||||||
6 | Power of Attorney will be in effect, your agent may exercise | ||||||
7 | the powers given to him or her throughout your lifetime, both | ||||||
8 | before and after you become incapacitated. A court, however, | ||||||
9 | can take away the powers of your agent if it finds that the | ||||||
10 | agent is not acting properly. You may also revoke this Power of | ||||||
11 | Attorney if you wish. | ||||||
12 | This Power
of Attorney does not authorize your agent to | ||||||
13 | appear in court for you as an attorney-at-law or otherwise to | ||||||
14 | engage in the practice of law unless he or she is a licensed | ||||||
15 | attorney who is authorized to practice law in Illinois. | ||||||
16 | The powers you give your agent are explained more fully in | ||||||
17 | Section 3-4 of the Illinois Power of Attorney Act. This form is | ||||||
18 | a part of that law. The "NOTE" paragraphs throughout this form | ||||||
19 | are instructions. | ||||||
20 | You are not required to sign this Power of Attorney, but it | ||||||
21 | will not take effect without your signature. You should not | ||||||
22 | sign this Power of Attorney if you do not understand everything | ||||||
23 | in it, and what your agent will be able to do if you do sign it. | ||||||
24 | Please place your initials on the following line indicating | ||||||
25 | that you have read this Notice: |
| |||||||
| |||||||
1 | ..................... | ||||||
2 | Principal's initials" | ||||||
3 | (d) The Illinois Statutory Short Form Power of Attorney for | ||||||
4 | Property shall be substantially as follows: | ||||||
5 | "ILLINOIS STATUTORY SHORT FORM | ||||||
6 | POWER OF ATTORNEY FOR PROPERTY
| ||||||
7 | (NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE | ||||||
8 | THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE | ||||||
9 | YOUR PROPERTY, WHICH MAY
INCLUDE POWERS TO PLEDGE, SELL OR | ||||||
10 | OTHERWISE DISPOSE OF ANY REAL OR PERSONAL
PROPERTY WITHOUT | ||||||
11 | ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS FORM DOES
NOT | ||||||
12 | IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS; BUT | ||||||
13 | WHEN POWERS
ARE EXERCISED, YOUR AGENT WILL HAVE TO USE DUE CARE | ||||||
14 | TO ACT FOR YOUR
BENEFIT AND IN ACCORDANCE WITH THIS FORM AND | ||||||
15 | KEEP A RECORD OF RECEIPTS,
DISBURSEMENTS AND SIGNIFICANT | ||||||
16 | ACTIONS TAKEN AS AGENT. A COURT CAN TAKE AWAY THE POWERS
OF | ||||||
17 | YOUR AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY. YOU | ||||||
18 | MAY NAME
SUCCESSOR AGENTS UNDER THIS FORM BUT NOT CO-AGENTS. | ||||||
19 | UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THIS POWER IN THE | ||||||
20 | MANNER PROVIDED BELOW, UNTIL YOU
REVOKE THIS POWER OR A COURT | ||||||
21 | ACTING ON YOUR BEHALF TERMINATES IT, YOUR
AGENT MAY EXERCISE | ||||||
22 | THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN
AFTER YOU | ||||||
23 | BECOME DISABLED. THE POWERS YOU GIVE YOUR AGENT ARE EXPLAINED
|
| |||||||
| |||||||
1 | MORE FULLY IN SECTION 3-4 OF THE ILLINOIS "STATUTORY SHORT FORM | ||||||
2 | POWER OF
ATTORNEY FOR PROPERTY LAW" OF WHICH THIS FORM IS A | ||||||
3 | PART
(SEE THE BACK OF THIS FORM). THAT LAW EXPRESSLY PERMITS | ||||||
4 | THE USE OF ANY
DIFFERENT FORM OF POWER OF ATTORNEY YOU MAY | ||||||
5 | DESIRE. IF THERE IS ANYTHING
ABOUT THIS FORM THAT YOU DO NOT | ||||||
6 | UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN
IT TO YOU.)
| ||||||
7 | POWER OF ATTORNEY made this .... day of ....... (month) | ||||||
8 | ...... (year)
| ||||||
9 | 1. I, ..............., (insert name and address of | ||||||
10 | principal)
hereby revoke all prior powers of attorney for | ||||||
11 | property executed by me and appoint:
| ||||||
12 | .............................................................
| ||||||
13 | (insert name and address of agent)
| ||||||
14 | (NOTE: You may not name co-agents using this form.) | ||||||
15 | as my attorney-in-fact (my "agent") to act for me and in my | ||||||
16 | name (in any
way I could act in person) with respect to the | ||||||
17 | following powers, as defined
in Section 3-4 of the "Statutory | ||||||
18 | Short Form Power of Attorney for Property Law"
(including all | ||||||
19 | amendments), but subject to any limitations on or additions
to | ||||||
20 | the specified powers inserted in paragraph 2 or 3 below:
| ||||||
21 | (NOTE: You must strike out any one or more of the following | ||||||
22 | categories of
powers you do not want your agent to have. | ||||||
23 | Failure to strike the title
of any category will cause the | ||||||
24 | powers described in that category to be
granted to the agent. | ||||||
25 | To strike out a category you must draw a line
through the title |
| |||||||
| |||||||
1 | of that category.) (YOU MUST STRIKE OUT ANY ONE OR MORE OF THE | ||||||
2 | FOLLOWING CATEGORIES OF
POWERS YOU DO NOT WANT YOUR AGENT TO | ||||||
3 | HAVE. FAILURE TO STRIKE THE TITLE
OF ANY CATEGORY WILL CAUSE | ||||||
4 | THE POWERS DESCRIBED IN THAT CATEGORY TO BE
GRANTED TO THE | ||||||
5 | AGENT. TO STRIKE OUT A CATEGORY YOU MUST DRAW A LINE
THROUGH | ||||||
6 | THE TITLE OF THAT CATEGORY.)
| ||||||
7 | (a) Real estate transactions.
| ||||||
8 | (b) Financial institution transactions.
| ||||||
9 | (c) Stock and bond transactions.
| ||||||
10 | (d) Tangible personal property transactions.
| ||||||
11 | (e) Safe deposit box transactions.
| ||||||
12 | (f) Insurance and annuity transactions.
| ||||||
13 | (g) Retirement plan transactions.
| ||||||
14 | (h) Social Security, employment and military service | ||||||
15 | benefits.
| ||||||
16 | (i) Tax matters.
| ||||||
17 | (j) Claims and litigation.
| ||||||
18 | (k) Commodity and option transactions.
| ||||||
19 | (l) Business operations.
| ||||||
20 | (m) Borrowing transactions.
| ||||||
21 | (n) Estate transactions.
| ||||||
22 | (o) All other property powers and transactions.
| ||||||
23 | (NOTE: Limitations on and additions to the agent's powers may | ||||||
24 | be included in this power of attorney if they are specifically | ||||||
25 | described below.) (LIMITATIONS ON AND ADDITIONS TO THE AGENT'S | ||||||
26 | POWERS MAY BE INCLUDED IN THIS
POWER OF ATTORNEY IF THEY ARE |
| |||||||
| |||||||
1 | SPECIFICALLY DESCRIBED BELOW.)
| ||||||
2 | 2. The powers granted above shall not include the following | ||||||
3 | powers or
shall be modified or limited in the following | ||||||
4 | particulars : | ||||||
5 | ( NOTE: Here here you may
include any specific limitations you | ||||||
6 | deem appropriate, such as a
prohibition or conditions on the | ||||||
7 | sale of particular stock or real estate or
special rules on | ||||||
8 | borrowing by the agent . ) :
| ||||||
9 | .............................................................
| ||||||
10 | .............................................................
| ||||||
11 | .............................................................
| ||||||
12 | .............................................................
| ||||||
13 | .............................................................
| ||||||
14 | 3. In addition to the powers granted above, I grant my | ||||||
15 | agent the
following powers : | ||||||
16 | ( NOTE: Here here you may add any other delegable powers | ||||||
17 | including,
without limitation, power to make gifts, exercise | ||||||
18 | powers of appointment,
name or change beneficiaries or joint | ||||||
19 | tenants or revoke or amend any trust
specifically referred to | ||||||
20 | below . ) :
| ||||||
21 | .............................................................
| ||||||
22 | .............................................................
| ||||||
23 | .............................................................
| ||||||
24 | .............................................................
| ||||||
25 | .............................................................
| ||||||
26 | (NOTE: Your agent will have authority to employ other persons |
| |||||||
| |||||||
1 | as necessary to enable the agent to properly exercise the | ||||||
2 | powers granted in this form, but your agent will have to make | ||||||
3 | all discretionary decisions. If you want to give your agent the | ||||||
4 | right to delegate discretionary decision-making powers to | ||||||
5 | others, you should keep paragraph 4, otherwise it should be | ||||||
6 | struck out.) (YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER | ||||||
7 | PERSONS AS NECESSARY TO
ENABLE THE AGENT TO PROPERLY EXERCISE | ||||||
8 | THE POWERS GRANTED IN THIS FORM, BUT
YOUR AGENT WILL HAVE TO | ||||||
9 | MAKE ALL DISCRETIONARY DECISIONS. IF YOU WANT TO
GIVE YOUR | ||||||
10 | AGENT THE RIGHT TO DELEGATE DISCRETIONARY DECISION-MAKING | ||||||
11 | POWERS
TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE, OTHERWISE | ||||||
12 | IT SHOULD BE STRUCK OUT.)
| ||||||
13 | 4. My agent shall have the right by written instrument to | ||||||
14 | delegate any
or all of the foregoing powers involving | ||||||
15 | discretionary decision-making to
any person or persons whom my | ||||||
16 | agent may select, but such delegation may be
amended or revoked | ||||||
17 | by any agent (including any successor) named by me who
is | ||||||
18 | acting under this power of attorney at the time of reference.
