Indiana Limited (Special) Power of Attorney Form

The Indiana limited (special) power of attorney form is a document that is used to transfer power to the Attorney-in-Fact so they can act on behalf of the Principal in the case that they become incapacitated. The difference between a limited power of attorney and a general power of attorney is in the scope of the authority bestowed on the Agent (Attorney-in-Fact); a limited (special) POA allows the Principal to specify which tasks the Agent has the ability to undertake. In the State of Indiana, it is required that this document be signed by the principal in the presence of a Notary Public (IC 30-5-4-2).

How to Write

Step 1 – Introduction – The Principal must review the following, before proceeding:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – The Principal’s Information –

  • Printed name of the Principal
  • The Street Address
  • City
  • State
  • AND
  • Enter the printed name of the Agent
  • Street Address
  • City
  • State
  • AND
  • The state where the document has originated
  • AND
  • Enter the name of a Successor Agent
  • Street Address
  • City
  • State
  • The Principal must read all of the following Titled Sections:
  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

Step 3 – Signatures – All signatures must be entered in the presence of a Notary Public

  • Print the Name of the Principal
  • Date the signature in dd/mm format
  • Enter the signature of the Principal
  • AND
  • Enter the Printed name of the Agent
  • The Agent must read the paragraph pertaining to appointment of the agent
  • Enter the Signature of the Agent
  • Date the Signature in mm/dd/yyyy format
  • AND
  • Printed name of the Successor Agent
  • The Successor must read the information pertaining to the Successor Agent’s duties
  • The Successor Agent must enter their Signature
  • Date the Signature in mm/dd/yyyy format

When the notary has witnessed all signatures, they will provide all of the information required to acknowledge the document and shall affix the seal

  • Agent and Successor Agent’s must review the acceptance information
  • Print the names of the Agent and Successor
  • Each Delegate must enter their signatures
  • Date the signatures in mm/dd/yyyy format
  • Witnesses must enter their signatures