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Arizona person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -6- by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature ofe or child, or the Notary Public -5- State of ARIZONA ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ _______________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ * may not be the Agent, the Agent's spous Signature*: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature*: ____ttorney as witnesses to the principal's signing and that to the best of our knowledge the principal is eighteen years of age or older, of sound mind and under no constraint or undue influence. Witnessy that the principal signs and executes this instrument as his/her power of attorney and that he/she signs it willingly, and that we, in the presence and hearing of the principal, sign this power of a__________________________ and ___________________________________, the witnesses, sign our names to the foregoing power of attorney, being first duly sworn, and do declare to the undersigned authoritage or older, of sound mind and under no constraint or undue influence. __________________________________ (Signature of Principal) __________________________________ (Name of Principal) We, _________ instrument as my power of attorney and that I sign it willingly and that I execute it as my free and voluntary act for the purposes expressed in the power of attorney and that I am eighteen years of __________________, the principal, sign my name to this power of attorney this _____ day of __________ and, being first duly sworn, do declare to the undersigned authority that I sign and execute thisity of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. Dated ____________________, ______, at _________________________, Arizona. I, __ses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willful misconduct, while acting under the author terminated by operation of law, any person relying in good faith on the authority of this document, without notice of such termination, shall be held harmless. -4- Agent shall not be liable for los knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. If this Durable Power of Attorney isppointment by my Agent. Any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actualable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policies I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of athe disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxument shall still remain in full force and effect and not be affected by any partial invalidity. No person needs to inquire as to the reasons for the use or issuance of this power-ofattorney or as to ition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the doc as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handled and all acts performednt of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensation for any services provan a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly. My Agent shall be entitled to reimburseme Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence (except as provided by any applicable statute). As used herein, "disability" or "incapacity" shall me shall become effective immediately upon execution of this instrument. The rights, powers, and authority of this document shall remain in full force and effect thereafter until my death. This Power oftitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. -3- This Durable Power of Attorney and the rights, powers, and authority of my Agent document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to which I would be en. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of thisuse any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) ess specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditorsue the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unluant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in valor otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or purso make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning d documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. Tn, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or relate business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sigother investments. -2- 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any .S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their contents me by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including Ud withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable toer similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits antain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and oth medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maindicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Me including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/orver and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies,des the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recoor personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This inclue, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real d, now due or due -1- in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, leas papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputee and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromiss or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obligations and such other instruments intock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companieonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, sn, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bot be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sig, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but non, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agenthalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any pers_____________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my beately KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ___sh to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- ARIZONA DURABLE POWER OF ATTORNEY Effective Immedibout these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisions for you. You may revoke this power of attorney if you later wir to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions aBefore signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on your behalf, including the powecluded with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions inf Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Please note that if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable Power olly binding upon the Grantor. The Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be lega mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. The Agent should berticular Form becomes effective immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes incapacitated. Note that the word "attorney" is not used here toperson (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf, even if the Principal later becomes incapacitated. This pact to the Disclaimers and Terms of Use found at findlegalforms.com. -1- Information Durable Power of Attorney Effective Immediately A Durable Power of Attorney allows a natural "mentally" competent u and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subjethe power to handle business and legal matters on the Principal's behalf. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for yoct) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has l should keep the original document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-falt. The Agent, the Agent's spouse or children, and the Notary should not be witnesses. Although not always required, it is a good idea to have two witnesses sign the Power of Attorney [_] The Principaization will allow the Durable Power of Attorney to be recorded as a public record, if necessary. [_] In Arizona, at least one witness needs to sign the Power of Attorney. The witness should be an adu allow the Durable Power of Attorney to be recorded as a public record, if necessary. [_] The Principal (i.e. the person granting the power of Attorney) should sign the document before a Notary. Notarn if the Principal (i.e. the Grantor) becomes subsequently incapacitated. [_] The Principal (i.e. the person granting the power of Attorney) should sign the document before a Notary. Notarization willtion for Durable Power of Attorney Effective Immediately; (3) Durable Power of Attorney Effective Immediately [_] This Durable Power of Attorney becomes effective immediately and remains effective eveInstructions & Checklist Arizona Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) Informa ArizonaArizona -6- _____________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped ng instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ______________ State: ___________________________________ * may not be the Agent, the Agent's spouse or child, or the Notary Public -5- State of ARIZONA ) ) ss County of ________________________ ) The foregoi____________________ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___________________________________ City: _______________________________ years of age or older, of sound mind and under no constraint or undue influence. Witness Signature*: ___________________________________ Name: ___________________________________ City: ______________illingly, and that we, in the presence and hearing of the principal, sign this power of attorney as witnesses to the principal's signing and that to the best of our knowledge the principal is eighteening power of attorney, being first duly sworn, and do declare to the undersigned authority that the principal signs and executes this instrument as his/her power of attorney and that he/she signs it wnature of Principal) __________________________________ (Name of Principal) We, ___________________________________ and ___________________________________, the witnesses, sign our names to the forego act for the purposes expressed in the power of attorney and that I am eighteen years of age or older, of sound mind and under no constraint or undue influence. __________________________________ (Signg first duly sworn, do declare to the undersigned authority that I sign and execute this instrument as my power of attorney and that I sign it willingly and that I execute it as my free and voluntarygent. Signed on: __________________, ______, at _________________________, Arizona. I, ____________________, the principal, sign my name to this power of attorney this _____ day of __________ and, bei failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Ae of such termination, shall be held harmless. -4- Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty,ty because of reliance on this power of attorney. If this Durable Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without noticower of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third parwn on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy of this document may act under it. Revocation of the pwer-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policies I may oo inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by this po or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person needs tspecific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, illegalalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing of ired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on my behied in writing by a licensed medical doctor. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desbility" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly, as certifter until my death. This Power of Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence, except as provided by any applicable statute. As used herein, "disactive upon my subsequent disability or incapacity as certified in writing by a licensed medical doctor. The rights, powers, and authority of this document shall remain in full force and effect thereafe entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and all rights and powers therein shall become effeocument), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to -3- which I would bTo transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this de any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) uss specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unlesnt to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuamake gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning ordocuments; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related usiness assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign,any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or bents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or . Treasury Securities. -2- 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their conte by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.Swithdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to m similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and in and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and otheredical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintacare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, mue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medincluding life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sr and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, is the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recove personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This include rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real orputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease,cial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disand settle any claim, against me or asserted on my behalf against any other person or entity. -1- 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commerriting of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obligations and such other instruments in wck certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies ds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, sto endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bon be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign,or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, ns. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person_________________ maintaining an address at: _____________________________________________________ as my alternate or successor Agent, as necessary, to serve with the same powers, rights and discretio________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. If the above named Agent is unable to serve for any reason, I appoint ____________________maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________d other legal responsibilities of an agent. -3- ARIZONA DURABLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") dical and other health-care decisions for you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary ane scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone to make meson ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within th CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing another perrmation is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2-o witnesses are necessary, if the Agent will deal with any real estate in Florida. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this infoDurable Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Tw it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the of Attorney is signed, in the event the original Agent is unable to serve or continue to serve as the Agent. A Durable Power of Attorney should always be notarized, even if your state does not requirePower of Attorney at any time. Since this Durable Power of Attorney takes effect only after the Principal becomes disabled or incompetent, an alternate Agent can be designated, at the time this Power ng upon the Principal. This is especially important if the Principal is incapacitated when the Power of Attorney goes into effect, or the Agent undertakes the acts. The Principal can revoke a Durable attorney. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally bindi"attorney" is not used here to mean "lawyer". The person acting as the attorney-in-fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an attorney-in-fact by a power ofIn-Fact") to act on his or her behalf, even if the Principal later becomes incapacitated. This particular Form becomes effective upon the disability or incapacity of the Principal. Note that the word y Effective upon Disability A Durable Power of Attorney allows a natural "mentally competent " person (called the "Principal" or "Principal") to authorize someone else (called the "Agent" or "Attorneyegotiating a document with another party. [_] The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attornend are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before nirst choice as Agent is unable to serve or continue to serve as the Agent. This section can be removed, deleted (and initialed) or the words "no one" can be entered. [_] These forms are not intended aad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. [_] This document offers the option of nominating an alternate Agent in the event that the fcting the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very bronot be a witness. [_] The Principal should keep the original document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instrusses sign the Power of Attorney. Two witnesses are necessary if the Agent will be dealing with any real estate in Florida. Anyone related by blood or marriage to the Principal, Agent or Notary should public record, if necessary. [_] In Arizona, at least one witness needs to sign the Power of Attorney. The witness should be an adult. Although not always required, it is a good idea to have two witnef the Principal. [_] The Principal (i.e. the person granting the Power of Attorney) should sign the document before a Notary. Notarization will allow the Durable Power of Attorney to be recorded as a Information for Durable Power of Attorney Effective upon Disability; (3) Durable Power of Attorney Effective upon Disability [_] This Durable Power of Attorney becomes effective upon the Disability oInstructions & Checklist Arizona Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2) ArizonaArizona inted, or stamped -5- oduced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, pr____ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has pr____________________________ State: ___________________________________ * may not be the Agent, the Agent's spouse or child, or the Notary Public State of ARIZONA ) ) ss County of _________________________ City: __________________________________ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___________________________________ City: ______the principal is eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness Signature*: ___________________________________ Name: ______________________________nd that he/she signs it willingly, and that we, in the presence and hearing of the principal, sign this power of attorney as witnesses to the principal's signing and that to the best of our knowledge n our names to the foregoing power of attorney, being first duly sworn, and do declare to the undersigned authority that the principal signs and executes this instrument as his/her power of attorney a____________________ (Signature of Principal) __________________________________ (Name of Principal) We, ___________________________________ and ___________________________________, the witnesses, sig as my free and voluntary act for the purposes expressed in the power of attorney and that I am eighteen years of age or older, of sound mind and under no constraint or undue influence. ________________________ and, being first duly sworn, do declare to the undersigned authority that I sign and execute this instrument as my power of attorney and that I sign it willingly and that I execute -4- ititten notice to my Agent. Dated ____________________, ______, at _________________________, Arizona. I, ____________________, the principal, sign my name to this power of attorney this _____ day of h of fiduciary duty, failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing wris document, without notice of such termination, shall be held harmless. Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breacrise against the third party because of reliance on this power of attorney. If this General Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of ther it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that ainsurance policies I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy of this document may act undted to my Agent by this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life lidity. No person needs to inquire as to the reasons for the use or issuance of this power-of-attorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granld to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invaAttorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is her fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed broadly as a General Power of is Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative oons, and/or to manage my financial resources and affairs properly. -3- My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of thr until my death or until my disability or incapacity. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisiwers, and authority of my Agent shall become effective immediately upon execution of this instrument. The rights, powers, and authority of this document shall remain in full force and effect thereaftesclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This General Power of Attorney and the rights, po (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not diI am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interesteditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the cr year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, myual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be noncumulative and shall lapse at the end of each calendarn or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardiatle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whether such gax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise or set prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other income and t 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. Tobentures, commodities, options or any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the future. -2- on, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, de United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with any other perser checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of thebut not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashints, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, including, al Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accouenefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Socinot limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental beposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To receive, dsk for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the right to a any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrument or 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all,atsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. -1-ey, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whbt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hold, possess and/or invest any and all sums of monigations and such other instruments in writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or dend loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obl, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documentsding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applications, aers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powonnection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratct for me and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in c________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorneyin-faent. -3- ARIZONA GENERAL POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________r you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agnt, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisions fousiness and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney docume by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle bot state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers grantedr later becomes disabled or incapacitated. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is n witnessed, it is always a very good idea to do so. Another type of Power of Attorney, called a Durable Power of Attorneys (available at findlegalforms.com as well), stays in effect even if the Granto validity of the Power of Attorney and will allow the General Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a General Power of Attorney beways be notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge theent, within the scope of the Power of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a General Power of Attorney at any time. A General Power of Attorney should alinted an Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agd or incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appo "Agent" or "Attorney-InFact") to act on his or her behalf. This particular Form becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disablerms.com -1- Information General Power of Attorney A General Power of Attorney allows a natural "mentally" competent person (called the "Principal" or "Grantor") to authorize someone else (called they first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalfoipal's behalf. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorneshould also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Princ Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor ry should not be witnesses. Although not always required, it is a good idea to have two witnesses sign the Power of Attorney [_] The Principal should keep the original document, as well as a copy. Therded as a public record, if necessary. [_] In Arizona, at least one witness needs to sign the Power of Attorney. The witness should be an adult. The Agent, the Agent's spouse or children, and the Nota The Principal (i.e. the person granting the Power of Attorney; sometimes called the Grantor) should sign the document before a Notary. Notarization will allow the General Power of Attorney to be recoeral Power of Attorney [_] This General Power of Attorney becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitated. [_]Instructions & Checklist Arizona General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) Gen ArizonaArizona ledgment (Notary Public) _________________________________ Name typed, printed, or stamped -4- _________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowprinted, or stamped State of ARIZONA ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by _________________ produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, _______ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has________________________ State: ___________________________________ * may not be the Agent, the Agent's spouse or child, or the Notary Public -3- State of ARIZONA ) ) ss County of __________________ City: __________________________________ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___________________________________ City: __________e Parents are eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness Signature*: ___________________________________ Name: __________________________________willingly, and that we, in the presence and hearing of the principal, sign this Power of Attorney for the Care of Children as witnesses to the Parents' signing and that to the best of our knowledge thildren, being first duly sworn, and do declare to the undersigned authority that the Parents sign and execute this instrument as their Power of Attorney for the Care of Children and that they sign it ____________________ Name of Mother We, ___________________________________ and ___________________________________, the witnesses, sign our names to the foregoing Power of Attorney for the Care of Chno constraint or undue influence. ________________________________ Signature of Father ________________________________ Name of Father ________________________________ Signature of Mother ____________t we sign it willingly and that we execute it as our free and voluntary act for the purposes expressed in the power of attorney and that we are eighteen years of age or older, of sound mind and under ney this _____ day of __________ and, being first duly sworn, do declare to the undersigned authority that we sign and execute this instrument as our Power of Attorney for the Care of Children and tha the Attorney-in-Fact. Dated ____________________, ______, at _________________________, Arizona. We, ____________________ and ______________________, the Parents, sign our name to this power of attorauthority of this document, without notice of such termination, shall be held harmless. -2- We may revoke this Power of Attorney before the expiration date at any time by providing written notice toy for any claims that arise against the third party because of reliance on this power of attorney. If this Power of Attorney is terminated by operation of law, any person relying in good faith on the s document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. We agree to indemnify the third partpplicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. Any third party who receives a copy of thimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If any part of this document is held to be invalid, illegal or unenforceable under an-Fact named herein. We hereby ratify and confirm all acts by the Attorney-in-Fact done by virtue of this power of attorney and the rights hereby granted. The Attorney-in-Fact shall be entitled to rei______________ ("expiration date"). By signing here, we indicate that we are fully informed as to the contents of this document and understand the full import of this grant of powers to the Attorney-ie the power to consent to the marriage of our child/children; (iii) have the power to consent to the adoption of our child/children. This power of attorney shall be in effect from _______________ to _ments. Notwithstanding other provisions in this Power of Attorney, Attorney-in-Fact shall not (i) have the authority to withhold or withdraw life sustaining procedures for any child/children; (ii) havs necessary for the performance of the powers granted by this document, including but not limited to consent forms, releases, waivers, insurance documents, claims, agreements, contracts and legal docuany health and other insurance for our child/children and to make and file any medical or other type of claim against any health or other type of insurance company. 6. Endorse and execute any documentssary on behalf of our child/children and to adjust, compromise and settle any claim, our child/children may have against any other person or entity. 5. Apply for, purchase, maintain and/or deal with ldren, including, but not limited to, provisions of living quarters, food, clothing, entertainment and other customary matters. -1- 4. Request, ask, demand, sue and take any and all legal steps nece child/children; allow our child/children to participate in activities and events offered by any group, organization or educational facility. 3. Maintain the customary living standard of the child/chies. 2. Determine the education of our child/children and to register and enroll our child/children in any educational programs, schools and extracurricular activities; review any school records of theical or dental care to our child/children. Health care shall include but not be limited to the administration of anesthesia, X-ray examination, performance of operations, diagnostic and other procedurary disclose the contents of any medical records; execute any consent, release or waiver of liability required by medical, dental or other health authorities incident to the provision of medical, surgorize and decline any health care at any hospital or other institution; employ any physicians, dentists, nurses, or other person whose services may be needed for such health care; review and if necess to do all acts necessary or desirable for maintaining the health, education, and welfare of our above named child/children, including, but not limited to, the powers to: 1. Provide for, approve, auth_________________ born on __________ Name: _________________________________ born on __________ The above named Attorney-in-Fact shall have the power and authority to act entirely in loco parentis and Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: _________________________________ born on __________ Name: ________________ our true and lawful agent and attorney-in-fact for us and in our name, and in our behalf to act as the guardian of our minor child/children: Name: _________________________________ born on ________________________________________ hereby make and appoint ________________________________________ ("Attorney-in-Fact") maintaining an address at: _____________________________________________________ as______________________________________________ ("Father") and ______________________________________ ("Mother"), jointly referred to as "Parents" or "Principals", maintaining an address at: __________e appointment, the Attorney-in-Fact assumes the fiduciary and other legal responsibilities of an agent. -3- POWER OF ATTORNEY FOR THE CARE OF CHILDREN KNOW ALL PERSONS BY THESE PRESENTS: We ________ally binding upon you. If you have any questions about these powers, obtain competent legal advice. You may revoke this power of attorney at any time. ATTORNEY-IN-FACT: By accepting or acting under thower to handle and control the care, custody, health and welfare of your child/children. Any such action undertaken by the Attorney-in-Fact, within the scope of this power of attorney document, is legAttorney for the Care of Children document are broad and sweeping. Before signing this document, consider its consequences. You ("Parents") are providing another person ("Attorney-in-Fact") with the pc. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PARENTS: The powers granted by this Power of a very good idea to do so. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specifiotarization will make it more difficult for any third party to challenge the validity of the Power of Attorney. Although, some states don't require that a Power of Attorney be witnessed, it is always e, the Parents can revoke the document at any time even before the expiration date. The Power of Attorney for the Care of Children should always be notarized, even if your state does not require it. Nhould also be careful in instructing the Attorney-in-Fact as to what the Attorney-in-Fact should do. Although the Power of Attorney for the Care of Children has a beginning and an "end/expiration" datbe very careful in the selection of the Attorney-in-Fact, as the powers granted by this document are very broad and sweeping and the children are being entrusted to the Attorney-in-Fact. The Parents sng for medical, dental or any other type of care. Medical personnel will also generally feel more comfortable dealing with an Attorney-inFact who can provide this type of document. The Parents should having this type of document available, the Attorney-in-Fact will be able to better deal with any types of emergency involving the children and can avoid potential problems when, for example, arrangiseful if the parent will be absent for a period of time. The powers granted by this instrument are very broad. Parents are basically giving temporary custody of the children to the Attorney-infact. By-in-Fact by a power of attorney. This form allows the Attorney-in-Fact to make decisions for the children in place of the parents, including health care, education and welfare decisions. This can be uhe word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-in-Fact for the Parents or the children does not need to be a lawyer. Almost anyone can be appointed an Attorneybe used. This document allows parents of one or more children (sometimes called the "Principals" or "Grantors") to appoint another person to act as their Attorney-in-Fact to care for their children. Tormation Power of Attorney for the Care of Children Whenever it becomes necessary to allow someone else to provide for the care of your children, a Power of Attorney for the Care of Children form can for you and should not be used without consulting with an attorney first. [_] The purchase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Infney-in-Fact, as the powers granted by this document are very broad and sweeping. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting pointign the Power of Attorney for the Care of Children. [_] The Parents should be careful giving instructions to the Attorney-in-Fact. The Parents should also be very careful in the selection of the Attorness should be an adult. The Attorney-in-Fact, the Attorney-inFact's spouse or children, and the Notary should not be witnesses. Although not always required, it is a good idea to have two witnesses suld keep a copy of the Power of Attorney for the Care of Children document for their records. [_] In Arizona, at least one witness needs to sign the Power of Attorney for the Care of Children. The wite Power of Attorney for the Care of Children document before a Notary. [_] The original Power of Attorney for the Care of Children document should be given to the Attorney-in-Fact. [_] The Parents sho) additional useful information about Power of Attorney for the Care of Children documents. [_] Both Parents need to sign the Power of Attorney for the Care of Children. [_] The Parents should sign thInstructions & Checklist Arizona Power of Attorney for the Care of Children [_] This package contains a (1) Power of Attorney for the Care of Children; (2) simple instructions plus a checklist; and (3 ArizonaArizona pal occurred on ________________. (date) I have agreed to comply with the provisions of this directive. ___________________________ Signature of Physician Page 5 of 5 ave reviewed this guidance document and have discussed with _________ any questions regarding the probable medical consequences of the treatment choices provided above. This discussion with the princiarticular treatment alternative. If you do speak with your physician it is a good idea to ask your physician to complete this affidavit and keep a copy for his file.) I, Dr. ________________________ h________________ My Commission Expires: _______________ Page 4 of 5 Physician Affidavit (Optional) (Before initialing any choices above you may wish to ask questions of your physician regarding a ps/her wishes and that he/she intends to adopt the Health Care Power of Attorney at this time. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public signature: ______________ acknowledging this Health Care Power of Attorney is physically unable to sign or mark this document, I verify that he/she directly indicated to me that this Health Care Power of Attorney expresses hilf. I am not directly involved in providing health care to the person signing. I am not entitled to any part of his/her estate under a will now existing or by operation of law. In the event the personsame for the purpose therein expressed.. I further declare I am not related to the person signing above by blood, marriage or adoption, or a person designated to make medical decisions on his/her behae undersigned Notary Public, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the foregoing Health Care Power of Attorney and acknowledged that they executed the ove Notarization STATE OF ARIZONA County of ______ ) ) ss. ) On this the ____ day of ___________, ____, PRINCIPAL and _____________________ and ____________________ personally appeared before me, th______________ Witness Signature: __________________________________________ Witness Address: __________________________________________ NOTE: A Notary Public is only required if no witness signed abch witness was present when the GRANTOR dated and signed this health care power of attorney. Witness Signature: __________________________________________ Witness Address: ____________________________ge 3 of 5 NOTE: This health care power of attorney must be notarized or witnessed Witness Statement Each witness who signs this health care power of attorney declares under penalty of perjury that su_________ Time: _______________________________________________________ Address of AGENT: ___________________________________________ Telephone of AGENT: __________________________________________ Pastate. _____ 5. I want my life to be prolonged to the greatest extent possible. Signature of Principal: __________________________________________ Date: ______________________________________________want the use of all medical care necessary to treat my condition until my doctors reasonably conclude that my condition is terminal or is irreversible and incurable or I am in a persistent vegetative withdrawn if it is possible that the embryo/fetus will develop to the point of live birth with the continued application of lifesustaining treatment. _____ 4. Notwithstanding my other directions I do od and fluids. _____ (c) To be taken to a hospital if