| ||||||
19 | (NOTE: Your agent will be entitled to reimbursement for all | ||||||
20 | reasonable expenses incurred in acting under this power of | ||||||
21 | attorney. Strike out paragraph 5 if you do not want your agent | ||||||
22 | to also be entitled to reasonable compensation for services as | ||||||
23 | agent.) (YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL | ||||||
24 | REASONABLE EXPENSES
INCURRED IN ACTING UNDER THIS POWER OF | ||||||
25 | ATTORNEY. STRIKE OUT THE NEXT
SENTENCE IF YOU DO NOT WANT YOUR | ||||||
26 | AGENT TO ALSO BE ENTITLED TO REASONABLE
COMPENSATION FOR |
| |||||||
| |||||||
1 | SERVICES AS AGENT.)
| ||||||
2 | 5. My agent shall be entitled to reasonable compensation | ||||||
3 | for services
rendered as agent under this power of attorney.
| ||||||
4 | (NOTE: This power of attorney may be amended or revoked by you | ||||||
5 | at any time and in any manner. Absent amendment or revocation, | ||||||
6 | the authority granted in this power of attorney will become | ||||||
7 | effective at the time this power is signed and will continue | ||||||
8 | until your death, unless a limitation on the beginning date or | ||||||
9 | duration is made by initialing and completing one or both of | ||||||
10 | paragraphs 6 and 7:) (THIS POWER OF ATTORNEY MAY BE AMENDED OR | ||||||
11 | REVOKED BY YOU AT ANY TIME AND IN
ANY MANNER. ABSENT AMENDMENT | ||||||
12 | OR REVOCATION, THE AUTHORITY GRANTED IN THIS
POWER OF ATTORNEY | ||||||
13 | WILL BECOME EFFECTIVE AT THE TIME THIS POWER IS SIGNED
AND WILL | ||||||
14 | CONTINUE UNTIL YOUR DEATH UNLESS A LIMITATION ON THE BEGINNING
| ||||||
15 | DATE OR DURATION IS MADE BY INITIALING AND COMPLETING EITHER | ||||||
16 | (OR BOTH) OF
THE FOLLOWING:)
| ||||||
17 | 6. ( ) This power of attorney shall become effective on
| ||||||
18 | .............................................................
| ||||||
19 | ( NOTE: Insert insert a future date or event during your | ||||||
20 | lifetime, such as a court
determination of your disability or a | ||||||
21 | written determination by your physician that you are | ||||||
22 | incapacitated , when you want this power to first take effect . )
| ||||||
23 | 7. ( ) This power of attorney shall terminate on
| ||||||
24 | .............................................................
| ||||||
25 | ( NOTE: Insert insert a future date or event, such as a court | ||||||
26 | determination that you are not under a legal disability or a |
| |||||||
| |||||||
1 | written determination by your physician that you are not | ||||||
2 | incapacitated, if of your
disability, when you want this power | ||||||
3 | to terminate prior to your death . )
| ||||||
4 | (NOTE: If you wish to name one or more successor agents, insert | ||||||
5 | the name and address of each successor agent in paragraph 8.) | ||||||
6 | (IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND | ||||||
7 | ADDRESS(ES)
OF SUCH SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)
| ||||||
8 | 8. If any agent named by me shall die, become incompetent, | ||||||
9 | resign
or refuse to accept the office of agent, I name the | ||||||
10 | following
(each to act alone and successively,
in the order | ||||||
11 | named) as successor(s) to such agent:
| ||||||
12 | .............................................................
| ||||||
13 | .............................................................
| ||||||
14 | For purposes of this paragraph 8, a person shall be considered | ||||||
15 | to be
incompetent if and while the person is a minor or an | ||||||
16 | adjudicated
incompetent or disabled person or the person is | ||||||
17 | unable to give prompt and
intelligent consideration to business | ||||||
18 | matters, as certified by a licensed physician.
| ||||||
19 | (NOTE: If you wish to, you may name your agent as guardian of | ||||||
20 | your estate if a court decides that one should be appointed. To | ||||||
21 | do this, retain paragraph 9, and the court will appoint your | ||||||
22 | agent if the court finds that this appointment will serve your | ||||||
23 | best interests and welfare. Strike out paragraph 9 if you do | ||||||
24 | not want your agent to act as guardian.) (IF YOU WISH TO NAME | ||||||
25 | YOUR AGENT AS
GUARDIAN OF YOUR ESTATE, IN THE EVENT A COURT | ||||||
26 | DECIDES THAT ONE
SHOULD BE APPOINTED, YOU
MAY, BUT ARE NOT |
| |||||||
| |||||||
1 | REQUIRED TO, DO SO BY RETAINING THE FOLLOWING PARAGRAPH.
THE | ||||||
2 | COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH | ||||||
3 | APPOINTMENT WILL SERVE YOUR
BEST INTERESTS AND WELFARE. STRIKE | ||||||
4 | OUT PARAGRAPH 9 IF YOU DO NOT WANT
YOUR AGENT TO ACT AS | ||||||
5 | GUARDIAN.)
| ||||||
6 | 9. If a guardian of my estate (my property) is to be | ||||||
7 | appointed, I
nominate the agent acting under this power of | ||||||
8 | attorney as such guardian,
to serve without bond or security.
| ||||||
9 | 10. I am fully informed as to all the contents of this form | ||||||
10 | and
understand the full import of this grant of powers to my | ||||||
11 | agent.
| ||||||
12 | (NOTE: This form does not authorize your agent to appear in | ||||||
13 | court for you as an attorney-at-law or otherwise to engage in | ||||||
14 | the practice of law unless he or she is a licensed attorney who | ||||||
15 | is authorized to practice law in Illinois.) | ||||||
16 | 11. The Notice to Agent is incorporated by reference and | ||||||
17 | included as part of this form. | ||||||
18 | Dated: ................ | ||||||
19 | Signed ..........................................
| ||||||
20 | (principal)
| ||||||
21 | (YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND | ||||||
22 | SUCCESSOR
AGENTS TO PROVIDE SPECIMEN SIGNATURES BELOW. IF YOU | ||||||
23 | INCLUDE SPECIMEN
SIGNATURES IN THIS POWER OF ATTORNEY, YOU MUST | ||||||
24 | COMPLETE THE CERTIFICATION
OPPOSITE THE SIGNATURES OF THE | ||||||
25 | AGENTS.)
| ||||||
26 | Specimen signatures of I certify that the signatures
|
| |||||||
| |||||||
1 | agent (and successors) of my agent (and successors)
| ||||||
2 | are correct.
| ||||||
3 | .......................... .............................
| ||||||
4 | (agent) (principal)
| ||||||
5 | .......................... .............................
| ||||||
6 | (successor agent) (principal)
| ||||||
7 | .......................... .............................
| ||||||
8 | (successor agent) (principal)
| ||||||
9 | (NOTE: This power of attorney will not be effective unless it | ||||||
10 | is signed by at least one witness and your signature is | ||||||
11 | notarized, using the form below. The notary may not also sign | ||||||
12 | as a witness.) (THIS POWER OF ATTORNEY WILL NOT BE EFFECTIVE | ||||||
13 | UNLESS IT IS NOTARIZED AND
SIGNED BY AT LEAST ONE ADDITIONAL | ||||||
14 | WITNESS,
USING THE FORM BELOW.)
| ||||||
15 | The undersigned witness certifies that ..............., known | ||||||
16 | to me to be
the same person whose name is subscribed as | ||||||
17 | principal to the foregoing power of
attorney, appeared before | ||||||
18 | me and the notary public and acknowledged signing and
| ||||||
19 | delivering the instrument as the free and voluntary act of the | ||||||
20 | principal, for
the
uses and purposes therein set forth. I | ||||||
21 | believe him or her to be of sound mind
and memory. The | ||||||
22 | undersigned witness also certifies that the witness is not: (a) | ||||||
23 | the attending physician or mental health service provider or a | ||||||
24 | relative of the physician or provider; (b) an owner, operator, |
| |||||||
| |||||||
1 | or relative of an owner or operator of a health care facility | ||||||
2 | in which the principal is a patient or resident; (c) a parent, | ||||||
3 | sibling, descendant, or any spouse of such parent, sibling, or | ||||||
4 | descendant of either the principal or any agent or successor | ||||||
5 | agent under the foregoing power of attorney, whether such | ||||||
6 | relationship is by blood, marriage, or adoption; or (d) an | ||||||
7 | agent or successor agent under the foregoing power of attorney.
| ||||||
8 | Dated: ................
| ||||||
9 | ..............................
| ||||||
10 | Witness | ||||||
11 | (NOTE: Illinois requires only one witness, but other | ||||||
12 | jurisdictions may require more than one witness. If you wish to | ||||||
13 | have a second witness, have him or her certify and sign here:) | ||||||
14 | (Second witness) The undersigned witness certifies that | ||||||
15 | ................, known to me to be the same person whose name | ||||||
16 | is subscribed as principal to the foregoing power of attorney, | ||||||
17 | appeared before me and the notary public and acknowledged | ||||||
18 | signing and delivering the instrument as the free and voluntary | ||||||
19 | act of the principal, for the uses and purposes therein set | ||||||
20 | forth. I believe him or her to be of sound mind and memory. The | ||||||
21 | undersigned witness also certifies that the witness is not: (a) | ||||||
22 | the attending physician or mental health service provider or a | ||||||
23 | relative of the physician or provider; (b) an owner, operator, | ||||||
24 | or relative of an owner or operator of a health care facility |
| |||||||
| |||||||
1 | in which the principal is a patient or resident; (c) a parent, | ||||||
2 | sibling, descendant, or any spouse of such parent, sibling, or | ||||||
3 | descendant of either the principal or any agent or successor | ||||||
4 | agent under the foregoing power of attorney, whether such | ||||||
5 | relationship is by blood, marriage, or adoption; or (d) an | ||||||
6 | agent or successor agent under the foregoing power of attorney. | ||||||
7 | Dated: ....................... | ||||||
8 | .............................. | ||||||
9 | Witness | ||||||
10 | State of ............)
| ||||||
11 | ) SS.
| ||||||
12 | County of ...........)
