STATUTORY SHORT FORM POWER OF ATTORNEY
MINNESOTA STATUTES, SECTION 523.23
IMPORTANT NOTICE: The powers granted by this document are broad and sweeping. They are defined in Minnesota Statutes section 523.24. If you have any questions about these powers, obtain competent advice. This power of attorney may be revoked by you if you wish to do so. This power of attorney is automatically terminated if it is to your spouse and proceedings are commenced for dissolution, legal separation or annulment of your marriage. This power of attorney authorizes, but does not require, the attorney-in-fact to act for you
Principal Name
Principal Address
ATTORNEY(S)-IN-FACT
(Names and Addresses)
SUCCESSOR ATTORNEY(S)-IN-FACT (Optional) To act if any named attorney-in-fact dies, resigns or is otherwise unable to serve. (Name and Address)
First Successor
Address
Second Successor
Address
NOTICE: If more than one attorney-in-fact is designated, make a check or “x” on the line in front of one of the following statements:
Each attorney-in-fact may independently exercise the powers granted.
All attorneys-in-fact must jointly exercise the powers granted.
EXPIRATION DATE (Optional)
MM slash DD slash YYYY

Use specific month, day and year only

I (the above named Principal), appoint the above named Attorney(s)-in-fact:
FIRST: To act for me in any way I could act with respect to the following matters, as each of them is defined in Minnesota Statutes, section 523.24:
(To grant the attorney-in fact any of the following powers, make a check or “x” on the line in front of each power being granted. You may, but need not, cross out each power not granted. Failure to make a check or “x” on the line in front of the power will have the effect of deleting the power unless the line in front of the power N is checked or x-ed.)
Check or “x”
(A) Real property transactions;
I choose to limit this power to real property in
County, MN described as follows: (use legal description. Do not use address.)
(If more space is needed, continue on the back or on an attachment.)
(B) Tangible personal property transactions;
(C) Bond, share, and commodity transactions;
(D) Banking transactions;
(E) Business operating transactions;
(F) Insurance transactions;
(G) Beneficiary transactions;
(H) Gift transactions;
(I) Fiduciary transactions;
(J) Claims and litigations;
(K) Family maintenance;
(L) Benefits from military service;
(M) Records, reports, and statements;
(N) All of the powers listed in (A) through (M) above and all other matters.
SECOND: (you must indicate below whether or not this power of attorney will be effective if you become incapacitated or incompetent. Make a check or “x” on the line in front of the statement that expresses you intent.)
This power of attorney shall continue to be effective if I become incapacitated or incompetent.
This power of attorney shall not be effective if I become incapacitated or incompetent.

THIRD: (you must mark below whether or not this power of attorney authorizes the attorney-in-fact to transfer your property to the attorney-in-fact. Make a check or “x” on the line in front of the statement that expresses your intent.)
This power of attorney authorizes the attorney-in-fact to transfer my property to the attorney-in-fact.
This power of attorney does not authorize the attorney-in-fact to transfer my property to the attorney-in-fact.
FOURTH: (you may indicate below whether or not the attorney-in-fact is required to make an accounting. Make a check or “x” on the line in front of the statement that expresses your intent.)
My attorney-in-fact does not have to give an accounting unless I ask for it or the accounting is
otherwise required by Minnesota Statutes, section 523.21.
My attorney-in-fact must give monthly, quarterly, annual (circle one) accountings to me, or to
Name
Address
during my lifetime, and a final accounting to the personal representative of my estate, if any is appointed, after my death.
In Witness Whereof I have hereunto signed my name this (date)
MM slash DD slash YYYY

In Witness Whereof I have hereunto signed my name this (date)
(Signature of Principal)
(Acknowledgment of Principal)
STATE OF MINNESOTA
County of
The foregoing instrument was acknowledged before me this (date)
MM slash DD slash YYYY

The foregoing instrument was acknowledged before me this (date)
by (Insert name of principal)
by (Insert name of principal)
Signature of Notary Public
This instrument was drafted by:
Specimen signature(s) of Attorney(s)-in-Fact:
(Notarization not required)

REVOCATION OF POWER OF ATTORNEY
Minnesota Statutes, § 523.11
TO WHOM IT MAY CONCERN:
I (your name)
I (your name)
revoke and declare null and void the POWER OF ATTORNEY I granted to
revoke and declare null and void the POWER OF ATTORNEY I granted to
which is dated
MM slash DD slash YYYY

which is dated
Please be advised that the above-named person no longer has power to act as my attorney-in-fact in any way.
Date
MM slash DD slash YYYY
(Principal)
(Principal)
STATE OF MINNESOTA County of
The foregoing instrument was acknowledged before me this (date)
MM slash DD slash YYYY

The foregoing instrument was acknowledged before me this (date)
By:
By:
Notary Public
Notary Public
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[Power of Attorney] Minnesota

[Power Of Attorney] Minnesota

Step 1 of 4

STATUTORY SHORT FORM POWER OF ATTORNEY
MINNESOTA STATUTES, SECTION 523.23

REVOCATION OF POWER OF ATTORNEY

Minnesota Statutes, § 523.11

[Power Of Attorney] Minnesota

Step 1 of 4

STATUTORY SHORT FORM POWER OF ATTORNEYMINNESOTA STATUTES, SECTION 523.23

REVOCATION OF POWER OF ATTORNEY

Minnesota Statutes, § 523.11

STATUTORY SHORT FORM POWER OF ATTORNEY
MINNESOTA STATUTES, SECTION 523.23