Tennessee Limited (Special) Power of Attorney Form

The Tennessee limited (special) power of attorney form is to be used by a Principal in order to delegate certain duties to an Agent. An Agent will be in command of whatever responsibilities are established within the form and will be permitted to act on behalf of the Principal for the predetermined length of time (if any). Implementing a limited (special) POA form provides benefits over its counterparts as it allows the Principal to create a scope of authority which the Agent will not be permitted to exceed. This POA form will be terminated after the Agent performs their duty or once a specified time period has passed.

How to Write

Step 1 – Titled Sections –

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – The Parties – Enter the following information:

  • Name of the Principal
  • Street Address
  • City
  • State
  • AND
  • Name of the Agent
  • Street Address
  • City
  • State
  • Enter the name of the state where the powers that the document shall be served by the Agent
  • AND
  • Enter the name of the selected Successor Agent
  • Street Address
  • City
  • State
  • Provide the state where the powers document shall be acted upon by the Successor
  • Read the Terms and Conditions pertaining to this document

Step 3 – The Granting of Powers – The Principal must review the powers provided in this section of this document. Should the Principal should choose to grant any specific power, initial the line(s) preceding the statement, otherwise place an “X” in the preceding line:

  • (A) Real property transactions
  • (B) Tangible personal property transactions
  • (C) Stock and bond transactions
  • (D) Commodity and option transactions
  • (E) Banking and other financial institution transactions
  • (F) Business operating transactions
  • (G) Insurance and annuity transactions
  • (H) Estate, trust, and other beneficiary transactions
  • (I) Claims and litigation
  • (J) Personal and family maintenance
  • (K) Benefits from Social Security, Medicare, Medicaid, or other governmental programs, or military service
  • (L) Retirement plan transactions
  • (M) Tax matters

Step 4 – Additional Titles to be Reviewed –

  • Third Parties
  • Compensation
  • Disclosure

Step 5 – Signatures – Sign only before a licensed state Notary

  • Print the name of the Principal
  • Date signature in dd/mm format
  • Submit the Principal’s Signature
  • AND
  • The printed name of the Agent
  • Provide the Agent’s Signature
  • Date the signature in mm/dd/yyyy format
  • AND
  • Print the name of the Successor Agent
  • Successor Agent’s signature
  • Date Successor Agent’s signature in mm/dd/yyyy format

Step 6 – Notary Acknowledgement –

Once the notary has witnessed all required signatures, the Notary shall then acknowledge the document by entering all of the information required by state law, to acknowledge the document

Step 7 – Acknowledgement and Acceptance Appointment as Agent and Successor Agent – Enter the following:

  • Agent must review the acceptance information:
  • Name each Agent in their respective paragraphs
  • Enter the Agent’s signatures
  • Date the signatures in mm/dd/yyyy format

Step 8 – Witness Attestation – The witnesses must review the attestation and enter:

  • Witnesses must enter their printed names
  • Witnesses must provide their signatures