| ||||||
13 | The undersigned, a notary public in and for the above | ||||||
14 | county and state,
certifies that ......................., | ||||||
15 | known to me to be the same person
whose name is subscribed as | ||||||
16 | principal to the foregoing power of attorney,
appeared before | ||||||
17 | me and the witness(es) ............. (and ..............) | ||||||
18 | additional witness in person and acknowledged
signing and | ||||||
19 | delivering the
instrument as the free and voluntary act of the | ||||||
20 | principal, for the uses and
purposes therein set forth (, and | ||||||
21 | certified to the correctness of the
signature(s) of the | ||||||
22 | agent(s)).
| ||||||
23 | Dated: ................ (SEAL)
| ||||||
24 | ..............................
| ||||||
25 | Notary Public
|
| |||||||
| |||||||
1 | My commission expires .................
| ||||||
2 | (NOTE: You may, but are not required to, request your agent and | ||||||
3 | successor agents to provide specimen signatures below. If you | ||||||
4 | include specimen signatures in this power of attorney, you must | ||||||
5 | complete the certification opposite the signatures of the | ||||||
6 | agents.)
| ||||||
7 | Specimen signatures of I certify that the signatures
| ||||||
8 | agent (and successors) of my agent (and successors)
| ||||||
9 | are genuine.
| ||||||
10 | .......................... .............................
| ||||||
11 | (agent) (principal)
| ||||||
12 | .......................... .............................
| ||||||
13 | (successor agent) (principal)
| ||||||
14 | .......................... .............................
| ||||||
15 | (successor agent) (principal) | ||||||
16 | The undersigned witness certifies that ................, known | ||||||
17 | to me to be
the same person whose name is subscribed as | ||||||
18 | principal to the foregoing power of
attorney, appeared before | ||||||
19 | me and the notary public and acknowledged signing and
| ||||||
20 | delivering the instrument as the free and voluntary act of the | ||||||
21 | principal, for
the
uses and purposes therein set forth. I | ||||||
22 | believe him or her to be of sound mind
and memory.
| ||||||
23 | Dated: ................ (SEAL)
|
| |||||||
| |||||||
1 | ..............................
| ||||||
2 | Witness
| ||||||
3 | (NOTE: The name, address, and phone number of the person | ||||||
4 | preparing this form or who assisted the principal in completing | ||||||
5 | this form should be inserted below.) (THE NAME AND ADDRESS OF | ||||||
6 | THE PERSON PREPARING THIS FORM SHOULD BE
INSERTED
IF THE AGENT | ||||||
7 | WILL HAVE POWER TO CONVEY ANY INTEREST IN REAL ESTATE.)
| ||||||
8 | Name: ....................... | ||||||
9 | Address: .................... | ||||||
10 | .............................. | ||||||
11 | .............................. | ||||||
12 | Phone: .................... | ||||||
13 | This document was prepared by:
| ||||||
14 |
| ||||||
15 | "
| ||||||
16 | (e) Notice to Agent. The following form may be known as | ||||||
17 | "Notice to Agent" and shall be supplied to an agent appointed | ||||||
18 | under a power of attorney for property. | ||||||
19 | "NOTICE TO AGENT | ||||||
20 | When you accept the authority granted under this power of | ||||||
21 | attorney a special legal relationship, known as agency, is | ||||||
22 | created between you and the principal. Agency imposes upon you | ||||||
23 | duties that continue until you resign or the power of attorney |
| |||||||
| |||||||
1 | is terminated or revoked. | ||||||
2 | As agent you must: | ||||||
3 | (1) do what you know the principal reasonably expects | ||||||
4 | you to do with the principal's property; | ||||||
5 | (2) act in good faith for the best interest of the | ||||||
6 | principal, using due care, competence, and diligence; | ||||||
7 | (3) keep a complete and detailed record of all | ||||||
8 | receipts, disbursements, and significant actions conducted | ||||||
9 | for the principal; | ||||||
10 | (4) attempt to preserve the principal's estate plan, to | ||||||
11 | the extent actually known by the agent, if preserving the | ||||||
12 | plan is consistent with the principal's best interest; and | ||||||
13 | (5) cooperate with a person who has authority to make | ||||||
14 | health care decisions for the principal to carry out the | ||||||
15 | principal's reasonable expectations to the extent actually | ||||||
16 | in the principal's best interest. | ||||||
17 | As agent you must not do any of the following: | ||||||
18 | (1) act so as to create a conflict of interest that is | ||||||
19 | inconsistent with the other principles in this Notice to | ||||||
20 | Agent; | ||||||
21 | (2) do any act beyond the authority granted in this | ||||||
22 | power of attorney; | ||||||
23 | (3) commingle the principal's funds with your funds; | ||||||
24 | (4) borrow funds or other property from the principal, | ||||||
25 | unless otherwise authorized; | ||||||
26 | (5) continue acting on behalf of the principal if you |
| |||||||
| |||||||
1 | learn of any event that terminates this power of attorney | ||||||
2 | or your authority under this power of attorney, such as the | ||||||
3 | death of the principal, your legal separation from the | ||||||
4 | principal, or the dissolution of your marriage to the | ||||||
5 | principal. | ||||||
6 | If you have special skills or expertise, you must use those | ||||||
7 | special skills and expertise when acting for the principal. You | ||||||
8 | must disclose your identity as an agent whenever you act for | ||||||
9 | the principal by writing or printing the name of the principal | ||||||
10 | and signing your own name "as Agent" in the following manner: | ||||||
11 | "(Principal's Name) by (Your Name) as Agent" | ||||||
12 | The meaning of the powers granted to you is contained in | ||||||
13 | Section 3-4 of the Illinois Power of Attorney Act, which is | ||||||
14 | incorporated by reference into the body of the power of | ||||||
15 | attorney for property document. | ||||||
16 | If you violate your duties as agent or act outside the | ||||||
17 | authority granted to you, you may be liable for any damages, | ||||||
18 | including attorney's fees and costs, caused by your violation. | ||||||
19 | If there is anything about this document or your duties | ||||||
20 | that you do not understand, you should seek legal advice from | ||||||
21 | an attorney." | ||||||
22 | (f) The requirement of the signature of a witness in | ||||||
23 | addition to the principal and the notary, an additional
witness | ||||||
24 | imposed by Public Act 91-790, this amendatory Act of the 91st | ||||||
25 | General
Assembly applies only to instruments executed on or |
| |||||||
| |||||||
1 | after June 9, 2000 ( the effective date of that Public Act). | ||||||
2 | this amendatory Act of the 91st
General Assembly. | ||||||
3 | (NOTE: This amendatory Act of the 96th General Assembly deletes | ||||||
4 | provisions that referred to the one required witness as an | ||||||
5 | "additional witness", and it also provides for the signature of | ||||||
6 | an optional "second witness".)
| ||||||
7 | (Source: P.A. 91-790, eff. 6-9-00 .)
| ||||||
8 | (755 ILCS 45/3-3.6 new) | ||||||
9 | Sec. 3-3.6. Limitations on who may witness property powers. | ||||||
10 | (a) Every property power shall bear the signature of a | ||||||
11 | witness to the signing of the agency and shall be notarized. | ||||||
12 | None of the following may serve as a witness to the signing of | ||||||
13 | a property power or as a notary public notarizing the property | ||||||
14 | power: | ||||||
15 | (1) the attending physician or mental health service | ||||||
16 | provider of the principal, or a relative of the physician | ||||||
17 | or provider; | ||||||
18 | (2) an owner, operator, or relative of an owner or | ||||||
19 | operator of a health care facility in which the principal | ||||||
20 | is a patient or resident; | ||||||
21 | (3) a parent, sibling, or descendant, or the spouse of | ||||||
22 | a parent, sibling, or descendant, of either the principal | ||||||
23 | or any agent or successor agent, regardless of whether the | ||||||
24 | relationship is by blood, marriage, or adoption; | ||||||
25 | (4) an agent or successor agent for property. |
| |||||||
| |||||||
1 | (b) The prohibition on the operator of a health care | ||||||
2 | facility from serving as a witness shall extend to directors | ||||||
3 | and executive officers of an operator that is a corporate | ||||||
4 | entity but not other employees of the operator.
| ||||||
5 | (755 ILCS 45/3-4) (from Ch. 110 1/2, par. 803-4)
| ||||||
6 | Sec. 3-4. Explanation of powers granted in the statutory | ||||||
7 | short form power
of attorney for property. This Section defines | ||||||
8 | each category of powers
listed in the statutory short form | ||||||
9 | power of attorney for property and the
effect of granting | ||||||
10 | powers to an agent , and is incorporated by reference into the | ||||||
11 | statutory short form. Incorporation by reference does not | ||||||
12 | require physical attachment of a copy of this Section 3-4 to | ||||||
13 | the statutory short form power of attorney for property . When | ||||||
14 | the title of any of the
following categories is retained (not | ||||||
15 | struck out) in a statutory property
power form, the effect will | ||||||
16 | be to grant the agent all of the principal's
rights, powers and | ||||||
17 | discretions with respect to the types of property and
| ||||||
18 | transactions covered by the retained category, subject to any | ||||||
19 | limitations
on the granted powers that appear on the face of | ||||||
20 | the form. The agent will
have authority to exercise each | ||||||
21 | granted power for and in the name of the
principal with respect | ||||||
22 | to all of the principal's interests in every type of
property | ||||||
23 | or transaction covered by the granted power at the time of
| ||||||
24 | exercise, whether the principal's interests are direct or | ||||||
25 | indirect, whole
or fractional, legal, equitable or |
| |||||||
| |||||||
1 | contractual, as a joint tenant or tenant
in common or held in | ||||||
2 | any other form; but the agent will not have power under
any of | ||||||
3 | the statutory categories (a) through (o) to make gifts of the
| ||||||
4 | principal's property, to exercise powers to appoint to others | ||||||
5 | or to change
any beneficiary whom the principal has designated | ||||||
6 | to take the principal's
interests at death under any will, | ||||||
7 | trust, joint tenancy, beneficiary form
or contractual | ||||||
8 | arrangement. The agent will be under no duty to exercise
| ||||||
9 | granted powers or to assume control of or responsibility for | ||||||
10 | the
principal's property or affairs; but when granted powers | ||||||
11 | are exercised, the
agent will be required to use due care to | ||||||
12 | act in good faith for the benefit of
the principal using due | ||||||
13 | care, competence, and diligence in accordance with the terms of | ||||||
14 | the statutory property power
and will be liable for negligent | ||||||
15 | exercise. The agent may act in person or
through others | ||||||
16 | reasonably employed by the agent for that purpose and will
have | ||||||
17 | authority to sign and deliver all instruments, negotiate and | ||||||
18 | enter
into all agreements and do all other acts reasonably | ||||||
19 | necessary to implement
the exercise of the powers granted to | ||||||
20 | the agent.
