{"data":{"id":"us-ia/iowa-code-633b.301","jurisdiction":"us-ia","citation":"Iowa Code § 633B.301","heading":"Power of attorney — form.","body":"A document substantially in the following form may be used to create a statutory power of attorney that has the meaning and effect prescribed by this chapter:\nIOWA STATUTORY POWER OF ATTORNEY FORM\n1. POWER OF ATTORNEY\nThis power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including but not limited to your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B.\nThis power of attorney does not authorize the agent to make health care decisions for you.\nYou should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent’s authority will continue until you die or revoke the power of attorney or the agent resigns or is unable to act for you.\nYour agent is not entitled to compensation unless you state otherwise in the optional Special Instructions.\nThis form provides for designation of one agent. If you wish to name more than one agent, you may name a coagent in the optional Special Instructions. Coagents must act by majority rule unless you provide otherwise in the optional Special Instructions.\nIf your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent.\nThis power of attorney becomes effective immediately upon signature and acknowledgment unless you state otherwise in the optional Special Instructions.\nIf you have questions about this power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.\nDESIGNATION OF AGENT\nI _________________________ (name of principal) name the following person as my agent:\nName of Agent ____________________________________________\nAgent’s Address __________________________________________\nAgent’s Telephone Number _________________________________\nDESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL)\nIf my agent is unable or unwilling to act for me, I name as my successor agent:\nName of Successor Agent __________________________________\nSuccessor Agent’s Address ________________________________\nSuccessor Agent’s Telephone Number _______________________\nIf my successor agent is unable or unwilling to act for me, I name as my second successor agent:\nName of Second Successor Agent ___________________________\nSecond Successor Agent’s Address _________________________\nSecond Successor Agent’s Telephone Number ________________\nGRANT OF GENERAL AUTHORITY\nI grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in the Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B:\n(Initial each subject you want to include in the agent’s general authority. If you wish to grant general authority over all of the subjects you may initial “All Preceding Subjects” instead of initialing each subject.)\n___ Real Property\n___ Tangible Personal Property\n___ Stocks and Bonds\n___ Commodities and Options\n___ Banks and Other Financial Institutions\n___ Operation of Entity or Business\n___ Insurance and Annuities\n___ Estates, Trusts, and Other Beneficial Interests\n___ Claims and Litigation\n___ Personal and Family Maintenance\n___ Benefits from Governmental Programs or Civil or Military Service\n___ Retirement Plans\n___ Taxes\n___ All Preceding Subjects\nGRANT OF SPECIFIC AUTHORITY (OPTIONAL)\nMy agent shall not do any of the following specific acts for me unless I have initialed the specific authority listed below:\n(Caution: Granting any of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death. Initial only the specific authority you WANT to give your agent.)\n___ Amend, revoke, or terminate a revocable inter vivos trust, if authorized by the trust.\n___ Agree to the amendment or termination of any other inter vivos trust.\n___ Make a gift to an individual who is not an agent, subject to the limitations of the Iowa Uniform Power of Attorney Act, Iowa Code section 633B.217, and any special instructions in this power of attorney.\nMake gifts, either direct or indirect, to my agent acting under this power of attorney as follows:\n___ Any such gift must be approved in writing by ________________; or\n___ No third-party approval is needed.\n___ Authorize another person to exercise the authority granted under this power of attorney.\n___ Waive the principal’s right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan.\n___ Exercise fiduciary powers that the principal has authority to delegate.\n___ Disclaim or refuse an interest in property, including a power of appointment.\nLIMITATION ON AGENT’S AUTHORITY\nAn agent that is not my ancestor, spouse, or descendant shall not use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the optional Special Instructions.\nSPECIAL INSTRUCTIONS (OPTIONAL)\nYou may give special instructions on the following lines:\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n___________________________________________________________\n_________________________ shall have the authority to request an accounting of any agent.