Language for Creating a Springing Durable Power of Attorney

“This power of attorney shall be effective only after any one licensed physician shall have signed and caused to be attached to this power of attorney his or her written statement indicating that I am incapable in his or her judgment of attending effectively to my financial affairs by reason of mental or physical disability.” “This written statement shall be acknowledged before a Notary Public. All persons relying on any such written statements attached to this power of attorney may presume that the identity and qualifications of the person signing any such statement are what they purport to be. There shall be no duty to make further inquiry or investigation beyond the review of each written statement itself. No physician furnishing any such written statement shall be liable to me or any other person for furnishing the same in good faith, for the disclosure of any information about me or my financial affairs contained in the statement, nor for any act or omission of my attorney-in-fact.”