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Florida ______ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- __________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. ___________________________: ___________________________________ State of __________________________ ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ______________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State_______ (state). ________________________________ Signature of Principal Witness Signature: ___________________________________ Name: ___________________________________ City: ______________________is Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), ___________________ting 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 authority of thed 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 losses resule 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 General Power of Attorney is terminatt 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 actual knowledgy 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 appointmensition 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 taxable to mll 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 the disposcope 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 document sha Agent. This Power of Attorney shall be construed broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definition or s 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 performed as myall 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 provided aack 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 reimbursement of , and -3- authority of this document shall remain in full force and effect thereafter until my death or until my disability or incapacity. As used herein, "disability" or "incapacity" shall mean a ly Agent or my Agent's estate. This General Power of Attorney and the rights, powers, and authority of my Agent shall become effective immediately upon execution of this instrument. The rights, powersstate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to mif such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, e obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, y hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I mannual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designategifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this aocuments. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any le property, to such persons or organizations without regard to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and drnmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangibdy, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including gove accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental boy own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. -2- 12. To maintain and/or operate any business that I currentlstorage area owned or leased by me alone or in conjunction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercisery to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other ank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessanking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bavings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any bay Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, sle request by any government or its agencies in connection with governmental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including ms, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonabnd to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefitansaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person aure; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such trred in the future by me) and to execute any necessary document, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the futr manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acqui, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any otheidends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due -1- in the future, owned by, due, owing payable, or belonging to or entity. 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, divtake any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other personion of mortgages, lien, judgments, security agreements and other debts and obligations and such other instruments in writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and s, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfactments, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slipy such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agree of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into anvirtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful businessngible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or inta____________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, Principal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _________ppointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- GENERAL POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("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 wish to do so. AGENT: By accepting or acting under the ach action undertaken by your agent, within the 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 . You ("principal") are providing another person ("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 sully include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequencestute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generatorneys (available at findlegalforms.com as well), stays in effect even if the Grantor later becomes disabled or incapacitated. Please note that this information is not intended as and is not a substiif necessary. Although, some states don't require that a General Power of Attorney be witnessed, it is always a very good idea to do so. Another type of Power of Attorney, called a Durable Power of Atoperty. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the General Power of Attorney to be recorded as a public record, revoke a General Power of Attorney at any time. A General Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any real prpowerful" 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 binding upon the Grantor. The Grantor can ney-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 be a competent adult. A Power of Attorney is a "remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attornt person (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf. This particular Form becomes effective immediately and se of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information General Power of Attorney A General Power of Attorney allows a natural "mentally" competebe a starting point for you 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 uweeping, as the Agent has the 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 e 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 broad and sitnesses. [_] 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 instructing tha public record, if necessary. [_] Two witnesses need to sign the Power of Attorney. The witnesses should be competent adults. The Agent, the Agent's spouse or children, and the Notary should not be wncipal (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 recorded as er 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. [_] The PriInstructions & Checklist General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) General Pow FloridaFlorida _________ (Print, type, or stamp commissioned name and affix official seal) Self-proved Will Affidavit ­ Florida Probate Code 732.503 e of the testator and the subscribing witnesses, all on _______________________ (date). _____________________________________________ (Signature of Officer) _____________________________________________________________ (name of third witness) who is personally known to me or who has produced ____________________________ (type of identification) as identification and subscribed by me in the presenc_______________________________ (name of second witness) who is personally known to me or who has produced _______________________________ (type of identification) as identification, and _____________the witnesses, _______________________________ (name of first witness) who is personally known to me or who has produced _______________________________ (type of identification) as identification and _______________________, (testator's name), who is personally known to me or who has produced ____________________ (type of identification) as identification, and sworn to and subscribed before me by ________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Acknowledged and subscribed before me by the testator, ________tator and of each other. _____________________________________________ (Witness) Print Name: ___________________________________ _____________________________________________ (Witness) Print Name: ___at officer on our oaths that the testator declared the instrument to be the testator's will and signed it in our presence and that we each signed the instrument as a witness in the presence of the tes (Testator) We ______________________________________, and _______________________________, and ______________________________________,, have been sworn by the officer signing below, and declare to th_________, declare to the officer taking my acknowledgment of this instrument, and to the subscribing witnesses, that I signed this instrument as my Will. _____________________________________________ __________ Witness __________ Witness __________ Witness Page 7 of ______ Self-Proved Will Affidavit STATE OF FLORIDA COUNTY OF ________________________ I, _______________________________________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testator_________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ __________: Name: Address: City: State: ___________________________________ ___________________________________ ___________________________________ ___________________________________ __________________________ides at the address set forth after his or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signatureind and memory; We believe that this Will was not procured by duress, menace, fraud or undue influence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resshown above. