Minnesota Limited (Special) Power of Attorney Form

The Minnesota limited (special) power of attorney form is used when a person wishes to choose a trusted representative to execute a task on their behalf. The Principal (individual creating the power of attorney) should relay the exact responsibilities they wish to bestow on the Attorney-in-Fact to clearly dictate the scope of the authority being provided. As opposed to a general power of attorney, this document limits the Attorney-in-Fact to just a few acts (often just a single act), and the limited power of attorney is often considered terminated once the duties listed therein have been completed. Once the document has been completed in its entirety, it should be signed by the Principal and by a Notary Public in accordance with the 2016 Minnesota State Statutes.

How to Write

Step 1 – Titled Sections – The Principal must begin by reviewing the following:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – The Parties – Provide:

  • Name of the Principal
  • Principal’s address
  • The Principal’s city of residence
  • State
  • AND
  • Agent’s full name
  • Agent’s Address
  • Agent’s City of residence
  • State
  • AND
  • The Principal may wish to appoint a Successor in the the event that the initial Agent should become unwilling or unable to serve,on behalf of the Principal
  • Name a Successor Agent (Optional)
  • Enter the Successor’s Address
  • City of residence
  • State
  • The state whereas the document shall be executed

Step 3 – Additional Titled Sections – The Principal must review:

  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

Step 4 – Signatures –  All signatures must be submitted before a licensed Notary Public – Enter:

  • Principal’s printed name
  • Date the Signature in dd/mm format
  • Principal’s must enter their Signature
  • AND
  • Agent’s printed name
  • Read the remaining information in this section
  • Agent must provide their signature
  • Date the Agent’s signature in mm/dd/yyyy format
  • AND
  • Successor Agent’s Printed name
  • Review the remaining information
  • Successor Agent’s Signature
  • Enter the date that the Principal would like to place the document into effect

Step 5 – Notarization –

After the notary has witnessed the signatures of the Agent’s and Witnesses, the notary will then complete the notarization section of the document by providing the Notary’s information to include the official stamp (if any)

Step 6 – Acknowledgement and Acceptance of Appointment of Agent(s) – Initially selected Agent and the Successor Agent, must provide the following:

  • Printed name of each Agent
  • Read the remainder of the section
  • Agent’s must submit signatures
  • Both Agent’s must date their signatures in mm/dd/yyyy format

Step 7 – Witness Attestation – The witnesses must:

  • Read the Attestation paragraph
  • The witnesses must enter their printed names
  • The witnesses must enter their individual signatures