ENDURING POWER OF ATTORNEY QUESTIONNAIRE

Attorney (the person or persons that will make financial decisions for you, this does not mean lawyer):

If you want more than one attorney to act together (joint attorneys), name the other attorney or attorneys here:

If you are naming more than two attorneys, do they make decisions on a majority basis or do they all have to agree?

If you are not naming joint attorneys and your first-named attorney cannot or will not act, name your second choice (your alternate attorney) here:

If your alternate attorney cannot or will not act, name your third choice here:

Indicate whether you want this power of attorney to come into effect immediately when you sign it, or only once you are incapacitated (called a “springing” enduring power of attorney because it “springs” into effect only when and if you lose capacity to make reasonable judgments relating to all or any part of your estate). Remember, this relates to your finances and property only, this is not for personal or medical decisions:

Note: If this is a springing power of attorney, you may name the person who decides whether or not you still have capacity to make reasonable judgments relating to all or some part of your estate:

If you want to expand your attorney’s powers beyond what happens automatically by law, indicate which of the following you want your attorney to be able to do with your assets:

Name any particular thing(s) you do not wish your attorney to do (such as sell certain real property that you own — you may want to consider items you have named in your will for giving, or items that have sentimental or particular value to you or others and should be kept, if at all possible):

Indicate below how you want your attorney to be paid for the time and effort acting on your behalf:

Do you own:

How do you want your attorney to invest money on your behalf:

e.g., 50% capital guaranteed/50% whatever they decide

or 75% capital guaranteed/25% whatever they decide

or 25% capital guaranteed/75% whatever they decide