West Virginia Limited (Special) Power of Attorney Form

The West Virginia limited (special) power of attorney form is used when the Principal (the individual issuing the form) wishes to bestow specific powers to an Agent. This Agent will only have the authority to transact the detailed list of tasks (often a singular act) relayed within the document. This can be as simple as receiving mail on behalf of the Principal or as significant as purchasing real estate. The document should provide the name and signature of the Principal as well as that of the Agent. It may also include the name and signature of a successor should the initial choice be unable to complete the specified acts. In accordance with WV Code § 39B-1-105 (through 1st Spec. Sess. 2012), the signature of the Principal must be acknowledged before a Notary Public in order for it to be considered genuine.

How to Write

Step 1 – Titled Subjects – Read the following:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – The Parties – Submit:

  • Principal’s name
  • Street Address
  • City
  • State
  • AND
  • Agent’s name
  • Street Address
  • City
  • State
  • Enter the state where the financial acts shall be performed
  • AND
  • Successor Agent’s name
  • Street Address
  • City
  • State
  • Enter the state where the financial acts will be provided

Step 4 – Additional Titles –

  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

Step 5 – Signatures – Witnesses and Notary acknowledgement required:

  • Print the Principal’s name
  • Date the signature in dd/mm format
  • Principal’s Signature
  • AND
  • Agent’s printed name
  • Agent’s Signature
  • Date the signature in mm/dd/yyyy format
  • AND
  • Alternate Agent’s printed name (optional)
  • Alternate Agent’s signature
  • Date Alternate’s signature in mm/dd/yyyy format

Step 6 – Notary Acknowledgement –

  • As the notary witnesses the signatures, the notary shall submit all remaining, required information

Step 7 – Acknowledgement and Acceptance of Appointment as Agent and Successor Agent –

  • Agents must read and agree to acceptance
  • Enter the name of the Agents (respective)
  • Agents signatures
  • Date signatures in mm/dd/yyyy formats

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

  • Witnesses – Submit printed names
  • Witnesses provide signatures (respectively)