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AB985,23,2523 9. If the authorization for final disposition was not signed in counterpart, a
24description of the method used to forward the authorization for final disposition to
25each remote witness for signing and to the supervising attorney after signing.
AB985,24,6
110. If the authorization for final disposition was signed in counterpart, a
2description of the method used to forward each counterpart to the supervising
3attorney and, if applicable, how and when the supervising attorney physically
4compiled the signed paper counterparts into a single document containing the
5authorization for final disposition, the signature of the declarant, and the signatures
6of the remote witnesses.
AB985,24,87 11. The name, state bar number, and business or residential address of the
8supervising attorney.
AB985,24,139 12. Any other information that the supervising attorney considers to be
10material with respect to the declarant's capacity to sign a valid authorization for final
11disposition, the declarant's and witnesses' compliance with this section, or any other
12information that the supervising attorney deems relevant to the execution of the
13authorization for final disposition.
AB985,24,1514 (L) The affidavit of compliance is attached to the authorization for final
15disposition.
AB985,24,1716 (m) An affidavit of compliance described in this subsection shall be
17substantially in the following form:
AB985,24,1818 AFFIDAVIT OF COMPLIANCE
AB985,24,1919 State of ....
AB985,24,2020 County of ....
AB985,24,2121 The undersigned, being first duly sworn under oath, states as follows:
AB985,24,2522 This Affidavit of Compliance is executed pursuant to Wis. Stat. § 154.30 (8m)
23to document the execution of the authorization for final disposition of [name of
24declarant] via remote appearance by 2-way, real-time audiovisual communication
25technology on [date].
AB985,25,1
11. The name and residential address of the declarant is ....
AB985,25,22 2. The name and [residential or business] address of remote witness 1 is ....
AB985,25,33 3. The name and [residential or business] address of remote witness 2 is ....
AB985,25,64 4. The address within the state of Wisconsin where the declarant was
5physically located at the time the declarant signed the authorization for final
6disposition is ....
AB985,25,97 5. The address within the state of Wisconsin where remote witness 1 was
8physically located at the time the remote witness witnessed the declarant's execution
9of the authorization for final disposition is ....
AB985,25,1210 6. The address within the state of Wisconsin where remote witness 2 was
11physically located at the time the remote witness witnessed the declarant's execution
12of the authorization for final disposition is ....
AB985,25,1613 7. The declarant and remote witnesses were all known to each other and to the
14supervising attorney. - OR - The declarant and remote witnesses were not all known
15to each other and to the supervising attorney. Each produced the following form of
16photo identification to confirm his or her identity:
AB985,25,1717 ....
AB985,25,2018 8. The declarant declared that the declarant is 18 years of age or older, that the
19document is the declarant's authorization for final disposition, and that the
20document was executed as the declarant's voluntary act.
AB985,25,2421 9. Each of the remote witnesses and the supervising attorney were able to see
22the declarant, or an individual 18 years of age or older at the express direction and
23in the physical presence of the declarant, sign. The declarant appeared to be 18 years
24of age or older and acting voluntarily.
AB985,25,2525 10. The audiovisual technology used for the signing process was ....
AB985,26,11
111. The authorization for final disposition was not signed in counterpart. The
2following methods were used to forward the authorization for final disposition to
3each remote witness for signing and to the supervising attorney after signing. - OR
4- The authorization for final disposition was signed in counterpart. The following
5methods were used to forward each counterpart to the supervising attorney. [If
6applicable] - The supervising attorney physically compiled the signed paper
7counterparts into a single document containing the authorization for final
8disposition, the signature of the declarant, and the signatures of the remote
9witnesses on [date] by [e.g., attaching page 7 from each counterpart signed by a
10remote witness to the back of the authorization for final disposition signed by the
11declarant].
AB985,26,1312 12. The name, state bar number, and [business or residential] address of the
13supervising attorney is ....
AB985,26,1514 13. [Optional] Other information that the supervising attorney considers to be
15material is as follows: ....
AB985,26,1616 .... (signature of supervising attorney)
AB985,26,1817 Subscribed and sworn to before me on .... (date) by .... (name of supervising
18attorney).
AB985,26,1919 .... (signature of notarial officer)
AB985,26,2020 Stamp
AB985,26,2121 .... (Title of office)
AB985,26,2222 [My commission expires: ....]
AB985,6 23Section 6 . 155.10 (3) of the statutes is created to read:
AB985,27,3
1155.10 (3) For purposes of sub. (1) (c), “in the presence of” includes the
2simultaneous remote appearance by 2-way, real-time audiovisual communication
3technology if all of the following conditions are satisfied:
AB985,27,54 (a) The signing is supervised by an attorney in good standing licensed by this
5state. The supervising attorney may serve as one of the remote witnesses.