| ||||||
21 | (a) Real estate transactions. The agent is authorized to: | ||||||
22 | buy,
sell, exchange, rent and lease real estate (which term | ||||||
23 | includes, without
limitation, real estate subject to a land | ||||||
24 | trust and all beneficial
interests in and powers of direction | ||||||
25 | under any land trust); collect all
rent, sale proceeds and | ||||||
26 | earnings from real estate; convey, assign and
accept title to |
| |||||||
| |||||||
1 | real estate; grant easements, create conditions and release
| ||||||
2 | rights of homestead with respect to real estate; create land | ||||||
3 | trusts and
exercise all powers under land trusts; hold, | ||||||
4 | possess, maintain, repair,
improve, subdivide, manage, operate | ||||||
5 | and insure real estate; pay, contest,
protest and compromise | ||||||
6 | real estate taxes and assessments; and, in general,
exercise | ||||||
7 | all powers with respect to real estate which the principal | ||||||
8 | could
if present and under no disability.
| ||||||
9 | (b) Financial institution transactions. The agent is | ||||||
10 | authorized to:
open, close, continue and control all accounts | ||||||
11 | and deposits in any type of
financial institution (which term | ||||||
12 | includes, without limitation, banks,
trust companies, savings | ||||||
13 | and building and loan associations, credit unions
and brokerage | ||||||
14 | firms); deposit in and withdraw from and write checks on any
| ||||||
15 | financial institution account or deposit; and, in general, | ||||||
16 | exercise all
powers with respect to financial institution | ||||||
17 | transactions which the
principal could if present and under no | ||||||
18 | disability. This authorization shall also apply to any Totten | ||||||
19 | Trust, Payable on Death Account, or comparable trust account | ||||||
20 | arrangement where the terms of such trust are contained | ||||||
21 | entirely on the financial institution's signature card, | ||||||
22 | insofar as an agent shall be permitted to withdraw income or | ||||||
23 | principal from such account, unless this authorization is | ||||||
24 | expressly limited or withheld under paragraph 2 of the form | ||||||
25 | prescribed under Section 3-3. This authorization shall not | ||||||
26 | apply to accounts titled in the name of any trust subject to |
| |||||||
| |||||||
1 | the provisions of the Trusts and Trustees Act, for which | ||||||
2 | specific reference to the trust and a specific grant of | ||||||
3 | authority to the agent to withdraw income or principal from | ||||||
4 | such trust is required pursuant to Section 2-9 of the Illinois | ||||||
5 | Power of Attorney Act and subsection (n) of this Section.
| ||||||
6 | (c) Stock and bond transactions. The agent is authorized | ||||||
7 | to: buy
and sell all types of securities (which term includes, | ||||||
8 | without limitation,
stocks, bonds, mutual funds and all other | ||||||
9 | types of investment securities
and financial instruments); | ||||||
10 | collect, hold and safekeep all dividends,
interest, earnings, | ||||||
11 | proceeds of sale, distributions, shares, certificates
and | ||||||
12 | other evidences of ownership paid or distributed with respect | ||||||
13 | to
securities; exercise all voting rights with respect to | ||||||
14 | securities in person
or by proxy, enter into voting trusts and | ||||||
15 | consent to limitations on the
right to vote; and, in general, | ||||||
16 | exercise all powers with respect to
securities which the | ||||||
17 | principal could if present and under no disability.
| ||||||
18 | (d) Tangible personal property transactions. The agent is
| ||||||
19 | authorized to: buy and sell, lease, exchange, collect, possess | ||||||
20 | and take
title to all tangible personal property; move, store, | ||||||
21 | ship, restore,
maintain, repair, improve, manage, preserve, | ||||||
22 | insure and safekeep tangible
personal property; and, in | ||||||
23 | general, exercise all powers with respect to
tangible personal | ||||||
24 | property which the principal could if present and under no | ||||||
25 | disability.
| ||||||
26 | (e) Safe deposit box transactions. The agent is authorized |
| |||||||
| |||||||
1 | to:
open, continue and have access to all safe deposit boxes; | ||||||
2 | sign, renew,
release or terminate any safe deposit contract; | ||||||
3 | drill or surrender any safe
deposit box; and, in general, | ||||||
4 | exercise all powers with respect to safe
deposit matters which | ||||||
5 | the principal could if present and under no disability.
| ||||||
6 | (f) Insurance and annuity transactions. The agent is | ||||||
7 | authorized to:
procure, acquire, continue, renew, terminate or | ||||||
8 | otherwise deal with any
type of insurance or annuity contract | ||||||
9 | (which terms include, without
limitation, life, accident, | ||||||
10 | health, disability, automobile casualty,
property or liability | ||||||
11 | insurance); pay premiums or assessments on or
surrender and | ||||||
12 | collect all distributions, proceeds or benefits payable under
| ||||||
13 | any insurance or annuity contract; and, in general, exercise | ||||||
14 | all powers
with respect to insurance and annuity contracts | ||||||
15 | which the principal could
if present and under no disability.
| ||||||
16 | (g) Retirement plan transactions. The agent is authorized | ||||||
17 | to:
contribute to, withdraw from and deposit funds in any type | ||||||
18 | of retirement
plan (which term includes, without limitation, | ||||||
19 | any tax qualified or
nonqualified pension, profit sharing, | ||||||
20 | stock bonus, employee savings and
other retirement plan, | ||||||
21 | individual retirement account, deferred compensation
plan and | ||||||
22 | any other type of employee benefit plan); select and change
| ||||||
23 | payment options for the principal under any retirement plan; | ||||||
24 | make rollover
contributions from any retirement plan to other | ||||||
25 | retirement plans or
individual retirement accounts; exercise | ||||||
26 | all investment powers available
under any type of self-directed |
| |||||||
| |||||||
1 | retirement plan; and, in general, exercise
all powers with | ||||||
2 | respect to retirement plans and retirement plan account
| ||||||
3 | balances which the principal could if present and under no | ||||||
4 | disability.
| ||||||
5 | (h) Social Security, unemployment and military service | ||||||
6 | benefits.
The agent is authorized to: prepare, sign and file | ||||||
7 | any claim or application
for Social Security, unemployment or | ||||||
8 | military service benefits; sue for,
settle or abandon any | ||||||
9 | claims to any benefit or assistance under any
federal, state, | ||||||
10 | local or foreign statute or regulation; control, deposit to
any | ||||||
11 | account, collect, receipt for, and take title to and hold all | ||||||
12 | benefits
under any Social Security, unemployment, military | ||||||
13 | service or other state,
federal, local or foreign statute or | ||||||
14 | regulation; and, in general, exercise
all powers with respect | ||||||
15 | to Social Security, unemployment, military service
and | ||||||
16 | governmental benefits which the principal could if present and | ||||||
17 | under no disability.
| ||||||
18 | (i) Tax matters. The agent is authorized to: sign, verify | ||||||
19 | and file
all the principal's federal, state and local income, | ||||||
20 | gift, estate, property
and other tax returns, including joint | ||||||
21 | returns and declarations of
estimated tax; pay all taxes; | ||||||
22 | claim, sue for and receive all tax refunds;
examine and copy | ||||||
23 | all the principal's tax returns and records; represent the
| ||||||
24 | principal before any federal, state or local revenue agency or | ||||||
25 | taxing body
and sign and deliver all tax powers of attorney on | ||||||
26 | behalf of the principal
that may be necessary for such |
| |||||||
| |||||||
1 | purposes; waive rights and sign all
documents on behalf of the | ||||||
2 | principal as required to settle, pay and
determine all tax | ||||||
3 | liabilities; and, in general, exercise all powers with
respect | ||||||
4 | to tax matters which the principal could if present and under | ||||||
5 | no disability.
| ||||||
6 | (j) Claims and litigation. The agent is authorized to: | ||||||
7 | institute,
prosecute, defend, abandon, compromise, arbitrate, | ||||||
8 | settle and dispose of
any claim in favor of or against the | ||||||
9 | principal or any property interests of
the principal; collect | ||||||
10 | and receipt for any claim or settlement proceeds and
waive or | ||||||
11 | release all rights of the principal; employ attorneys and | ||||||
12 | others
and enter into contingency agreements and other | ||||||
13 | contracts as necessary in
connection with litigation; and, in | ||||||
14 | general, exercise all powers with
respect to claims and | ||||||
15 | litigation which the principal could if present and
under no | ||||||
16 | disability. The statutory short form power
of attorney for | ||||||
17 | property does not authorize the agent to appear in court or any | ||||||
18 | tribunal as an attorney-at-law for the principal or otherwise | ||||||
19 | to engage in the practice of law without being a licensed | ||||||
20 | attorney who is authorized to practice law in Illinois under | ||||||
21 | applicable Illinois Supreme Court Rules.
| ||||||
22 | (k) Commodity and option transactions. The agent is | ||||||
23 | authorized to:
buy, sell, exchange, assign, convey, settle and | ||||||
24 | exercise commodities
futures contracts and call and put options | ||||||
25 | on stocks and stock indices
traded on a regulated options | ||||||
26 | exchange and collect and receipt for all
proceeds of any such |
| |||||||
| |||||||
1 | transactions; establish or continue option accounts
for the | ||||||
2 | principal with any securities or futures broker; and, in | ||||||
3 | general,
exercise all powers with respect to commodities and | ||||||
4 | options which the
principal could if present and under no | ||||||
5 | disability.
