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Download Massachusetts Power of Attorney Forms and Templates

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MASSACHUSETTS GENERAL DURABLE POWER OF ATTORNEY FORM This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the Uniform Power of Attorney Act. This power of attorney does not authorize the agent to make health-care decisions for you. You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent’s authority will continue until you revoke the power of attorney or the agent resigns or is unable to act for you. Your agent is entitled to reasonable compensation unless you state otherwise in the Special Instructions. This form provides for designation of one agent. If you wish to name more than one agent you may name a coagent in the Special Instructions. Coagents are not required to act together unless you include that requirement in the Special Instructions. If your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent. This power of attorney becomes effective immediately unless you state otherwise in the Special Instructions. If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form. I _____________________________________________________ name the following (Name of Principal) person as my agent: Name of Agent: Agent’s Address: Agent’s Telephone Number:

Durable General ($)

NOTICE: The following form is protected by federal copyright law and may be photocopied or reproduced only by the end user for his or her personal use. Health care organizations, institutions, professionals, and others can purchase the form in quantity from Massachusetts Health Decisions, the non-profit publisher of the form and educational materials related to the Massachusetts Health Care Proxy. The form is available in English and nine other languages. A complete information packet including two copies of the form, a basic brochure, and a 16-page "User's Guide" in question-and-answer format is available for $6 postpaid. Please contact: Massachusetts Health Decisions, PO Box 417, Sharon, MA 02067. MASSACHUSETTS HEALTH CARE PROXY Information, Instructions, and Form What does the Health Care Proxy Law allow? The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions. It is an important document, however, because it concerns not only the choices you make about your health care, but also the relationships you have with your physician, family, and others who may be involved with your care. Read this and follow the instructions to ensure that your wishes are honored. Under the Health Care Proxy Law (Massachusetts General Laws, Chapter 201D), any competent adult 18 years of age or over may use this form to appoint a Health Care Agent. You (known as the "Principal") can appoint any adult EXCEPT the administrator, operator, or employee of a health care facility such as a hospital or nursing home where you are a patient or resident UNLESS that person is also related to you by blood, marriage, or adoption. What can my Agent do? Your Agent will make decisions about your health care only when you are, for some reason, unable to do that yourself. This means that your Agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions. Your Agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions. Your doctor will tell you of this if there is any sign that you would understand it. Acting with your authority, your Agent can make any health care decision that you could, if you were able. If you give your Agent full authority to act for you, he or she can consent to or refuse any medical treatment, including treatment that could keep you alive. Your Agent will make decisions for you only after talking with your doctor or health care provider, and after fully considering all the options regarding diagnosis, prognosis, and treatment of your illness or condition. Your Agent has the legal right to get any information, including confidential medical information, necessary to make informed decisions for you. Your Agent will make health care decisions for you according to your wishes or according to his/her assessment of your wishes, including your religious or moral beliefs. You may wish to talk first with your doctor, religious advisor, or other people before giving instructions to your Agent. It is very important that you talk with your Agent so that he or she knows what is important to you. If your Agent does not know what your wishes would be in a particular situation, your Agent will decide based on what he or she thinks would be in your best interests. After your doctor has determined that you lack the ability to make health care decisions, if you still object to any decision made by your Agent, your own decisions will be honored unless a Court determines that you lack capacity to make health care decisions. © Massachusetts Health Decisions 1999 Licensed for use by the Massachusetts Medical Society

Health Care

Form M-2848 Power of Attorney and Declaration of Representative Rev. 8/11 Massachusetts Department of Revenue See separate instructions. Please print or type. Part 1. Power of Attorney Name of taxpayer(s) Social Security number(s) Number and street, including apartment number or rural route Federal Identification number City/Town State Zip Hereby appoint(s) the following individual(s) as attorney(s)-in-fact to represent the taxpayer(s) before any office of the Massachusetts Department of Revenue for the following tax matter(s) (specify the type(s) of tax and year(s) or period(s) (date of death if estate tax)): Name Address Telephone number Type of tax (individual, corporate, etc.) Year(s) or period(s) (date of death if estate tax) The attorney(s)-in-fact (or any of them) are authorized, subject to any limitations set forth below or to revocation, to receive confidential information and to perform any and all acts that the principal(s) can perform with respect to the above specified tax matters, such as the authority to sign any agreements, consents or other documents.The authority does not include the power to substitute another representative (unless specifically added below) or the power to receive refund checks. List any specific additions or deletions to the acts otherwise authorized in this power of attorney: Originals of notices and other written communications go to the taxpayer(s). Send copies of all notices and all other written communications addressed to the taxpayer(s) in proceedings involving the above tax matters to: 1 the appointee first named above, or 2 (name of another appointee designated above) This power of attorney revokes all earlier powers of attorney on file with the Department of Revenue for the same tax matters and years or periods covered by this power of attorney, except the following (specify to whom granted, date and address including Zip code or attach copies of earlier powers): Signature of or for taxpayer(s). If signed by a corporate officer, partner, or fiduciary on behalf of the taxpayer, I certify that I have the authority to execute this power of attorney on behalf of the taxpayer. Signature Title (if applicable) Date If signing for a taxpayer who is not an individual, type or print your name Signature Title (if applicable) Date A B C D E

State Tax Filing (M-2848)

Massachusetts power of attorney allows for a resident to make someone have the legal right to act in his or her place for any financial or medical related decision. All acts by the representative must be in the best interests of the Principal and the form must be signed with a Notary Public present to be legal. View the Statutes and Laws if either party has any questions about their rights and responsibilities.

Durable General ($) – Allows for a principal to grant any and all access for someone else to act and make financial decisions on their behalf. This is common among the elderly where you usually have bills and financial guidance needed if one can no longer think for themselves. The document needs to be signed after it is completed in the presence of a notary public.
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Medical – Also known as a “Health Care Proxy”, allows a person to choose a medical surrogate to handle their treatment and facility decisions as well as set up a living will.
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State Tax – Choose an agent (usually a Certified Public Accountant or Tax Attorney) to handle the filing of State taxes. It is recommended to choose someone knowledgeable in the field as the principal will ultimately be responsible for any mis-filings or errors in their statement.
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Sources

Durable General – www.sportslegalforms.com
Medical – www.massmed.org
Tax (M-2848) – www.mass.gov/dor/docs/dor/forms/miscform/pdfs/m-2848.pdf

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