Kansas Limited Power of Attorney Form

A Kansas limited power of attorney (POA) is a form used by residents of Kansas (called the “principal”) to give another person (called the “agent”) the legal ability to act on their behalf. It contains the name and address of the principal, as well as the duties they have requested and the expiration date of the form. Both parties must sign and date the document for it to be considered valid. Once the form is active, the principal can remove the agent’s power at any time by completing a Kansas revocation form.

Signing requirements (§ 58-629(e)): Requires two (2) witnesses and notarization.



How to Write

Download: Adobe PDF, Word (.docx), Rich Text (.rtf)

Step 1 – Name Principal + Agent

Enter the name of the principal and their current address (i.e. street, city/town, state). On the next line, write the full name of the appointed agent and the city/town and state in which they reside.

Step 2 – Assign Task(s)

Include the exact responsibilities that are being given to the agent. This section must be specific to ensure that boundaries are set and the agent understands their role. While it is an optional part of the form, the principal can enter the start and end date of the form on the line after the words “effective on.”

Step 3 – Sign

The principal and agent must sign the document in order for it to become official. Each party has specific responsibilities when filling out this section.

The principal is required to include:

  • Full signature
  • Printed name
  • Date of signing
  • The location where they signed.

The agent must provide the following:

  • Official signature
  • Printed name (first + last name)
  • Signing date
  • Current address
  • Telephone number
  • Name of the town in which they signed.

Step 4 – Notarize

Kansas requires notarization for limited POA forms, as well as two (2) witnesses. Once the notary public watches both parties sign, they will digitally or physically stamp the form. Additionally, they must include their full name, signature, the signing date, and the expiration date of their commission.