| ||||||
6 | (l) Business operations. The agent is authorized to: | ||||||
7 | organize or
continue and conduct any business (which term | ||||||
8 | includes, without limitation,
any farming, manufacturing, | ||||||
9 | service, mining, retailing or other type of
business operation) | ||||||
10 | in any form, whether as a proprietorship, joint
venture, | ||||||
11 | partnership, corporation, trust or other legal entity; | ||||||
12 | operate,
buy, sell, expand, contract, terminate or liquidate | ||||||
13 | any business; direct,
control, supervise, manage or | ||||||
14 | participate in the operation of any business
and engage, | ||||||
15 | compensate and discharge business managers, employees, agents,
| ||||||
16 | attorneys, accountants and consultants; and, in general, | ||||||
17 | exercise all
powers with respect to business interests and | ||||||
18 | operations which the principal
could if present and under no | ||||||
19 | disability.
| ||||||
20 | (m) Borrowing transactions. The agent is authorized to: | ||||||
21 | borrow
money; mortgage or pledge any real estate or tangible or | ||||||
22 | intangible
personal property as security for such purposes; | ||||||
23 | sign, renew, extend, pay
and satisfy any notes or other forms | ||||||
24 | of obligation; and, in general,
exercise all powers with | ||||||
25 | respect to secured and unsecured borrowing which
the principal | ||||||
26 | could if present and under no disability.
|
| |||||||
| |||||||
1 | (n) Estate transactions. The agent is authorized to: | ||||||
2 | accept,
receipt for, exercise, release, reject, renounce, | ||||||
3 | assign, disclaim, demand,
sue for, claim and recover any | ||||||
4 | legacy, bequest, devise, gift or other
property interest or | ||||||
5 | payment due or payable to or for the principal; assert
any | ||||||
6 | interest in and exercise any power over any trust, estate or | ||||||
7 | property
subject to fiduciary control; establish a revocable | ||||||
8 | trust solely for the
benefit of the principal that terminates | ||||||
9 | at the death of the principal and
is then distributable to the | ||||||
10 | legal representative of the estate of the
principal; and, in | ||||||
11 | general, exercise all powers with respect to estates and
trusts | ||||||
12 | which the principal could if present and under no disability;
| ||||||
13 | provided, however, that the agent may not make or change a will | ||||||
14 | and may not
revoke or amend a trust revocable or amendable by | ||||||
15 | the principal or require
the trustee of any trust for the | ||||||
16 | benefit of the principal to pay income or
principal to the | ||||||
17 | agent unless specific authority to that end is given, and
| ||||||
18 | specific reference to the trust is made, in the statutory | ||||||
19 | property power form.
| ||||||
20 | (o) All other property powers and transactions. The agent | ||||||
21 | is
authorized to: exercise all possible authority powers of the | ||||||
22 | principal with respect
to all possible types of property and | ||||||
23 | interests in property, except to the
extent limited in | ||||||
24 | subsections (a) through (n) of this Section 3-4 and to the | ||||||
25 | extent that the principal otherwise limits the generality of | ||||||
26 | this category (o) by striking
out one or more of categories (a) |
| |||||||
| |||||||
1 | through (n) or by specifying other
limitations in the statutory | ||||||
2 | property power form.
| ||||||
3 | (Source: P.A. 94-938, eff. 1-1-07.)
| ||||||
4 | (755 ILCS 45/3-5 new) | ||||||
5 | Sec. 3-5. Savings clause. This amendatory Act of the 96th | ||||||
6 | General Assembly does not in any way invalidate any property | ||||||
7 | power executed or any act of any agent done, or affect any | ||||||
8 | claim, right, or remedy that accrued, prior to the effective | ||||||
9 | date of this amendatory Act of the 96th General Assembly.
| ||||||
10 | (755 ILCS 45/4-4) (from Ch. 110 1/2, par. 804-4)
| ||||||
11 | Sec. 4-4. Definitions. As used in this Article:
| ||||||
12 | (a) "Attending physician" means the physician who has | ||||||
13 | primary
responsibility at the time of reference for the | ||||||
14 | treatment and care of the patient.
| ||||||
15 | (b) "Health care" means any care, treatment, service or | ||||||
16 | procedure to
maintain, diagnose, treat or provide for the | ||||||
17 | patient's physical or mental
health or personal care.
| ||||||
18 | (c) "Health care agency" means an agency governing any type | ||||||
19 | of health
care, anatomical gift, autopsy or disposition of | ||||||
20 | remains for and on behalf
of a patient and refers to the power | ||||||
21 | of attorney or other written
instrument defining the agency or | ||||||
22 | the agency, itself, as appropriate to the context.
| ||||||
23 | (d) "Health care provider" or "provider" means the | ||||||
24 | attending physician
and any other person administering health |
| |||||||
| |||||||
1 | care to the patient at the time
of reference who is licensed, | ||||||
2 | certified, or otherwise authorized or
permitted by law to | ||||||
3 | administer health care in the ordinary course of
business or | ||||||
4 | the practice of a profession, including any person employed by
| ||||||
5 | or acting for any such authorized person.
| ||||||
6 | (e) "Patient" means the principal or, if the agency governs | ||||||
7 | health care
for a minor child of the principal, then the child.
| ||||||
8 | (f) "Incurable or irreversible condition" means an illness | ||||||
9 | or injury (i) for which there is no reasonable prospect of cure | ||||||
10 | or recovery, (ii) that ultimately will cause the patient's | ||||||
11 | death even if life-sustaining treatment is initiated or | ||||||
12 | continued, (iii) that imposes severe pain or otherwise imposes | ||||||
13 | an inhumane burden on the patient, or (iv) for which initiating | ||||||
14 | or continuing life-sustaining treatment, in light of the | ||||||
15 | patient's medical condition, provides only minimal medical | ||||||
16 | benefit. | ||||||
17 | (g) "Permanent unconsciousness" means a condition that, to | ||||||
18 | a high degree of medical certainty, (i) will last permanently, | ||||||
19 | without improvement, (ii) in which thought, sensation, | ||||||
20 | purposeful action, social interaction, and awareness of self | ||||||
21 | and environment are absent, and (iii) for which initiating or | ||||||
22 | continuing life-sustaining treatment, in light of the | ||||||
23 | patient's medical condition, provides only minimal medical | ||||||
24 | benefit. For the purposes of this definition, "medical benefit" | ||||||
25 | means a chance to cure or reverse a condition. | ||||||
26 | (h) "Terminal condition" means an illness or injury for |
| |||||||
| |||||||
1 | which there is no reasonable prospect of cure or recovery, | ||||||
2 | death is imminent, and the application of life-sustaining | ||||||
3 | treatment would only prolong the dying process. | ||||||
4 | (Source: P.A. 85-701.)
| ||||||
5 | (755 ILCS 45/4-5.1 new) | ||||||
6 | Sec. 4-5.1. Limitations on who may witness health care | ||||||
7 | agencies. | ||||||
8 | (a) Every health care agency shall bear the signature of a | ||||||
9 | witness to the signing of the agency. None of the following may | ||||||
10 | serve as a witness to the signing of a health care agency: | ||||||
11 | (1) the attending physician or mental health service | ||||||
12 | provider of the principal, or a relative of the physician | ||||||
13 | or provider; | ||||||
14 | (2) an owner, operator, or relative of an owner or | ||||||
15 | operator of a health care facility in which the principal | ||||||
16 | is a patient or resident; | ||||||
17 | (3) a parent, sibling, or descendant, or the spouse of | ||||||
18 | a parent, sibling, or descendant, of either the principal | ||||||
19 | or any agent or successor agent, regardless of whether the | ||||||
20 | relationship is by blood, marriage, or adoption; | ||||||
21 | (4) an agent or successor agent for health care. | ||||||
22 | (b) The prohibition on the operator of a health care | ||||||
23 | facility from serving as a witness shall extend to directors | ||||||
24 | and executive officers of an operator that is a corporate | ||||||
25 | entity but not other employees of the operator.
|
| |||||||
| |||||||
1 | (755 ILCS 45/4-10) (from Ch. 110 1/2, par. 804-10)
| ||||||
2 | Sec. 4-10. Statutory short form power of attorney for | ||||||
3 | health care.
| ||||||
4 | (a) The following form prescribed in this Section | ||||||
5 | (sometimes also referred to in this Act as the
"statutory | ||||||
6 | health care power") may be used to grant an agent powers with
| ||||||
7 | respect to the principal's own health care; but the statutory | ||||||
8 | health care
power is not intended to be exclusive nor to cover | ||||||
9 | delegation of a parent's
power to control the health care of a | ||||||
10 | minor child, and no provision of this
Article shall be | ||||||
11 | construed to invalidate or bar use by the principal of any
| ||||||
12 | other or
different form of power of attorney for health care. | ||||||
13 | Nonstatutory health
care powers must be
executed by the | ||||||
14 | principal, designate the agent and the agent's powers, and
| ||||||
15 | comply with Section 4-5 of this Article, but they need not be | ||||||
16 | witnessed or
conform in any other respect to the statutory | ||||||
17 | health care power. When a
power of attorney in substantially | ||||||
18 | the
following form prescribed in this Section is used, | ||||||
19 | including the "Notice to the Individual Signing the Illinois | ||||||
20 | Statutory Short Form Power of Attorney for Health Care" (or | ||||||
21 | "Notice" paragraphs) "notice" paragraph at the beginning of the | ||||||
22 | form on a separate sheet in 14-point type
in capital letters , | ||||||
23 | it shall have the meaning and effect prescribed in this
Act. A | ||||||
24 | power of attorney for health care shall be deemed to be in | ||||||
25 | substantially the same format as the statutory form if the |
| |||||||
| |||||||
1 | explanatory language throughout the form (the language | ||||||
2 | following the designation "NOTE:") is distinguished in some way | ||||||
3 | from the legal paragraphs in the form, such as the use of | ||||||
4 | boldface or other difference in typeface and font or point | ||||||
5 | size, even if the "Notice" paragraphs at the beginning are not | ||||||
6 | on a separate sheet of paper or are not in 14-point type, or if | ||||||
7 | the principal's initials do not appear in the acknowledgement | ||||||
8 | at the end of the "Notice" paragraphs. The statutory health | ||||||
9 | care power may be included in or
combined with any
other form | ||||||
10 | of power of attorney governing property or other matters.
