Illinois Power of Attorney
This document serves as a Power of Attorney in accordance with the laws of the state of Illinois. Please complete the sections below to designate an agent who will act on your behalf.
Principal Information:
- Name: __________________________
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- City: __________________________
- State: __________________________
- Zip Code: __________________________
- Date of Birth: __________________________
Agent Information:
- Name: __________________________
- Address: __________________________
- City: __________________________
- State: __________________________
- Zip Code: __________________________
- Phone Number: __________________________
Powers Granted:
Check all that apply:
Effective Date:
This Power of Attorney becomes effective on: __________________________.
Revocation:
This document may be revoked at any time by notifying the agent in writing.
Signature:
Executed this ____ day of ______________, 20___.
______________________________
Signature of Principal
Witness Information:
Signature of Witness: __________________________
Name of Witness: __________________________
Address of Witness: __________________________
This template is not a substitute for legal advice. It is recommended to consult with a qualified attorney before signing any legal documents.