AB985,27,76 (b) The principal attests to being physically located in this state during the
72-way, real-time audiovisual communication.
AB985,27,98 (c) Each remote witness attests to being physically located in this state during
9the 2-way, real-time audiovisual communication.
AB985,27,1310 (d) The principal and each of the remote witnesses identify themselves. If the
11principal and remote witnesses are not personally known to each other and to the
12supervising attorney, the principal and each of the remote witnesses display photo
13identification.
AB985,27,1714 (e) The principal identifies anyone else present in the same physical location
15as the principal and, if possible, the principal makes a visual sweep of the principal's
16physical surroundings so that the supervising attorney and each remote witness can
17confirm the presence of any other person.
AB985,27,2118 (f) The principal displays the power of attorney for health care, confirms the
19total number of pages and the page number of the page on which the principal's
20signature will be affixed, and declares to the remote witnesses and the supervising
21attorney all of the following:
AB985,27,2222 1. That the principal is 18 years of age or older.
AB985,27,2323 2. That the document is the principal's power of attorney for health care.
AB985,27,2424 3. That the document is being executed as a voluntary act.
AB985,28,4
1(g) The principal, or an individual 18 years of age or older at the express
2direction and in the physical presence of the principal, dates and signs the power of
3attorney for health care in a manner that allows each of the remote witnesses and
4the supervising attorney to see the execution.
AB985,28,105 (h) The audiovisual communication technology used allows communication by
6which a person is able to see, hear, and communicate in an interactive way with
7another person in real time using electronic means, except that if the principal, a
8remote witness, or the supervising attorney has an impairment that affects hearing,
9sight, or speech, assistive technology or learned skills may be substituted for audio
10or visual if it allows that person to actively participate in the signing in real time.
AB985,28,1211 (i) The power of attorney for health care indicates that it is being executed
12pursuant to this subsection.
AB985,28,1313 (j) One of the following occurs:
AB985,29,214 1. The principal, or another person at the direction of the principal, personally
15delivers or transmits by U.S. mail or commercial courier service the entire signed
16original power of attorney for health care to the supervising attorney within a
17reasonable time after execution. The supervising attorney then personally delivers
18or transmits by U.S. mail or commercial courier service the entire signed original
19power of attorney for health care to the remote witnesses within a reasonable time.
20The first remote witness to receive the original power of attorney for health care signs
21and dates the original power of attorney for health care as a witness and forwards
22the entire signed original power of attorney for health care by personal delivery or
23U.S. mail or commercial courier service within a reasonable time to the 2nd remote
24witness, who signs and dates it as a witness and forwards the entire signed original

1power of attorney for health care by personal delivery or U.S. mail or commercial
2courier service within a reasonable time to the supervising attorney.
AB985,29,173 2. The principal, or another person at the direction of the principal, personally
4delivers or transmits by U.S. mail or commercial courier service the entire signed
5original power of attorney for health care to the supervising attorney within a
6reasonable time after execution and transmits by facsimile or electronic means a
7legible copy of the entire signed power of attorney for health care directly to each
8remote witness within a reasonable time after execution. Each remote witness then
9signs the transmitted copy of the power of attorney for health care as a witness and
10personally delivers or transmits by U.S. mail or commercial courier service the entire
11signed copy of the power of attorney for health care to the supervising attorney
12within a reasonable time after witnessing. The signed original and signed copies
13together shall constitute one original document, unless the supervising attorney,
14within a reasonable time after receiving the signed original and signed copies,
15compiles the signed original and signed copies into one document by attaching the
16signature pages of each remote witness to the original signed by or on behalf of the
17principal, in which case the compiled document shall constitute the original.
AB985,30,218 3. The principal and each of the remote witnesses sign identical copies of the
19original. The principal, or another person at the direction of the principal, and each
20of the remote witnesses personally deliver or transmit by U.S. mail or commercial
21courier service the signed originals to the supervising attorney within a reasonable
22time after execution. All of the signed originals together shall constitute one original
23document, unless the supervising attorney, within a reasonable time after receiving
24all signed originals, compiles the originals into one document by attaching the

1signature pages of each remote witness to the original signed by or on behalf of the
2principal, in which case the compiled document shall constitute the original.
AB985,30,43 (k) The supervising attorney completes an affidavit of compliance that contains
4the following information:
AB985,30,55 1. The name and residential address of the principal.
AB985,30,66 2. The name and residential or business address of each remote witness.
AB985,30,87 3. The address within this state where the principal was physically located at
8the time the principal signed the power of attorney for health care.
AB985,30,119 4. The address within this state where each remote witness was physically
10located at the time the remote witness witnessed the principal's execution of the
11power of attorney for health care.
AB985,30,1412 5. A statement that the principal and remote witnesses were all known to each
13other and the supervising attorney or a description of the form of photo identification
14used to confirm the identity of the principal and each remote witness.
