Utah Limited (Special) Power of Attorney Form

The Utah limited (special) power of attorney form is a document which is used to permit an Agent to handle the personal and business affairs of a Principal, to be effective only under the circumstance(s) defined within the form. This written delegation of authority may be necessary when the Principal is preparing for overseas travel or surgery; the Principal can rest assured knowing that the Agent is legally able to act on their behalf up to the extent defined within the document. The form shall be signed by the Principal before a Notary Public or other individual authorized by law to make such acknowledgments. If the Principal is physically incapable of providing their signature, a separate individual may sign so long as the individual is in the Principal’s conscious presence.

How to Write

Step 1 – Titled Sections – Read the information contained in:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – The Parties – Submit the following information:

  • The name of the Principal
  • Street Address
  • City
  • State
  • AND
  • The name of the Agent
  • Street Address
  • City
  • State
  • AND
  • The name of the selected Successor Agent
  • Street Address
  • City
  • State

Step 3 – Additional Titles

  • Third Parties
  • Compensation
  • Disclosure

Step 5 – Signatures – Sign before a licensed state Notary

  • The name of the Principal
  • Date signature in dd/mm format
  • Enter the Principal’s Signature
  • AND
  • Printed name of the Agent
  • Enter  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’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 the information required by state law, to acknowledge the document

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

  • The Agent must read the acceptance information:
  • Name each Agent
  • Enter the Agent’s signatures
  • Date the signatures in mm/dd/yyyy format

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

  • Witnesses must print their name
  • Witnesses shall provide their signatures