CONNECTICUT STATUTORY FINANCIAL POWER OF ATTORNEY
(Connecticut Uniform Power of Attorney Act, C.G.S. §§ 1-350 to 1-353b)
NOTICE TO PRINCIPAL
IMPORTANT INFORMATION BEFORE SIGNING
This is an important legal document. It gives the person you designate (your "Agent") broad authority over your financial affairs. Before signing this document:
- You should consult a Connecticut-licensed attorney.
- Your Agent must act in your best interest and keep records of all transactions.
- This document may be made durable, meaning it remains effective if you later become incapacitated.
- You may revoke this Power of Attorney at any time while you are competent.
- If you have questions, consult a lawyer.
PART 1 - IDENTIFICATION OF PRINCIPAL AND AGENT
Principal (Person Granting the Power):
Name: [[Principal Full Legal Name]]
Date of Birth: [[Date of Birth]]
Address: [[Principal Street Address, City, Connecticut, ZIP Code]]
Phone: [[Phone Number]]
Email: [[Email Address]]
Agent (Person Receiving the Power) - Primary Agent:
Name: [[Primary Agent Full Legal Name]]
Relationship to Principal: [[Spouse / Child / Sibling / Friend / Attorney / Other]]
Address: [[Agent Street Address, City, State, ZIP Code]]
Phone: [[Phone Number]]
Email: [[Email Address]]
Successor Agent No. 1 (takes over only if Primary Agent is unable or unwilling to serve):
Name: [[Successor Agent 1 Full Legal Name]]
Address: [[Address, City, State, ZIP Code]]
Phone: [[Phone Number]]
Successor Agent No. 2 (takes over only if Successor Agent No. 1 is unable or unwilling to serve):
Name: [[Successor Agent 2 Full Legal Name]]
Address: [[Address, City, State, ZIP Code]]
Phone: [[Phone Number]]
Co-Agents (if applicable - indicate "None" if not used):
- Co-Agent 1: [[Name and Address]]
- Co-Agent 2: [[Name and Address]]
If Co-Agents are appointed, they shall act:
- [ ] Independently (either may act alone without the consent of the other); OR
- [ ] Jointly (both must consent to any action).
PART 2 - DURABILITY AND EFFECTIVENESS
2.1 Durability Election.
Select one:
- [ ] DURABLE POWER OF ATTORNEY (Recommended): This Power of Attorney shall NOT be affected by my subsequent disability or incapacity. Pursuant to C.G.S. § 1-350b, this Power of Attorney is durable and shall remain in full force and effect notwithstanding my subsequent disability, incompetence, or incapacity. The following language is required under Connecticut law to make this POA durable:
> "THIS POWER OF ATTORNEY SHALL NOT BE AFFECTED BY DISABILITY, INCOMPETENCE, OR INCAPACITY OF THE PRINCIPAL."
- [ ] NON-DURABLE POWER OF ATTORNEY: This Power of Attorney shall terminate automatically upon my disability, incompetence, or incapacity.
2.2 Effective Date.
Select one:
- [ ] IMMEDIATE EFFECTIVENESS: This Power of Attorney is effective immediately upon my signature and proper execution.
- [ ] SPRINGING POWER OF ATTORNEY: This Power of Attorney shall become effective only upon the occurrence of my disability or incapacity, as certified in writing by [[one / two]] licensed physician(s) who have personally examined me and determined that I am unable to manage my financial affairs. Copies of such written certification shall be attached to this Power of Attorney when exercised. The certification shall be dated no more than [[90]] days before the Agent acts under this authority.
PART 3 - GRANT OF POWERS
INSTRUCTIONS: Initial ONLY the powers you wish to grant. Leaving a line un-initialed means that power is NOT granted. Powers not listed here are not granted.
3A - General Financial Powers
| Initial | Power | Description |
|---------|-------|-------------|
| ______ | Banking and Financial Institutions | Open, close, and manage bank, savings, and investment accounts; endorse and deposit checks; make withdrawals; access safe-deposit boxes. |
| ______ | Real Estate Transactions | Buy, sell, lease, encumber, and manage real property; sign deeds, mortgages, and closing documents; pay property taxes. |
| ______ | Personal Property | Buy, sell, lease, and manage personal property, vehicles, and other tangible assets. |
| ______ | Business Operations | Manage sole proprietorships, partnerships, LLCs, and corporations in which Principal has an interest; sign contracts and checks. |
| ______ | Insurance and Annuities | Purchase, cancel, collect on, or change beneficiary designations for life, health, automobile, and property insurance policies and annuities. |
| ______ | Claims and Litigation | Commence, defend, and settle legal claims, arbitrations, and administrative proceedings; receive legal process. |
| ______ | Taxes | Prepare and file federal (Form 1040, 1040-ES), Connecticut (CT-1040), and other tax returns; respond to audits; make tax payments; claim refunds; elect filing status. |
| ______ | Retirement Plans | Manage IRAs, 401(k)s, 403(b)s, and other retirement accounts; make contributions and withdrawals (subject to IRS rules). |
| ______ | Government Benefits | Apply for, receive, and manage Social Security, Medicare, Medicaid, veterans' benefits, and other government programs. |
| ______ | Estate, Trust, and Beneficiary Matters | Manage interests in trusts and estates; act as trustee in place of Principal where permitted; receive fiduciary distributions. |
| ______ | Gifts to Charitable Organizations | Make charitable contributions up to $[[Annual Limit]] per organization per calendar year from Principal's assets. |
| ______ | Delegation | Delegate Agent authority to a sub-agent where appropriate, subject to Agent's fiduciary duty. |
| ______ | All Other Lawful Financial Matters | Take any other action with respect to Principal's financial affairs that Principal could take if personally present. |
3B - HOT POWERS (Express Grant Required - MUST Initial Each Separately)
WARNING: These powers are NOT granted unless you EXPRESSLY initial each line below. A general grant of financial powers does NOT include these hot powers. Exercise care before initialing - these authorizations are significant.
