ENDURING POWER OF ATTORNEY QUESTIONNAIRE

Date

Given Name

Family Name

Middle Name

Address

City

Province

Postal code

Phone

Fax

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

Given Name

Family Name

Middle Name

Address

City

Province

Postal code

Phone

Fax

Relationship

Age

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

Given Name

Family Name

Middle Name

Address

City

Province

Postal code

Phone

Fax

Relationship

Age

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

Given Name

Family Name

Middle Name

Address

City

Province

Postal code

Phone

Fax

Relationship

Age

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

Given Name

Family Name

Middle Name

Address

City

Province

Postal code

Phone

Fax

Relationship

Age

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

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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

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