Kentucky Limited (Special) Power of Attorney Form

The Kentucky limited (special) power of attorney form grants a person the ability to transfer power to an Agent in order to enable them to transact specific tasks and duties on their behalf. The Principal may be as broad or as narrow as they please when defining the scope of the authority bestowed on the Attorney-in-Fact within the document. They may specify tasks as simple as receiving mail and paying bills, or as complex as purchasing or renting property. Once the form has been completed, it should be signed by both parties in the presence of a Notary Public and two (2) adult witnesses.

How to Write

Step 1 – Review of the Titled Sections – The Principal must review of the following titled sections:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – Parties – Provide the following:

  • The Principal’s name
  • The Street Address
  • City
  • State
  • AND
  • Submit the name of the Attorney In Fact/Agent
  • Their Physcial/Street Address
  • City
  • State
  • Enter the state in which the document has been executed
  • AND
  • (Optional) -Enter the name of a Successor Attorney In Fact/Agent should the initial Agent become unable to properly serve in this position
  • Their Street Address
  • City
  • State
  • Provide the state where the document will be utilized

Step 3 – Additional Titled Sections – The Principal and Agent(s) should review the following:

  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

Step 4 – Signatures – Must be signed before a Notary Public:

  • Enter the Principal’s Printed Name
  • Date in which the document is being executed in dd/mm/yyyy format
  • Carefull review the remaining portion of the paragraph
  • If the Principal agrees they must enter their signature
  • AND
  • The Agent must review the remainder of the paragraph and enter their printed name
  • If the Agent is in agreement with the “Attorney In Fact” section, the Agent must submit  their signature on the line provided on the form
  • Provide the date that the signature is provided in mm/dd/yyyy format
  • AND
  • The Successor Agent (if any) must carefully read the “Successor Attorney In Fact” section
  • If the Successor Agent agrees, then they shall enter their Signature
  • Enter the date in which the signature is being entered

Step 5 – Notary Acknowledgement –

The Notary Public will witness all signatures of all of the signatories. Once all signatures have been witnessed, the Notary Public will be required to enter all of the notary information that will place the document in acknowledgement of the document as well as it’s signatories

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

  • The primary Agent must read the paragraph
  • Should the Agent agree with the statements, they must enter their printed name
  • Submit the Agent’s signature
  • Enter the Date that the Agent’s signature is being provided

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

  • Should the Successor Agent find that they are in agreement, they must enter their printed name
  • Provide the Successor Agent’s signature
  • Submit the date in which the document has provided in mm/dd/yyyy format

Step 8 – Witness Attestation –

  • The Witnesses must review the information located in the Witness Attestation
  • If the Witnesses agree, enter the printed name of the witness
  • Enter the Witnesses respective signatures. Both printed names and signatures will be entered within the same paragraph