| ||||||
11 | (b) The Illinois Statutory Short Form Power of Attorney for | ||||||
12 | Health Care shall be substantially as follows: | ||||||
13 | "NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS | ||||||
14 | STATUTORY SHORT FORM POWER OF ATTORNEY FOR HEALTH CARE | ||||||
15 | PLEASE READ THIS NOTICE CAREFULLY. The form that you will | ||||||
16 | be signing is a legal document. It is governed by the Illinois | ||||||
17 | Power of Attorney Act. If there is anything about this form | ||||||
18 | that you do not understand, you should ask a lawyer to explain | ||||||
19 | it to you. | ||||||
20 | The purpose of this Power of Attorney is to give your | ||||||
21 | designated "agent" broad powers to make health care decisions | ||||||
22 | for you, including the power to require, consent to, or | ||||||
23 | withdraw treatment for any physical or mental condition, and to | ||||||
24 | admit you or discharge you from any hospital, home, or other |
| |||||||
| |||||||
1 | institution. You may name successor agents under this form, but | ||||||
2 | you may not name co-agents. | ||||||
3 | This form does not impose a duty upon your agent to make | ||||||
4 | such health care decisions, so it is important that you select | ||||||
5 | an agent who will agree to do this for you and who will make | ||||||
6 | those decisions as you would wish. It is also important to | ||||||
7 | select an agent whom you trust, since you are giving that agent | ||||||
8 | control over your medical decision-making, including | ||||||
9 | end-of-life decisions. Any agent who does act for you has a | ||||||
10 | duty to act in good faith for your benefit and to use due care, | ||||||
11 | competence, and diligence. He or she must also act in | ||||||
12 | accordance with the law and with the statements in this form. | ||||||
13 | Your agent must keep a record of all significant actions taken | ||||||
14 | as your agent. | ||||||
15 | Unless you specifically limit the period of time that this | ||||||
16 | Power of Attorney will be in effect, your agent may exercise | ||||||
17 | the powers given to him or her throughout your lifetime, even | ||||||
18 | after you become disabled. A court, however, can take away the | ||||||
19 | powers of your agent if it finds that the agent is not acting | ||||||
20 | properly. You may also revoke this Power of Attorney if you | ||||||
21 | wish. | ||||||
22 | The Powers you give your agent, your right to revoke those | ||||||
23 | powers, and the penalties for violating the law are explained | ||||||
24 | more fully in Sections 4-5, 4-6, and 4-10(b) of the Illinois | ||||||
25 | Power of Attorney Act. This form is a part of that law. The | ||||||
26 | "NOTE" paragraphs throughout this form are instructions. |
| |||||||
| |||||||
1 | You are not required to sign this Power of Attorney, but it | ||||||
2 | will not take effect without your signature. You should not | ||||||
3 | sign it if you do not understand everything in it, and what | ||||||
4 | your agent will be able to do if you do sign it. | ||||||
5 | Please put your initials on the following line indicating | ||||||
6 | that you have read this Notice: | ||||||
7 | ...................... | ||||||
8 | (Principal's initials)" | ||||||
9 | "ILLINOIS STATUTORY SHORT FORM | ||||||
10 | POWER OF ATTORNEY FOR HEALTH CARE
| ||||||
11 | (NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE | ||||||
12 | THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO MAKE | ||||||
13 | HEALTH CARE DECISIONS FOR YOU,
INCLUDING POWER TO REQUIRE, | ||||||
14 | CONSENT TO OR WITHDRAW ANY TYPE OF PERSONAL
CARE OR MEDICAL | ||||||
15 | TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND TO ADMIT
YOU | ||||||
16 | TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME OR OTHER | ||||||
17 | INSTITUTION. THIS
FORM DOES NOT IMPOSE A DUTY ON YOUR AGENT TO | ||||||
18 | EXERCISE GRANTED POWERS; BUT
WHEN POWERS ARE EXERCISED, YOUR | ||||||
19 | AGENT WILL HAVE TO USE
DUE CARE TO ACT FOR
YOUR BENEFIT AND IN | ||||||
20 | ACCORDANCE WITH THIS FORM AND KEEP A RECORD OF
RECEIPTS, | ||||||
21 | DISBURSEMENTS AND SIGNIFICANT ACTIONS TAKEN AS AGENT. A COURT
| ||||||
22 | CAN TAKE AWAY THE
POWERS OF YOUR AGENT IF IT FINDS THE AGENT IS | ||||||
23 | NOT ACTING PROPERLY. YOU MAY
NAME SUCCESSOR AGENTS UNDER THIS |
| |||||||
| |||||||
1 | FORM
BUT NOT CO-AGENTS, AND NO HEALTH CARE PROVIDER MAY BE | ||||||
2 | NAMED. UNLESS
YOU EXPRESSLY LIMIT THE DURATION OF THIS POWER
IN | ||||||
3 | THE MANNER PROVIDED BELOW, UNTIL YOU REVOKE THIS POWER OR A | ||||||
4 | COURT ACTING
ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY | ||||||
5 | EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN | ||||||
6 | AFTER YOU BECOME DISABLED. THE POWERS YOU
GIVE YOUR AGENT, YOUR | ||||||
7 | RIGHT TO REVOKE THOSE POWERS AND THE PENALTIES FOR
VIOLATING | ||||||
8 | THE LAW ARE EXPLAINED MORE FULLY IN SECTIONS 4-5, 4-6, 4-9 AND
| ||||||
9 | 4-10(b) OF THE ILLINOIS
"POWERS OF ATTORNEY FOR HEALTH CARE | ||||||
10 | LAW"
OF WHICH THIS FORM IS A PART (SEE THE BACK OF THIS FORM). | ||||||
11 | THAT LAW
EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM OF | ||||||
12 | POWER OF ATTORNEY YOU
MAY DESIRE. IF THERE IS ANYTHING ABOUT | ||||||
13 | THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER | ||||||
14 | TO EXPLAIN IT TO YOU.)
| ||||||
15 | POWER OF ATTORNEY made this .......................day of
| ||||||
16 | ................................
| ||||||
17 | (month) (year)
| ||||||
18 | 1. I, ..................................................,
| ||||||
19 | (insert name and address of principal)
hereby revoke all prior | ||||||
20 | powers of attorney for health care executed by me and appoint:
| ||||||
21 | ............................................................
| ||||||
22 | (insert name and address of agent)
| ||||||
23 | (NOTE: You may not name co-agents using this form.) | ||||||
24 | as my attorney-in-fact (my "agent") to act for me and in my | ||||||
25 | name (in any
way I could act in person) to make any and all | ||||||
26 | decisions for me concerning
my personal care, medical |
| |||||||
| |||||||
1 | treatment, hospitalization and health care and to
require, | ||||||
2 | withhold or withdraw any type of medical treatment or | ||||||
3 | procedure,
even though my death may ensue. | ||||||
4 | A. My agent shall have the same access to my
medical | ||||||
5 | records that I have, including the right to disclose the | ||||||
6 | contents
to others. My agent shall also have full power to
| ||||||
7 | authorize an autopsy and direct the disposition of my remains. | ||||||
8 | B.
Effective upon my death, my agent has the full power to | ||||||
9 | make an anatomical
gift of the following (initial one) : | ||||||
10 | (NOTE: Initial one. In the event none of the options are | ||||||
11 | initialed, then it shall be concluded that you do not wish to | ||||||
12 | grant your agent any such authority.)
| ||||||
13 | .... Any organs, tissues, or eyes suitable for | ||||||
14 | transplantation or used for
research or education.
| ||||||
15 | .... Specific organs: ................................
| ||||||
16 | .... I do not grant my agent authority to make any | ||||||
17 | anatomical gifts. | ||||||
18 | C. My agent shall also have full power to authorize an | ||||||
19 | autopsy and direct the disposition of my remains. I intend for | ||||||
20 | this power of attorney to be in substantial compliance with | ||||||
21 | Section 10 of the Disposition of Remains Act. All decisions | ||||||
22 | made by my agent with respect to the disposition of my remains, | ||||||
23 | including cremation, shall be binding. I hereby direct any | ||||||
24 | cemetery organization, business operating a crematory or | ||||||
25 | columbarium or both, funeral director or embalmer, or funeral | ||||||
26 | establishment who receives a copy of this document to act under |
| |||||||
| |||||||
1 | it. | ||||||
2 | D. I intend for the person named as my agent to be treated | ||||||
3 | as I would be with respect to my rights regarding the use and | ||||||
4 | disclosure of my individually identifiable health information | ||||||
5 | or other medical records, including records or communications | ||||||
6 | governed by the Mental Health and Developmental Disabilities | ||||||
7 | Confidentiality Act. This release authority applies to any | ||||||
8 | information governed by the Health Insurance Portability and | ||||||
9 | Accountability Act of 1996 ("HIPAA") and regulations | ||||||
10 | thereunder. I intend for the person named as my agent to serve | ||||||
11 | as my "personal representative" as that term is defined under | ||||||
12 | HIPAA and regulations thereunder. | ||||||
13 | (i) The person named as my agent shall have the power to | ||||||
14 | authorize the release of information governed by HIPAA to third | ||||||
15 | parties. | ||||||
16 | (ii) I authorize any physician, health care professional, | ||||||
17 | dentist, health plan, hospital, clinic, laboratory, pharmacy | ||||||
18 | or other covered health care provider, any insurance company | ||||||
19 | and the Medical Informational Bureau, Inc., or any other health | ||||||
20 | care clearinghouse that has provided treatment or services to | ||||||
21 | me, or that has paid for or is seeking payment for me for such | ||||||
22 | services to give, disclose, and release to the person named as | ||||||
23 | my agent, without restriction, all of my individually | ||||||
24 | identifiable health information and medical records, regarding | ||||||
25 | any past, present, or future medical or mental health | ||||||
26 | condition, including all information relating to the diagnosis |
| |||||||
| |||||||
1 | and treatment of HIV/AIDS, sexually transmitted diseases, drug | ||||||
2 | or alcohol abuse, and mental illness (including records or | ||||||
3 | communications governed by the Mental Health and Developmental | ||||||
4 | Disabilities Confidentiality Act). | ||||||
5 | (iii) The authority given to the person named as my agent | ||||||
6 | shall supersede any prior agreement that I may have with my | ||||||
7 | health care providers to restrict access to, or disclosure of, | ||||||
8 | my individually identifiable health information. The authority | ||||||
9 | given to the person named as my agent has no expiration date | ||||||
10 | and shall expire only in the event that I revoke the authority | ||||||
11 | in writing and deliver it to my health care provider. The | ||||||
12 | authority given to the person named as my agent to serve as my | ||||||
13 | "personal representative" as defined under HIPAA and | ||||||
14 | regulations thereunder and to access my individually | ||||||
15 | identifiable health information or authorize the release of the | ||||||
16 | same to third parties shall take effect immediately, even if I | ||||||
17 | designate in Paragraph 3 of this document that this agency | ||||||
18 | shall otherwise take effect at some future date. | ||||||
19 | (NOTE: The above grant of power is intended to be as broad as | ||||||
20 | possible so that your agent will have the authority to make any | ||||||
21 | decision you could make to obtain or terminate any type of | ||||||
22 | health care, including withdrawal of food and water and other | ||||||
23 | life-sustaining measures, if your agent believes such action | ||||||
24 | would be consistent with your intent and desires. If you wish | ||||||
25 | to limit the scope of your agent's powers or prescribe special | ||||||
26 | rules or limit the power to make an anatomical gift, authorize |
| |||||||
| |||||||
1 | autopsy or dispose of remains, you may do so in the following | ||||||
2 | paragraphs.) (THE ABOVE GRANT OF POWER IS INTENDED TO BE AS | ||||||
3 | BROAD AS POSSIBLE SO THAT
YOUR AGENT WILL HAVE AUTHORITY TO | ||||||
4 | MAKE ANY DECISION YOU COULD MAKE TO
OBTAIN OR TERMINATE ANY | ||||||
5 | TYPE OF HEALTH CARE, INCLUDING WITHDRAWAL OF FOOD
AND WATER AND | ||||||
6 | OTHER LIFE-SUSTAINING MEASURES, IF YOUR AGENT BELIEVES SUCH
| ||||||
7 | ACTION WOULD BE CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU | ||||||
8 | WISH TO
LIMIT THE SCOPE OF YOUR AGENT'S POWERS OR PRESCRIBE | ||||||
9 | SPECIAL RULES OR LIMIT
THE POWER TO MAKE AN ANATOMICAL GIFT, | ||||||
10 | AUTHORIZE AUTOPSY OR DISPOSE OF
REMAINS, YOU MAY DO SO IN THE | ||||||
11 | FOLLOWING PARAGRAPHS.)
