Connecticut Limited (Special) Power of Attorney Form

The Connecticut limited (special) power of attorney form is a binding document between two individuals, the Principal and the Attorney-in-Fact/Agent, which bestows certain powers upon the Attorney-in-Fact to perform specific tasks and duties on the Principal’s behalf. The special power of attorney granted to the Attorney-in-Fact will be relayed within the document and signed by the Principal in the presence of “a notary public, a commissioner of the Superior Court, or other individual authorized by law to take acknowledgment” (as stated in section 1-350d of the Connecticut Uniform Power of Attorney Act).

How To Write

Step 1 – Download the form, begin by reading the information regarding the terms on page one, to better educate yourself prior to creating the form.

Step 2 – Principal – Provide the following information:

  • Name of Principal
  • Physical Street Address of Principal
  • City
  • State

Step 3 – Attorney In Fact/Agent – Provide the following information regarding who the Principal is appointing as agent:

  • Name of Attorney In Fact
  • Physical Address of Attorney-in-Fact
  • City
  • State
  • Name the state in which the Attorney In Fact/Agent will perform stated duties
  • Principal must provide a detailed description of the specific powers granted to the agent in the line provided (if more room is needed, add a sheet with the additional information to be attached form)

Step 4 – Successor Attorney In Fact/Agent (This section is optional) -If the Principal would like to provide a successor attorney in fact/agent in the event the original attorney in fact becomes unable or unwilling to serve, provide the following information:

  • Name of Successor Attorney-in-Fact
  • Physical Address
  • City
  • State
  • Name the state where the successor would serve
  • Provide a detailed description of the exact powers you would like to grant your successor attorney in fact if needed in the line provided. If more room is required, add a sheet with the additional information and attach it to this form.

Step 5 – Signatures – On page three, the principal should read the 4 paragraphs provided. Prior to signing the document, you must either retain the services of a notary public and/or have at least two witnesses sign the form. It is highly recommended that you sign before a notary.

  • Once all of the people required to sign the form are in one place with a notary public
  • The Principal will provide their printed name
  • Principal will provide the date in dd/mm format for the date the document is being signed
  • Principal will read the paragraph and if in agreement, will provide a their signature
  • AND
  • Signature for Attorney In Fact/Agent – Print the name of the Attorney in Fact/Agent
  • Attorney in Fact/Agent must read the paragraph and then provide their signature
  • Attorney in Fact/Agent must provide the date in which they are signing the document in mm/dd/yyyy format
  • AND
  • Signature for Successor Attorney In Fact/Agent –  Print the name of the Successor Attorney in Fact/Agent
  • Successor Attorney in Fact/Agent must read the paragraph and then provide their signature
  • Successor Attorney in Fact/Agent must provide the date in which they are signing the document in mm/dd/yyyy format

Step 6 – Witness Attestations/Signatures –

  • Both Witnesses must print the name of each witnesses on the form in the same paragraph
  • Both Witnesses must read the witness paragraph – if they agree:
  • Each witness must provide their signatures at the end of the paragraph

Step 7 – Notarization –

  • The notary will complete all of the required information provide their signature and affix their state seal

Step 8 – Acknowledgement and Acceptance of Appointment of Attorney In Fact/Agent and Successor Attorney In Fact –

  • There are two paragraphs provided for both the Attorney In Fact and the Successor, each must review their respective paragraphs
  • Once read, if each one agrees, provide the following information:
  • Printed Name of Attorney In Fact
  • Signature of Attorney In Fact
  • Date of Signature in mm/dd/yyyy format
  • Printed Name of Successor Attorney In Fact
  • Signature of Successor Attorney In Fact
  • Date of signatnature mm/dd/yyyy

Step 9 – Once the document is complete and notarized and/or witnessed, make copies, provide the original copy to the Attorney In Fact