Rhode Island Limited (Special) Power of Attorney Form

The Rhode Island limited (special) power of attorney form allows a Principal to entrust an Agent with the authority to act on their behalf. The Principal should nominate an Agent who is trustworthy, one who will operate in good faith and with the Principal’s best interests in mind. Contrary to a general POA form, a limited (special) POA form allows the Principal to establish specific scenarios where their authority is permitted, such as when they are overseas or in an emergency. This particular form also allows the Principal to permit their authority for a specified amount of time and/or until a tasks has been accomplished (e.x. picking up a vehicle, receiving mail).

How to Write

1 – Notice to Principal

The Principal must carefully review the following sections:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary
  • AND
  • Additional Titles toward the end of the document:
  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

2 – Principal and Agent(s)

Provide the following information in section titled “V. Principal:”

  • The Principal’s Full Name should be reported on the blank space labeled “Name of Principal.”
  • The Principal’s Street Address (Building Number/Street/Apt Number) must be reported on the blank space labeled “Street Address of Principal.”
  • The City where the Principal’s Street Address is found should be filled into the blank space labeled “City of Principal.”
  • The State where the Principal’s City is located should be entered on the blank space labeled “State of Principal.”

Supply the following information, using the spaces provided, in the “VI. Attorney-In-Fact” section.

  • The blank space labeled “Name of Attorney-in-Fact” must have the Full Name of the person who may act with Principal Authority entered.
  • The blank line, designated “Street Address of Attorney-in-Fact” will require the Building Number, the Street Name, and the Unit Number/Apartment Number where the Attorney-in-Fact will be physically found.
  • The blank space designated as “City of Attorney-in-Fact” will require the Attorney-in-Fact’s City to be filled in
  • The blank space, with the label “State of Attorney-in-Fact,” will require the Attorney-in-Fact’s State to be filled in.
  • The next space, labeled “State,” must have the State where the Attorney-in-Fact may utilize the Power of Attorney granted by this document.
  • The final blank line of this section, “A Detailed Description of Exact Powers granted,” will require a Principal report on what exact the Attorney-in-Fact may do and/or decide upon displayed. The Principal is encouraged to be very specific when providing this description.

If the Principal wishes to name a Successor Attorney-In-Fact, then document the requested information in the blank spaces in the section labeled “VII. Successor Attorney-In-Fact:”

  • Document the Full Name of the Successor Attorney-In-Fact, using the first blank space in this section (following the word “…appoint”)
  • Document the Building Number/Street/Unit Number where the Successor Attorney-In-Fact is found using the second blank line in this paragraph
  • Use the blank spaces following the terms “City of” and “State of” to document the City and State where the Successor Attorney-In-Fact.
  • Report the State where the Successor Attorney-in-Fact may act with Principal Authority.
  • Next, on the blank line labeled “A Detailed Description of Exact Powers granted,” must have a full report from the Principal on what powers the Successor Attorney-in-Fact may have in Principal matters.

3 – Signatures

Signatures must only be signed in the presence of a licensed Notary Public. The Principal must personally supply the following information in “XII. Principal’s Signature:”

  • The Principal’s Name must be printed in “Printed Name of Principal.”
  • Use the blank space labeled “Day” to enter the Calendar Date when the Principal signs this document.
  • Use the blank space labeled “Month,” to enter the Month and Year when the Principal signs this document
  • The Principal must sign his or her name on the blank space labeled “Signature of Principal”

The Attorney-in-Fact will also be require to provide items in the blank spaces in the “XIII. Attorney-In-Fact’s Signature:”

  • The Attorney-in-Fact must print his or her name on the blank line labeled “Name of Attorney-in-Fact.”
  • The Attorney-in-Fact must sign his or her Name on the blank line labeled “Signature of Attorney-in-Fact”
  • The Attorney-in-Fact must enter the Day, Month, and Year he or she is signing this document on the blank line labele “Date.”

In cases where the Principal has named a Successor Attorney-in-Fact, the “VIV. Successor Attorney-in-Fact’s Signature” will need to be filled out.

  • The first blank space, “Name of successor Attorney-in-Fact,” must have the printed name of this individual provided
  • The Successor Attorney-in-Fact must sign the blank line labeled “Signature of Successor Attorney-in-Fact”
  • Finally the Successor Attorney-in-Fact must report the Date he or she signed this document on the space labeled “Date”

Generally such documentation must be signed in the presence of two Witnesses. If this is the case, then each witness must fill in the section labeled “Witness Attestation:’

  • The first Witness must print his or her name on the blank space labeled “Printed Name of First Witness”
  • The second Witness must print his or her name on the second blank space, labeled “Printed Name of Second Witness”
  • The first Witness must sign the line labeled “Signature of First Witness”
  • The second Witness must sign the line labeled “Signature of Second Witness”

4 – Notary Acknowledgment

After the Notary Public has witnessed all required signatures, they must then enter all of the state required notarization information. This will provide acknowledgement of the document. Only a Notary Public attending this document’s signing may supply the necessary items on the page labeled “Notary Acknowledgment (Must be completed by Notary)”

5 – Acknowledgement and Acceptance of Agents

The Agents shall carefully review the acknowledgement statements and supply the requested items. First the Attorney-in-Fact must locate the paragraph labeled “Acknowledgment and Acceptance of Appointment as Attorney-in-Fact:”

  • The first blank space, “Name of Attorney-in-Fact,” necessitates the Printed Name of the Attorney-in-Fact to be provided
  • The blank line designated as “Signature of Attorney-in-Fact” must be signed by the Attorney-in-Fact
  • The Attorney-in-Fact must enter the date he or she signed this document on the line labeled “Date”

If a Successor Attorney-in-Fact has been named then he or she must read and tend to the paragraph labeled “Acceptance of Appointment as successor Attorney-in-Fact:”

  • The Successor Attorney-in-Fact must print his or her Full Name on the space labeled “Name of successor Attorney-in-Fact”
  • The “Signature of Successor Attorney-in-Fact” line must have the Signature of the Successor Attorney-in-Fact
  • The line labeled “Date,” requires the Successor Attorney-in-Fact to report the Date he or she signed this form