{
  "documentType": "power_of_attorney",
  "language": "EN",
  "placeholders": [
    {
      "id": "poa_date",
      "label": "Date of this power of attorney",
      "type": "date",
      "required": true
    },
    {
      "id": "governing_state",
      "label": "Governing state",
      "type": "select",
      "required": true,
      "options": [
        {
          "value": "Alabama",
          "label": "Alabama"
        },
        {
          "value": "Alaska",
          "label": "Alaska"
        },
        {
          "value": "Arizona",
          "label": "Arizona"
        },
        {
          "value": "Arkansas",
          "label": "Arkansas"
        },
        {
          "value": "California",
          "label": "California"
        },
        {
          "value": "Colorado",
          "label": "Colorado"
        },
        {
          "value": "Connecticut",
          "label": "Connecticut"
        },
        {
          "value": "Delaware",
          "label": "Delaware"
        },
        {
          "value": "District of Columbia",
          "label": "District of Columbia"
        },
        {
          "value": "Florida",
          "label": "Florida"
        },
        {
          "value": "Georgia",
          "label": "Georgia"
        },
        {
          "value": "Hawaii",
          "label": "Hawaii"
        },
        {
          "value": "Idaho",
          "label": "Idaho"
        },
        {
          "value": "Illinois",
          "label": "Illinois"
        },
        {
          "value": "Indiana",
          "label": "Indiana"
        },
        {
          "value": "Iowa",
          "label": "Iowa"
        },
        {
          "value": "Kansas",
          "label": "Kansas"
        },
        {
          "value": "Kentucky",
          "label": "Kentucky"
        },
        {
          "value": "Louisiana",
          "label": "Louisiana"
        },
        {
          "value": "Maine",
          "label": "Maine"
        },
        {
          "value": "Maryland",
          "label": "Maryland"
        },
        {
          "value": "Massachusetts",
          "label": "Massachusetts"
        },
        {
          "value": "Michigan",
          "label": "Michigan"
        },
        {
          "value": "Minnesota",
          "label": "Minnesota"
        },
        {
          "value": "Mississippi",
          "label": "Mississippi"
        },
        {
          "value": "Missouri",
          "label": "Missouri"
        },
        {
          "value": "Montana",
          "label": "Montana"
        },
        {
          "value": "Nebraska",
          "label": "Nebraska"
        },
        {
          "value": "Nevada",
          "label": "Nevada"
        },
        {
          "value": "New Hampshire",
          "label": "New Hampshire"
        },
        {
          "value": "New Jersey",
          "label": "New Jersey"
        },
        {
          "value": "New Mexico",
          "label": "New Mexico"
        },
        {
          "value": "New York",
          "label": "New York"
        },
        {
          "value": "North Carolina",
          "label": "North Carolina"
        },
        {
          "value": "North Dakota",
          "label": "North Dakota"
        },
        {
          "value": "Ohio",
          "label": "Ohio"
        },
        {
          "value": "Oklahoma",
          "label": "Oklahoma"
        },
        {
          "value": "Oregon",
          "label": "Oregon"
        },
        {
          "value": "Pennsylvania",
          "label": "Pennsylvania"
        },
        {
          "value": "Rhode Island",
          "label": "Rhode Island"
        },
        {
          "value": "South Carolina",
          "label": "South Carolina"
        },
        {
          "value": "South Dakota",
          "label": "South Dakota"
        },
        {
          "value": "Tennessee",
          "label": "Tennessee"
        },
        {
          "value": "Texas",
          "label": "Texas"
        },
        {
          "value": "Utah",
          "label": "Utah"
        },
        {
          "value": "Vermont",
          "label": "Vermont"
        },
        {
          "value": "Virginia",
          "label": "Virginia"
        },
        {
          "value": "Washington",
          "label": "Washington"
        },
        {
          "value": "West Virginia",
          "label": "West Virginia"
        },
        {
          "value": "Wisconsin",
          "label": "Wisconsin"
        },
        {
          "value": "Wyoming",
          "label": "Wyoming"
        }
      ]
    },
    {
      "id": "principal_name",
      "label": "Principal name (the person granting authority)",
      "type": "text",
      "required": true
    },
    {
      "id": "principal_address",
      "label": "Principal address",
      "type": "textarea",
