Kansas Limited (Special) Power of Attorney Form

The Kansas limited (special) power of attorney form provides the Principal with the ability to elect an Attorney-in-Fact to manage certain affairs on their behalf. The Principal is able to relay the limitations of the power within the form, granting as little or as much authority as they deem necessary. The POA form linked on this page does not in fact allow the Agent (Attorney-in-Fact) to make medical decisions on account of the Principal, a medical power of attorney form should be employed in this case. Once completed, it is suggested that the form be signed in front of a Notary Public in order to validate the principal’s signature and provide proof of their consent. It is also required that two (2) adult witnesses be present during the signing of this form.

How to Write

Step 1 – Important Titled Sections – The Principal must download the document and begin by reviewing the following titled sections:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – The Parties – Enter the following information:

  • Enter the Principal’s name
  • Street Address
  • City
  • State
  • AND
  • Enter the name of the Attorney In Fact/Agent
  • Street Address
  • City
  • State
  • Enter the state in which the document will be exercised
  • AND
  • Enter the name of a Successor Attorney In Fact/Agent in the event the initial Agent becomes unwilling or unable to properly serve in this position
  • Street Address
  • City
  • State
  • Enter the state where the document will be used

Step 3 – More Titled Sections – The Principal and Agent(s) must carefully review the following:

  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

Step 4 – Signatures – Must be signed by all parties, before a Notary Public:

  • The Principal must enter their printed name
  • Date that the document is being executed in dd/mm/yyyy format
  • Review the remainder of the paragraph
  • If in agreement, Principal must enter their signature
  • AND
  • The Agent must review the paragraph  and begin by providing their printed name
  • If the Agent is in agreement with the “Attorney In Fact” section, then the Agent must provide their signature
  • Provide the date that the signature is being provided in mm/dd/yyyy format
  • AND
  • The Successor Agent (if any) must review the “Successor Attorney In Fact” section
  • If the Successor Agent is in agreement, then they must enter their Signature
  • Date the date in which the signature is being provided

Step 5 – Notary Acknowledgement –

The Notary Public will witness all of the signatures of all involved parties. Once all signatures have been witnessed by the notary, they will be required to enter all of the notary information in acknowledgement of the document and it’s signatories

Step 6 – Acknowledgement and Acceptance of Appointment as Primary Agent –

  • The primary Agent must review the paragraph provided
  • If, after review, the Agent agrees with the duties imposed, then they must enter their printed name
  • Enter the Agent’s signature
  • Enter the Date in which the Agent’s signature was provide

Step 7 – Successor Agent – The Agent must review their section of this document:

  • If the Successor Agent is in agreement, they must first enter their printed name at the top of the paragraph
  • Enter the Successor Agent’s signature
  • Provide the date in which the document was provided in mm/dd/yyyy format

Step 8 – Witness Attestation –

  • The Witnesses must review the information pertaining to the Witness Attestation
  • If the Witnesses are in agreement, enter the printed name of the witness in the first line of the paragraph
  • Enter the Witnesses signatures (respectively), both within the same paragraph