at all avoidable. _____ 3. Notwithstanding my other directions, if I am known to be pregnant, I do not want life-sustaining treatment withheld or me comfortable, but I do not want the following: _____ (a) Cardiopulmonary resuscitation, for example, the use of drugs, electric shock and artificial breathing. _____ (b) Artificially administered foion or an irreversible coma or a persistent vegetative state that my doctors reasonably feel to be irreversible or incurable, I do want the medical treatment necessary to provide care that would keep want my life to be prolonged and I do not want life-sustaining treatment, beyond comfort care, that would serve only to artificially delay the moment of my death. _____ 2. If I am in a terminal conditg to your health care. You may initial any combination of paragraphs 1, 2, 3 and 4 but if you initial paragraph 5 the others should not be initialed.) _____ 1. If I have a terminal condition I do not d initial that statement. Read all of these statements carefully before you initial your selection. You can also write your own statement concerning life-sustaining treatment and other matters relatingive health care directions. Page 2 of 5 5. Living Will (Optional) (Some general statements concerning your health care options are outlined below. If you agree with one of the statements, you shoully. 4. Other or Additional Statements of Desires I have _____ I have not _____ attached additional special provisions or limitations to this document to be honored in the absence of my being able to ___________________________________ _____________________________________________________________________________ for (check one): Any legally authorized purpose. Transplant or therapeutic purposes onndividual or institution: _____________________________ _______ Pursuant to Arizona law, I hereby give, effective on my death: Any needed organ or parts. The following part or organs listed: _________make an organ or tissue donation and I do not want my agent or family to do so. _______ I have already signed a written agreement or donor card regarding organ and tissue donation with the following iof the statements. If you do not check any of the statements, your agent and your family will have the authority to make a gift of all or part of your body under Arizona law. _______ I do not want to ons you make in this health care power of attorney survive your death.) If any of the statements below reflects your desire, initial on the line next to that statement. You do not have to initial any f or state that you do not want to make a gift. If you do not complete this section, your agent will have the authority to make a gift of a part of your body pursuant to law. Note: The donation electience. You may also authorize your agent to do so or a member of your family may make a gift unless you give them notice that you do not want a gift made. In the space below you may make a gift yourselo a bank or storage facility or a hospital, physician or medical or dental school for transplantation, therapy, medical or dental evaluation or research or for the advancement of medical or dental sciy. _______ 2. I consent to an autopsy. _______ 3. My agent may give consent to or refuse an autopsy. 3. Organ Donation (Optional) (Under Arizona law, you may make a gift of all or part of your body tI have given notice of its revocation. 2. Autopsy (under Arizona law an autopsy may be required) (Optional) If you wish to do so, reflect your desires below: _______ 1. I do not consent to an autops section 36-3251, Arizona Revised Statutes. This health care directive is made under section 36-3221, Arizona Revised Statutes, and continues in effect for all who may rely on it except those to whom cisions or after my death. My agent is directed to implement those choices I have initialed in the living will. I have _____ I have not _____ completed a prehospital medical care directive pursuant to____ completed and attached a living will for purposes of providing specific direction to my agent in situations that may occur during any period when I am unable to make or communicate health care deives as if I were alive, competent and acting for myself. If my agent is unwilling or unable to serve or continue to serve, I hereby appoint ____________________ as my agent. I have _____ I have not _ing any period when I am unable to make or communicate health care decisions or when there is uncertainty whether I am dead or alive have the same effect on my heirs, devisees and personal representatll medical, surgical, hospital and related health care. This power of attorney is effective on my inability to make or communicate health care decisions. All of my agent's actions under this power dur, __________________________, as principal, designate _________________ as my agent for all matters relating to my health care, including, without limitation, full power to give or refuse consent to any part of the principal's estate by will or by operation of law at the time that the power of attorney is executed. STATE OF ARIZONA HEALTH CARE POWER OF ATTORNEY 1. Health Care Power of Attorney Iattorney is executed. D. If a health care power of attorney is witnessed by only one person, that person may not be related to the principal by blood, marriage or adoption and may not be entitled to awing: 1. A person designated to make medical decisions on the principal's behalf. 2. A person directly involved with the provision of health care to the principal at the time the health care power of otary or witness that the power of attorney expressed the person's wishes and that the person intended to adopt the power of attorney at that time. C. A notary or witness shall not be any of the folloer of attorney. B. If a person is physically unable to sign or mark a health care power of attorney, the notary or each witness shall verify on the document that the person directly indicated to the nr marked the health care power of attorney, except as provided under subsection B, and that the person appeared to be of sound mind and free from duress at the time of execution of the health care powthe subject of the health care power of attorney. 3. Is notarized or is witnessed in writing by at least one adult who affirms that the notary or witness was present when the person dated and signed oontains language that clearly indicates that the person intends to create a health care power of attorney. 2. Except as provided under subsection B, is dated and signed or marked by the person who is dult individual or other adult individuals to make health care decisions on that person's behalf by executing a written health care power of attorney that meets all of the following requirements: 1. CInformation Arizona Health Care Power of Attorney Arizona Revised Statutes 36-3221. Health care power of attorney; scope; requirements; limitations A. A person who is an adult may designate another a Arizona