| ||||||
12 | 2. The powers granted above shall not include the following | ||||||
13 | powers or
shall be subject to the following rules or | ||||||
14 | limitations : | ||||||
15 | (NOTE: Here (here you may include
any specific limitations you | ||||||
16 | deem appropriate, such as: your own
definition of when | ||||||
17 | life-sustaining measures should be withheld; a direction
to | ||||||
18 | continue food and fluids or life-sustaining treatment in
all | ||||||
19 | events; or instructions to refuse
any specific types of | ||||||
20 | treatment that are inconsistent with your religious
beliefs or | ||||||
21 | unacceptable to you for any other reason, such as blood
| ||||||
22 | transfusion, electro-convulsive therapy, amputation, | ||||||
23 | psychosurgery,
voluntary admission to a mental institution, | ||||||
24 | etc.) :
| ||||||
25 | .............................................................
| ||||||
26 | .............................................................
|
| |||||||
| |||||||
1 | .............................................................
| ||||||
2 | .............................................................
| ||||||
3 | .............................................................
| ||||||
4 | (NOTE: The subject of life-sustaining treatment is of | ||||||
5 | particular importance. For your convenience in dealing with | ||||||
6 | that subject, some general statements concerning the | ||||||
7 | withholding or removal of life-sustaining treatment are set | ||||||
8 | forth below. If you agree with one of these statements, you may | ||||||
9 | initial that statement; but do not initial more than one. These | ||||||
10 | statements serve as guidance for your agent, who shall give | ||||||
11 | careful consideration to the statement you initial when | ||||||
12 | engaging in health care decision-making on your behalf.) (THE | ||||||
13 | SUBJECT OF LIFE-SUSTAINING TREATMENT IS OF PARTICULAR | ||||||
14 | IMPORTANCE. FOR
YOUR CONVENIENCE IN DEALING WITH THAT SUBJECT, | ||||||
15 | SOME GENERAL STATEMENTS
CONCERNING THE WITHHOLDING OR REMOVAL | ||||||
16 | OF LIFE-SUSTAINING TREATMENT ARE SET
FORTH BELOW. IF YOU AGREE | ||||||
17 | WITH ONE OF THESE STATEMENTS, YOU MAY
INITIAL THAT STATEMENT; | ||||||
18 | BUT DO NOT INITIAL MORE THAN ONE):
| ||||||
19 | I do not want my life to be prolonged nor do I want | ||||||
20 | life-sustaining
treatment to be provided or continued if my | ||||||
21 | agent believes the burdens of
the treatment outweigh the | ||||||
22 | expected benefits. I want my agent to consider
the relief of | ||||||
23 | suffering, the expense involved and the quality as well as
the | ||||||
24 | possible extension of my life in making decisions concerning
| ||||||
25 | life-sustaining treatment.
| ||||||
26 | Initialed ...........................
|
| |||||||
| |||||||
1 | I want my life to be prolonged and I want life-sustaining | ||||||
2 | treatment to be
provided or continued , unless I am in a coma | ||||||
3 | which my attending physician
believes to be irreversible , in | ||||||
4 | the opinion of my attending physician, in accordance with | ||||||
5 | reasonable medical
standards at the time of reference , in a | ||||||
6 | state of "permanent unconsciousness" or suffer from an | ||||||
7 | "incurable or irreversible condition" or "terminal condition", | ||||||
8 | as those terms are defined in Section 4-4 of the Illinois Power | ||||||
9 | of Attorney Act . If and when I am in any one of these states or | ||||||
10 | conditions, I have suffered
irreversible coma, I want | ||||||
11 | life-sustaining treatment to be withheld or
discontinued.
| ||||||
12 | Initialed ...........................
| ||||||
13 | I want my life to be prolonged to the greatest extent | ||||||
14 | possible in accordance with reasonable medical standards | ||||||
15 | without
regard to my condition, the chances I have for recovery | ||||||
16 | or the cost of the
procedures.
| ||||||
17 | Initialed ...........................
| ||||||
18 | (NOTE: This power of attorney may be amended or revoked by you | ||||||
19 | in the manner provided in Section 4-6 of the Illinois Power of | ||||||
20 | Attorney Act. Your agent can act immediately, unless you | ||||||
21 | specify otherwise; but you cannot specify otherwise with | ||||||
22 | respect to your "personal representative" under subparagraph | ||||||
23 | D(iii).) (THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY | ||||||
24 | YOU IN THE MANNER
PROVIDED IN SECTION 4-6 OF THE ILLINOIS | ||||||
25 | "POWERS OF ATTORNEY FOR HEALTH CARE
LAW" (SEE THE BACK OF THIS | ||||||
26 | FORM). ABSENT AMENDMENT OR
REVOCATION, THE AUTHORITY GRANTED IN |
| |||||||
| |||||||
1 | THIS
POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE TIME THIS | ||||||
2 | POWER IS SIGNED
AND WILL CONTINUE UNTIL YOUR DEATH, AND BEYOND | ||||||
3 | IF ANATOMICAL GIFT, AUTOPSY
OR DISPOSITION OF REMAINS IS | ||||||
4 | AUTHORIZED, UNLESS A LIMITATION ON THE
BEGINNING DATE OR | ||||||
5 | DURATION IS MADE BY INITIALING AND COMPLETING EITHER OR
BOTH OF | ||||||
6 | THE FOLLOWING:)
| ||||||
7 | 3. ( ) This power of attorney shall become effective on
| ||||||
8 | .............................................................
| ||||||
9 | .............................................................
| ||||||
10 | ( NOTE: Insert insert a future date or event during your | ||||||
11 | lifetime, such as a court
determination of your disability or a | ||||||
12 | written determination by your physician that you are | ||||||
13 | incapacitated , when you want this power to first take
effect . )
| ||||||
14 | (NOTE: If you do not amend or revoke this power, or if you do | ||||||
15 | not specify a specific ending date in paragraph 4, it will | ||||||
16 | remain in effect until your death; except that your agent will | ||||||
17 | still have the authority to donate your organs, authorize an | ||||||
18 | autopsy, and dispose of your remains after your death, if you | ||||||
19 | grant that authority to your agent.) | ||||||
20 | 4. ( ) This power of attorney shall terminate on
.......
| ||||||
21 | .............................................................
| ||||||
22 | ( NOTE: Insert insert a future date or event, such as a court | ||||||
23 | determination that you are not under a legal disability or a | ||||||
24 | written determination by your physician that you are not | ||||||
25 | incapacitated, if of your
disability, when you want this power | ||||||
26 | to terminate prior to your death . )
|
| |||||||
| |||||||
1 | (NOTE: You cannot use this form to name co-agents. If you wish | ||||||
2 | to name successor agents, insert the names and addresses of the | ||||||
3 | successors in paragraph 5.) (IF YOU WISH TO NAME SUCCESSOR | ||||||
4 | AGENTS, INSERT THE NAMES AND ADDRESSES OF
SUCH SUCCESSORS IN | ||||||
5 | THE FOLLOWING PARAGRAPH.)
| ||||||
6 | 5. If any agent named by me shall die, become incompetent, | ||||||
7 | resign,
refuse to accept the office of agent or be unavailable, | ||||||
8 | I name
the following (each to act alone
and successively, in | ||||||
9 | the order named) as successors to such agent:
| ||||||
10 | .............................................................
| ||||||
11 | .............................................................
| ||||||
12 | For purposes of this paragraph 5, a person shall be considered | ||||||
13 | to be
incompetent if and while the person is a minor , or an | ||||||
14 | adjudicated
incompetent or disabled person , or the person is | ||||||
15 | unable to give prompt and
intelligent consideration to health | ||||||
16 | care matters, as certified by a licensed physician.