\nEFFECTIVE DATE\nThis power of attorney is effective immediately upon signature and acknowledgment unless I have stated otherwise in the optional Special Instructions.\nNOMINATION OF CONSERVATOR AND GUARDIAN (OPTIONAL)\nIf it becomes necessary for a court to appoint a conservator of my estate or guardian of my person, I nominate the following person(s) for appointment:\nName of Nominee for Conservator of My Estate _____________\nNominee’s Address ________________________________________\nNominee’s Telephone Number _______________________________\nName of Nominee for Guardian of My Person ________________\nNominee’s Address ________________________________________\nNominee’s Telephone Number _______________________________\nRELIANCE ON THIS POWER OF ATTORNEY\nAny person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless that person knows it has terminated or is invalid.\nSIGNATURE AND ACKNOWLEDGMENT\n_____________________________\t_________________________\nYour Signature\tDate\n_____________________________\nYour Name Printed\n_____________________________\n_____________________________\nYour Address\n_____________________________\nYour Telephone Number\nState of ____________________\nCounty of ___________________\nThis document was acknowledged before me on _______________ (date), by __________________________ (name of principal)\n_____________________________\t(Seal, if any)\nSignature of Notary\nMy commission expires ________________\nThis document prepared by\n___________________________________________________________\n___________________________________________________________\n2. IMPORTANT INFORMATION FOR AGENT\nAGENT’S DUTIES\nWhen you accept the authority granted under this power of attorney, a special legal relationship is created between the principal and you. This relationship imposes upon you legal duties that continue until you resign or the power of attorney is terminated or revoked. You must do all of the following:\nDo what you know the principal reasonably expects you to do with the principal’s property or, if you do not know the principal’s expectations, act in the principal’s best interest.\nAct in good faith.\nDo nothing beyond the authority granted in this power of attorney.\nDisclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as agent in the following manner:\n_______________________ (principal’s name) by\n_______________________ (your signature) as Agent\nUnless the Special Instructions in this power of attorney state otherwise, you must also do all of the following:\nAct loyally for the principal’s benefit.\nAvoid conflicts that would impair your ability to act in the principal’s best interest.\nAct with care, competence, and diligence.\nKeep a record of all receipts, disbursements, and transactions made on behalf of the principal.\nCooperate with any person that has authority to make health care decisions for the principal to do what you know the principal reasonably expects or, if you do not know the principal’s expectations, to act in the principal’s best interest.\nAttempt to preserve the principal’s estate plan if you know the plan and preserving the plan is consistent with the principal’s best interest.\nTERMINATION OF AGENT’S AUTHORITY\nYou must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include any of the following:\nDeath of the principal.\nThe principal’s revocation of the power of attorney or your authority.\nThe occurrence of a termination event stated in the power of attorney.\nThe purpose of the power of attorney is fully accomplished.\nIf you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal separation, unless the Special Instructions in this power of attorney state that such an action will not terminate your authority.\nLIABILITY OF AGENT\nThe meaning of the authority granted to you is defined in the Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B. If you violate the Iowa Uniform Power of Attorney Act, Iowa Code chapter 633B, or act outside the authority granted, you may be liable for any damages caused by your violation.\nIf there is anything about this document or your duties that you do not understand, you should seek legal advice.","path":["Title XV - JUDICIAL BRANCH AND JUDICIAL PROCEDURES (Ch. 595 - 686D)","Chapter 633B - POWERS OF ATTORNEY","Subchapter III - FORMS"],"source_url":"https://www.legis.iowa.gov/docs/code/2026/633B.301.pdf","current_through":"Iowa Code 2026 edition","vintage":"","retrieved_at":"2026-09-14T19:40:16Z","sha256":"411895cf28aed948b4ee08f77a0c1717d2ab87be96b238301655a800f48ea012","source_id":"us-ia","stale":false,"prev":"us-ia/iowa-code-633b.300","next":"us-ia/iowa-code-633b.302"},"notice":"GroundRules: Original legal text. Not legal advice."}