You probably need to contact an estates attorney to assist you in drafting this document. In most states, It then has to be signed by you in front of two witnesses and notarized. Contact an IN estates attorney to assist you.
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There are attorneys who can visit with people in jail to fill out and sign powers of attorney. You should talk with the criminal law attorney who represents the incarcerated person to see if he has a suggestion or can perhaps also perform that service.
I would caution against trying to use a 'fill in the blank' form found on the Internet or a stationary store just because the witnessing and notarizing requirements may be difficult to meet -- especially when someone is incarcerated -- without legal help. Seek a local professional.