| ||||||
17 | (NOTE: If you wish to, you may name your agent as guardian of | ||||||
18 | your person if a court decides that one should be appointed. To | ||||||
19 | do this, retain paragraph 6, and the court will appoint your | ||||||
20 | agent if the court finds that this appointment will serve your | ||||||
21 | best interests and welfare. Strike out paragraph 6 if you do | ||||||
22 | not want your agent to act as guardian.) (IF YOU WISH TO NAME | ||||||
23 | YOUR AGENT AS GUARDIAN OF YOUR PERSON,
IN THE EVENT A COURT | ||||||
24 | DECIDES
THAT ONE SHOULD BE APPOINTED, YOU MAY, BUT ARE NOT | ||||||
25 | REQUIRED TO, DO SO BY
RETAINING THE FOLLOWING
PARAGRAPH. THE | ||||||
26 | COURT
WILL APPOINT YOUR AGENT IF THE COURT FINDS THAT SUCH
|
| |||||||
| |||||||
1 | APPOINTMENT WILL SERVE YOUR BEST INTERESTS AND WELFARE. STRIKE | ||||||
2 | OUT
PARAGRAPH 6 IF YOU DO NOT WANT YOUR AGENT TO ACT AS | ||||||
3 | GUARDIAN.)
| ||||||
4 | 6. If a guardian of my person is to be appointed, I | ||||||
5 | nominate the agent
acting under this power of attorney as such
| ||||||
6 | guardian, to serve without bond or security.
| ||||||
7 | 7. I am fully informed as to all the contents of this form | ||||||
8 | and
understand the full import of this grant of powers to my | ||||||
9 | agent.
| ||||||
10 | Dated: .......... | ||||||
11 | Signed ..............................
| ||||||
12 | ( principal's signature or mark principal )
| ||||||
13 | The principal has had an opportunity to review read the | ||||||
14 | above form and has
signed the form or acknowledged his or her | ||||||
15 | signature or mark on the form in my presence. The undersigned | ||||||
16 | witness certifies that the witness is not: (a) the attending | ||||||
17 | physician or mental health service provider or a relative of | ||||||
18 | the physician or provider; (b) an owner, operator, or relative | ||||||
19 | of an owner or operator of a health care facility in which the | ||||||
20 | principal is a patient or resident; (c) a parent, sibling, | ||||||
21 | descendant, or any spouse of such parent, sibling, or | ||||||
22 | descendant of either the principal or any agent or successor | ||||||
23 | agent under the foregoing power of attorney, whether such | ||||||
24 | relationship is by blood, marriage, or adoption; or (d) an | ||||||
25 | agent or successor agent under the foregoing power of attorney.
|
| |||||||
| |||||||
1 | ....................... | ||||||
2 | (Witness Signature) | ||||||
3 | ....................... | ||||||
4 | (Print Witness Name) | ||||||
5 | ....................... | ||||||
6 | (Street Address) | ||||||
7 | ....................... | ||||||
8 | (City, State, ZIP) | ||||||
9 | .......................... Residing at......................
| ||||||
10 | (witness)
| ||||||
11 | (NOTE: You may, but are not required to, request your agent and | ||||||
12 | successor agents to provide specimen signatures below. If you | ||||||
13 | include specimen signatures in this power of attorney, you must | ||||||
14 | complete the certification opposite the signatures of the | ||||||
15 | agents.) (YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT | ||||||
16 | AND SUCCESSOR AGENTS
TO PROVIDE SPECIMEN SIGNATURES BELOW. IF | ||||||
17 | YOU INCLUDE SPECIMEN SIGNATURES
IN THIS POWER OF ATTORNEY, YOU | ||||||
18 | MUST COMPLETE THE CERTIFICATION OPPOSITE THE
SIGNATURES OF THE | ||||||
19 | AGENTS.)
| ||||||
20 | Specimen signatures of I certify that the signatures of my
| ||||||
21 | agent (and successors). agent (and successors) are correct.
| ||||||
22 | ....................... ...................................
| ||||||
23 | (agent) (principal)
| ||||||
24 | ....................... ...................................
| ||||||
25 | (successor agent) (principal)
| ||||||
26 | ....................... ...................................
|
| |||||||
| |||||||
1 | (successor agent) (principal)"
| ||||||
2 | (NOTE: The name, address, and phone number of the person | ||||||
3 | preparing this form or who assisted the principal in completing | ||||||
4 | this form is optional.) | ||||||
5 | ......................... | ||||||
6 | (name of preparer) | ||||||
7 | ......................... | ||||||
8 | ......................... | ||||||
9 | (address) | ||||||
10 | ......................... | ||||||
11 | (phone) | ||||||
12 | (c) (b) The statutory short form power of attorney for | ||||||
13 | health care (the
"statutory health care power") authorizes the | ||||||
14 | agent to make any and all
health care decisions on behalf of | ||||||
15 | the principal which the principal could
make if present and | ||||||
16 | under no disability, subject to any limitations on the
granted | ||||||
17 | powers that appear on the face of the form, to be exercised in | ||||||
18 | such
manner as the agent deems consistent with the intent and | ||||||
19 | desires of the
principal. The agent will be under no duty to | ||||||
20 | exercise granted powers or
to assume control of or | ||||||
21 | responsibility for the principal's health care;
but when | ||||||
22 | granted powers are exercised, the agent will be required to use
| ||||||
23 | due care to act for the benefit of the principal in accordance | ||||||
24 | with the
terms of the statutory health care power and will be | ||||||
25 | liable
for negligent exercise. The agent may act in person or |
| |||||||
| |||||||
1 | through others
reasonably employed by the agent for that | ||||||
2 | purpose
but may not delegate authority to make health care | ||||||
3 | decisions. The agent
may sign and deliver all instruments, | ||||||
4 | negotiate and enter into all
agreements and do all other acts | ||||||
5 | reasonably necessary to implement the
exercise of the powers | ||||||
6 | granted to the agent. Without limiting the
generality of the | ||||||
7 | foregoing, the statutory health care power shall include
the | ||||||
8 | following powers, subject to any limitations appearing on the | ||||||
9 | face of the form:
| ||||||
10 | (1) The agent is authorized to give consent to and | ||||||
11 | authorize or refuse,
or to withhold or withdraw consent to, | ||||||
12 | any and all types of medical care,
treatment or procedures | ||||||
13 | relating to the physical or mental health of the
principal, | ||||||
14 | including any medication program, surgical procedures,
| ||||||
15 | life-sustaining treatment or provision of food and fluids | ||||||
16 | for the principal.
| ||||||
17 | (2) The agent is authorized to admit the principal to | ||||||
18 | or discharge the
principal from any and all types of | ||||||
19 | hospitals, institutions, homes,
residential or nursing | ||||||
20 | facilities, treatment centers and other health care
| ||||||
21 | institutions providing personal care or treatment for any | ||||||
22 | type of physical
or mental condition. The agent shall have | ||||||
23 | the same right to visit the
principal in the hospital or | ||||||
24 | other institution as is granted to a spouse or
adult child | ||||||
25 | of the principal, any rule of the institution to the | ||||||
26 | contrary
notwithstanding.
|
| |||||||
| |||||||
1 | (3) The agent is authorized to contract for any and all | ||||||
2 | types of health
care services and facilities in the name of | ||||||
3 | and on behalf of the principal
and to bind the principal to | ||||||
4 | pay for all such services and facilities,
and to have and | ||||||
5 | exercise those powers over the principal's property as are
| ||||||
6 | authorized under the statutory property power, to the | ||||||
7 | extent the agent
deems necessary to pay health care costs; | ||||||
8 | and
the agent shall not be personally liable for any | ||||||
9 | services or care contracted
for on behalf of the principal.
| ||||||
10 | (4) At the principal's expense and subject to | ||||||
11 | reasonable rules of the
health care provider to prevent | ||||||
12 | disruption of the principal's health care,
the agent shall | ||||||
13 | have the same right the principal has to examine and copy
| ||||||
14 | and consent to disclosure of all the principal's medical | ||||||
15 | records that the agent deems
relevant to the exercise of | ||||||
16 | the agent's powers, whether the records
relate to mental | ||||||
17 | health or any other medical condition and whether they are | ||||||
18 | in
the possession of or maintained by any physician, | ||||||
19 | psychiatrist,
psychologist, therapist, hospital, nursing | ||||||
20 | home or other health care
provider.
| ||||||
21 | (5) The agent is authorized: to direct that an autopsy | ||||||
22 | be made pursuant
to Section 2 of "An Act in relation to | ||||||
23 | autopsy of dead bodies", approved
August 13, 1965, | ||||||
24 | including all amendments;
to make a disposition of any
part | ||||||
25 | or all of the principal's body pursuant to the Illinois | ||||||
26 | Anatomical Gift
Act, as now or hereafter amended; and to |
| |||||||
| |||||||
1 | direct the disposition of the
principal's remains.
| ||||||
2 | (Source: P.A. 93-794, eff. 7-22-04.)
| ||||||
3 | (755 ILCS 45/4-12) (from Ch. 110 1/2, par. 804-12)
| ||||||
4 | Sec. 4-12. Saving clause. This Act does not in any way
| ||||||
5 | invalidate any health care agency executed or any act of any
| ||||||
6 | agent done, or affect any claim, right or
remedy that accrued, | ||||||
7 | prior to September 22, 1987.
| ||||||
8 | This amendatory Act of the 96th General Assembly does not | ||||||
9 | in any way invalidate any health care agency executed or any | ||||||
10 | act of any agent done, or affect any claim, right, or remedy | ||||||
11 | that accrued, prior to the effective date of this amendatory | ||||||
12 | Act of the 96th General Assembly. | ||||||
13 | (Source: P.A. 86-736.)
| ||||||
14 | (755 ILCS 45/2-7.5 rep.) | ||||||
15 | Section 10. The Illinois Power of Attorney Act is amended | ||||||
16 | by repealing Section 2-7.5. | ||||||
17 | Section 99. Effective date. This Act takes effect July 1, | ||||||
18 | 2011. |