| Initial | Hot Power | Description |
|---------|-----------|-------------|
| ______ | Gifts to Agent or Agent's Family | Make gifts to Agent, Agent's spouse/domestic partner, or Agent's descendants (limit: $[[Annual Exclusion Amount, e.g., $18,000 per recipient per year as of 2024; verify current IRS exclusion]] per recipient per year, or as otherwise specified below). |
| ______ | Gifts to Third Parties | Make gifts to persons other than Agent's family, including outright gifts, 529 contributions, UTMA deposits, in amounts up to $[[Annual Exclusion Amount]] per donee per year OR up to $[[Larger specified amount if authorized]]. |
| ______ | Change Beneficiary Designations | Change beneficiary designations on life insurance policies, retirement accounts, annuities, bank accounts (POD), and investment accounts (TOD). |
| ______ | Create or Amend a Trust | Create, amend, revoke, or terminate a revocable living trust naming Principal as grantor; fund such trust with Principal's assets. |
| ______ | Modify Joint Tenancy or Community Property | Change the form of ownership of property held in joint tenancy or as community property with any person. |
| ______ | Create or Amend Rights of Survivorship | Change or create rights of survivorship in real or personal property. |
| ______ | Disclaim or Refuse Inheritance | Disclaim interests in property or an estate on behalf of Principal. |
| ______ | Delegate Agent Authority to Co-Agent | Delegate to a Co-Agent the authority to perform any act authorized in this POA. |
Gift Limit Specification (if gifts to Agent authorized):
Agent may make annual gifts to Agent or Agent's family members not to exceed $[[per-recipient amount, e.g., IRS annual exclusion in effect]] per donee per year, provided that Agent's own gifts are approved by:
- [ ] The Successor Agent; OR
- [ ] An independent co-agent; OR
- [ ] No additional approval required.
Self-Dealing Controls. Agent is prohibited from using Principal's funds to pay any obligation of Agent personally without Principal's express written consent, EXCEPT for Agent's compensation set forth in Part 6.
PART 4 - AGENT'S DUTIES AND FIDUCIARY STANDARD
4.1 Fiduciary Duty. Agent shall act: (a) in the Principal's best interest; (b) in good faith; (c) only within the scope of authority granted herein; (d) with the care, competence, and diligence ordinarily exercised by agents in similar circumstances; and (e) in accordance with C.G.S. § 1-350u.
4.2 Record-Keeping. Agent shall maintain detailed records of all transactions, receipts, disbursements, and actions taken on behalf of Principal, and shall make such records available to Principal, a co-agent, any successor agent, or any court upon request.
4.3 Duty to Preserve Plan. Agent shall, to the extent known, preserve the Principal's estate plan, including avoiding actions that would impair the effectiveness of the plan.
4.4 Duty to Cooperate. Agent shall cooperate with any healthcare agent designated by Principal under a separate healthcare power of attorney.
4.5 Conflicts. Agent shall promptly disclose any actual or potential conflict of interest to Principal and shall not act in any conflict without Principal's written consent.
4.6 Agent Accounting. Agent shall provide an accounting to Principal (or Principal's legal representative) within [[30 / 60]] days of written request.
PART 5 - AGENT ACCEPTANCE
By signing below, Agent accepts appointment as Agent under this Power of Attorney and agrees to act in accordance with the Connecticut Uniform Power of Attorney Act and the terms of this document.
Agent Signature: ______________________________
Printed Name: [[Primary Agent Full Legal Name]]
Date: [[Date]]
PART 6 - AGENT COMPENSATION
Agent shall be compensated as follows (select one):
- [ ] No compensation - Agent serves without payment.
- [ ] Reimbursement of expenses only - Agent is reimbursed for reasonable, documented out-of-pocket expenses.
- [ ] Reasonable compensation - Agent is paid $[[Hourly Rate or Monthly Fee]] per hour/month, subject to annual accounting review.