      "required": true
    },
    {
      "id": "principal_dob",
      "label": "Principal date of birth",
      "type": "date",
      "required": true
    },
    {
      "id": "principal_phone",
      "label": "Principal phone",
      "type": "tel",
      "required": true
    },
    {
      "id": "agent_name",
      "label": "Agent name (attorney-in-fact)",
      "type": "text",
      "required": true
    },
    {
      "id": "agent_address",
      "label": "Agent address",
      "type": "textarea",
      "required": true
    },
    {
      "id": "agent_phone",
      "label": "Agent phone",
      "type": "tel",
      "required": true
    },
    {
      "id": "agent_relationship",
      "label": "Agent relationship to the principal",
      "type": "text",
      "placeholder": "e.g. daughter",
      "required": true
    },
    {
      "id": "successor_agent_name",
      "label": "Successor agent name",
      "type": "text",
      "required": false
    },
    {
      "id": "successor_agent_address",
      "label": "Successor agent address",
      "type": "textarea",
      "required": false
    },
    {
      "id": "poa_type",
      "label": "Type of power of attorney",
      "type": "select",
      "options": [
        {
          "value": "limited (special)",
          "label": "Limited / special — one matter only"
        },
        {
          "value": "general",
          "label": "General — broad authority"
        }
      ],
      "required": true
    },
    {
      "id": "powers_granted",
      "label": "Powers granted to the agent",
      "type": "textarea",
      "placeholder": "e.g. sign closing documents for the sale of 12 Oak Street",
      "required": true
    },
    {
      "id": "specific_matter",
      "label": "Specific matter or property this power concerns",
      "type": "text",
      "required": true
    },
    {
      "id": "institutions",
      "label": "Institutions or people the agent may deal with",
      "type": "textarea",
      "required": true
    },
    {
      "id": "limitations",
      "label": "Limits and exclusions",
      "type": "textarea",
      "required": false
    },
    {
      "id": "may_delegate",
      "label": "May the agent delegate this authority",
      "type": "select",
      "options": [
        {
          "value": "may not",
          "label": "May not delegate"
        },
        {
          "value": "may",
          "label": "May delegate"
        }
      ],
      "required": true
    },
    {
      "id": "may_gift",
      "label": "May the agent make gifts of the principal property",
      "type": "select",
      "options": [
        {
          "value": "may not",
          "label": "May not make gifts"
        },
        {
          "value": "may",
          "label": "May make gifts"
        }
      ],
      "required": true
    },
    {
      "id": "compensation_clause",
      "label": "Is the agent paid for serving",
      "type": "select",
      "options": [
        {
          "value": "is not",
          "label": "Serves without compensation"
        },
        {
          "value": "is",
          "label": "Is entitled to compensation"
        }
      ],
      "required": true
    },
    {
      "id": "effective_date",
      "label": "Effective date",
      "type": "date",
      "required": true
    },
    {
      "id": "expiration_date",
      "label": "Expiration date",
      "type": "date",
      "required": true
    },
    {
      "id": "durability_clause",
      "label": "Durability",
      "type": "select",
      "options": [
        {
          "value": "this power of attorney is NOT durable and ends if the Principal becomes incapacitated",
          "label": "Not durable — ends on incapacity"
        },
        {
          "value": "this power of attorney IS durable and is not affected by the Principal later becoming incapacitated",
          "label": "Durable — survives incapacity"
        }
      ],
      "required": true
    },
    {
      "id": "principal_signature",
      "label": "Principal signature",
      "type": "text",
      "required": false
    },
    {
      "id": "agent_signature",
      "label": "Agent signature",
      "type": "text",
      "required": false
    },
    {
      "id": "witness_name",
      "label": "Witness name",
      "type": "text",
      "required": false
    },
    {
      "id": "witness_signature",
      "label": "Witness signature",
      "type": "text",
      "required": false
    },
    {
      "id": "second_witness_name",
      "label": "Second witness name",
      "type": "text",
      "required": false
    },
    {
      "id": "second_witness_signature",
      "label": "Second witness signature",
      "type": "text",
      "required": false
    },
    {
      "id": "notary_block",
      "label": "Notary acknowledgment",
      "type": "textarea",
      "required": false
    }
  ]
}