AB985,30,1715 6. Confirmation that the principal declared that the principal is 18 years of age
16or older, that the document is the principal's power of attorney for health care, and
17that the document was being executed as the principal's voluntary act.
AB985,30,2118 7. Confirmation that each of the remote witnesses and the supervising attorney
19were able to see the principal, or an individual 18 years of age or older at the express
20direction and in the physical presence of the principal, sign, and that the principal
21appeared to be 18 years of age or older and acting voluntarily.
AB985,30,2222 8. A description of the audiovisual technology used for the signing process.
AB985,30,2523 9. If the power of attorney for health care was not signed in counterpart, a
24description of the method used to forward the power of attorney for health care to
25each remote witness for signing and to the supervising attorney after signing.
AB985,31,6
110. If the power of attorney for health care was signed in counterpart, a
2description of the method used to forward each counterpart to the supervising
3attorney and, if applicable, how and when the supervising attorney physically
4compiled the signed paper counterparts into a single document containing the power
5of attorney for health care, the signature of the principal, and the signatures of the
6remote witnesses.
AB985,31,87 11. The name, state bar number, and business or residential address of the
8supervising attorney.
AB985,31,139 12. Any other information that the supervising attorney considers to be
10material with respect to the principal's capacity to sign a valid power of attorney for
11health care, the principal's and witnesses' compliance with this section, or any other
12information that the supervising attorney deems relevant to the execution of the
13power of attorney for health care.
AB985,31,1514 (L) The affidavit of compliance is attached to the power of attorney for health
15care.
AB985,31,1716 (m) An affidavit of compliance described in this subsection shall be
17substantially in the following form:
AB985,31,1818 AFFIDAVIT OF COMPLIANCE
AB985,31,1919 State of ....
AB985,31,2020 County of ....
AB985,31,2121 The undersigned, being first duly sworn under oath, states as follows:
AB985,31,2522 This Affidavit of Compliance is executed pursuant to Wis. Stat. § 155.10 (3) to
23document the execution of the power of attorney for health care of [name of principal]
24via remote appearance by 2-way, real-time audiovisual communication technology
25on [date].
AB985,32,1
11. The name and residential address of the principal is ....
AB985,32,22 2. The name and [residential or business] address of remote witness 1 is ....
AB985,32,33 3. The name and [residential or business] address of remote witness 2 is ....
AB985,32,54 4. The address within the state of Wisconsin where the principal was physically
5located at the time the principal signed the power of attorney for health care is ....
AB985,32,86 5. The address within the state of Wisconsin where remote witness 1 was
7physically located at the time the remote witness witnessed the principal's execution
8of the power of attorney for health care is ....
AB985,32,119 6. The address within the state of Wisconsin where remote witness 2 was
10physically located at the time the remote witness witnessed the principal's execution
11of the power of attorney for health care is ....
AB985,32,1512 7. The principal and remote witnesses were all known to each other and to the
13supervising attorney. - OR - The principal and remote witnesses were not all known
14to each other and to the supervising attorney. Each produced the following form of
15photo identification to confirm his or her identity:
AB985,32,1616 ....
AB985,32,1917 8. The principal declared that the principal is 18 years of age or older, that the
18document is the principal's power of attorney for health care, and that the document
19was being executed as the principal's voluntary act.
AB985,32,2320 9. Each of the remote witnesses and the supervising attorney were able to see
21the principal, or an individual 18 years of age or older at the express direction and
22in the physical presence of the principal, sign. The principal appeared to be 18 years
23of age or older and acting voluntarily.
AB985,32,2424 10. The audiovisual technology used for the signing process was ....
AB985,33,10
111. The power of attorney for health care was not signed in counterpart. The
2following methods were used to forward the power of attorney for health care to each
3remote witness for signing and to the supervising attorney after signing. - OR - The
4power of attorney for health care was signed in counterpart. The following methods
5were used to forward each counterpart to the supervising attorney. [If applicable]
6- The supervising attorney physically compiled the signed paper counterparts into
7a single document containing the power of attorney for health care, the signature of
8the principal, and the signatures of the remote witnesses on [date] by [e.g., attaching
9page 7 from each counterpart signed by a remote witness to the back of the power of
10attorney for health care signed by the principal].
AB985,33,1211 12. The name, state bar number, and business or residential address of the
12supervising attorney is ....
AB985,33,1413 13. [Optional] Other information that the supervising attorney considers to be
14material is as follows: ....
AB985,33,1515 .... (signature of supervising attorney)
AB985,33,1716 Subscribed and sworn to before me on .... (date) by .... (name of supervising
17attorney).
AB985,33,1818 .... (signature of notarial officer)
AB985,33,1919 Stamp
AB985,33,2020 .... (Title of office)
AB985,33,2121 [My commission expires: ....]
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