PART 7 - REVOCATION
This Power of Attorney may be revoked by Principal at any time while Principal has legal capacity by delivering a signed, written revocation to Agent. To protect third parties who may rely on this document, Principal should also:
- Notify all financial institutions and parties holding a copy of this POA;
- Request return of all copies; and
- File a Notice of Revocation with the Connecticut land records (if used for real estate transactions) pursuant to C.G.S. § 47-34.
This Power of Attorney is automatically revoked or suspended by:
- Appointment of a Conservator for Principal's estate (unless court orders otherwise per C.G.S. § 1-350r);
- The death of Principal (Agent's authority terminates immediately upon Principal's death; Agent must not act after learning of Principal's death);
- Termination date specified below (if applicable): [[Date or Event, or "None"]].
PART 8 - THIRD-PARTY RELIANCE
Third parties who deal with Agent in good faith and in reasonable reliance on this Power of Attorney are protected from liability even if this Power of Attorney has been revoked (C.G.S. § 1-350v). A third party may request, and Agent shall provide, an Agent Certification under C.G.S. § 1-350t.
PART 9 - EXECUTION AND ACKNOWLEDGMENT
CONNECTICUT STATUTORY FORM - SIGNATURE REQUIREMENTS (C.G.S. § 1-350i)
Under Connecticut law, a Power of Attorney must be:
- Signed by the Principal (or at Principal's direction in Principal's presence if Principal is physically unable to sign);
- Acknowledged before a Notary Public or other officer authorized to take acknowledgments.
Two witnesses are not required under Connecticut's Uniform POA Act but are strongly recommended as best practice and may be required by some financial institutions.
PRINCIPAL'S SIGNATURE:
I, [[Principal Full Legal Name]], of [[City, Connecticut]], hereby execute this Power of Attorney freely and voluntarily, with full understanding of its contents and legal effect.
Signature: ______________________________
Printed Name: [[Principal Full Legal Name]]
Date: ______________________________
NOTARY ACKNOWLEDGMENT - STATE OF CONNECTICUT
State of Connecticut
County of [[County Name]]
On this [[Day]] day of [[Month]], [[Year]], before me personally appeared [[Principal Full Legal Name]], to me personally known (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument, and acknowledged to me that they executed the same in their authorized capacity, and that by their signature on the instrument, they executed the instrument.
Notary Public: ______________________________
Printed Name: ______________________________
Commission Expires: ______________________________
[NOTARY SEAL]
WITNESS SIGNATURES (Recommended; not required by statute)
Each witness confirms that the Principal signed in their presence and appeared to be of sound mind and under no undue influence.
Witness 1 Signature: ______________________________
Printed Name: [[Witness 1 Name]]
Address: [[Witness 1 Address]]
Date: ______________________________
Witness 2 Signature: ______________________________
Printed Name: [[Witness 2 Name]]
Address: [[Witness 2 Address]]
Date: ______________________________
Note: A witness may NOT be: (a) the Agent; (b) a relative of the Principal or Agent; (c) a person who will inherit from the Principal's estate; or (d) the person's healthcare provider.
PART 10 - AGENT CERTIFICATION (For Use by Agent When Acting Under This POA)
(C.G.S. § 1-350t - may be completed at time of use)
I, [[Agent Full Legal Name]], hereby certify under penalty of perjury that:
- The Principal, [[Principal Full Legal Name]], is alive as of the date signed below;
- I have no actual knowledge that this Power of Attorney has been revoked, suspended, or terminated;
- I have no actual knowledge that the occurrence of any event referenced for springing effectiveness has not occurred (if applicable);
- My powers are in full force and effect; and
- I am acting within the scope of authority granted by this Power of Attorney.
Agent Signature: ______________________________
Printed Name: [[Agent Full Legal Name]]
Date: ______________________________
Notary (if required by recipient): ______________________________
> DISCLAIMER: This document is a template for informational purposes only and does not constitute legal advice. Requirements for powers of attorney vary by state and may change. Connecticut's Uniform Power of Attorney Act (C.G.S. §§ 1-350 to 1-353b) governs this form; financial institutions may impose additional requirements. Consult a Connecticut-licensed attorney before signing. No attorney-client relationship is created by use of this template.
Sources (as of June 2026):
- Connecticut Uniform Power of Attorney Act, C.G.S. §§ 1-350 to 1-353b (enacted 2016, effective October 1, 2016)
- C.G.S. § 1-350b (durability)
- C.G.S. § 1-350u (agent duties)
- C.G.S. § 1-350t (agent certification)
- C.G.S. § 1-350v (third-party reliance)
- C.G.S. § 1-350r (conservatorship interplay)
- IRS Annual Gift Tax Exclusion (I.R.C. § 2503(b); verify current exclusion amount)
- Uniform Power of Attorney Act (2006) - model basis for Connecticut's act