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 6 of ______ We understand this is the Testator's Will; We believe the maker is of sound md we, at the Testator's request and in the Testator's sight and presence and at Testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date e(s) which contain the witness signatures, was signed in our sight and presence by _____________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament anWe, the undersigned, hereby certify and declare under penalty of perjury under the laws of the State of ____________________ that the above instrument, which consists of _____ pages, including the pag_________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) s under no constraint or undue influence and ask the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: ________________________ this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare this to be my Last Will and Testament, that I am of legal age and sound mind, that I make thinforceability should affect only that provision and all other provision should remain effective. 7. No Spouse. I am not currently married to anyone. IN WITNESS WHEREOF, I have signed my name below tonder, free from all matrimonial rights or controls by his or her spouse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unearing or division of property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereu not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of she bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if's good faith actions or non-actions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that thfaith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciarytator __________ Witness __________ Witness __________ Witness Page 5 of ______ 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad iate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date of my death. Initials: __________ Tes only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. 2. Thirty Day Survival Requirement. For the purposes of determining the approprall be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, butthis Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronouns shpplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VI MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be sutenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question g an advantage on any one or more of the beneficiaries or would otherwise, but for the foregoing, be considered as being other than an impartial exercise of their duties hereunder or as not being mainthority and discretion granted herein in what Executor deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have the effect of conferrinnted to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor shall exercise the powers, auction with administering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor shall be fully protected in exercising any discretion graconditions as the Executor may deem advisable and to refer to arbitration all such claims if the Executor deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in conne. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and _________ Witness __________ Witness __________ Witness Page 4 of ______ 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my deathenced by any such person or by my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor in good faith. Initials: __________ Testator _ll be conclusive and binding upon all the beneficiaries hereof. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experif America, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor sha refrain from making, in Executor's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States ong any bond or security and without liability for any loss or damage. The Executor shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make ort actually producing income shall be treated as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property or real property, without paying any rent, without givir assets so retained shall be deemed to be authorized investments for all purposes of my Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest noe in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's absolute discretion without responsibility for loss to the intent that investments ostribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and cause any share to be composed of money, property or undivided fractional shart as they may in their absolute discretion decide upon, or to postpone such conversion of my estate or any part or parts thereof for such length of time as they may think best. Make any division or dil, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cash or credit or for part cash and part credions concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor may be beneficially interested in the property or any part thereof so valued. 5. Seliscretion fix the value of my estate or any part thereof for the purpose of making any such division, setting aside or payment and the decision of the Executor shall be final and binding upon all pers in part in the assets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and declare that the Executor shall in their absolute dgage or mortgages which may be in existence at any time forming part of my estate. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly ormortgage or mortgages upon any real estate forming part of my estate or any part thereof, to borrow money on any such real estate upon the security of any mortgage or mortgages and to pay off any mortses and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor shall also have the right to renew and keep renewed any er and to the extent that the Executor shall deem advisable. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 3 of ______ 3. To accept surrenders of lea period as the Executor shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the mannsale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate administration of my estate for suchr of court and without notice to anyone. I also give to the Executor power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a real or personal property that may be included in my estate in such manner and for such purposes, for such prices, and upon such terms, credits and conditions as may be deemed advisable, without ordeproper administration of my estate, the Executor shall have the right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of anyutor serving hereunder. ARTICLE V POWERS OF EXECUTOR In addition to the existing authority of the Executor and in addition to other powers and authority granted by law or necessary or appropriate for "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any Exece. To the extent permitted by law, the Executor shall have the right to administer my estate without adjudication, order or direction of the court having jurisdiction over my estate, using "informal",e each Executor, Executrix, and Personal Representatives of my Will, my estate or any portion thereof who may be acting as such from time to time whether original or substituted and whether one or mor, I appoint ___________________________________, , to be the Executor of this my Will in the place and stead of the first aforementioned Executor. References to "Executor" in this my Will shall includpoint ___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or is unable to serve or continue to serve as Executor for any reasonto any other person the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE IV NOMINATION OF EXECUTOR I ap______ Witness __________ Witness __________ Witness Page 2 of ______ committee of such person, trustee of such person, person with whom the beneficiary resides at the time of the distribution or er disability, I authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservator, Initials: __________ Testator ____s may be specifically otherwise provided herein or directed otherwise by law, if any person should become entitled to any share in my estate before attaining the age of majority or while under any othrespective shares to be determined under the laws of the State of ________________________, then in effect, as if I had died intestate at the time fixed for distribution under this provision. Except a________________________________________________________________________ If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and ct that my residuary estate be distributed in equal shares per stirpes to: ___________________________________________ ____________________________________________________________________________ ___________________________ (name(s)). If more than one child is named, then the distribution shall be in equal shares per stirpes. If none of the named child(ren) or their descendants, survive me, I direiduary Estate I direct that my residuary estate, including any real property and personal property, be distributed, bequeathed and given to my child(ren) ______________________________________________homestead, if any, shall be distributed to my child(ren) ___________________________________ (name(s)). If more than one child is named, then the distribution shall be in equal shares per stirpes. Res ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. Primary Residence All my interest in my primary residence or ____________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to____________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to _______II DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. _____________________________________________ shall be distributed to _______________haser or transferee in connection with any property transferred to or acquired by such purchaser or transferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE I Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 1 of ______ This direction shall not extend to or include any such taxes that may be payable by a purcent of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not seek reimbursement from any beneficiary for the payment of the taxes.his Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me either during my lifetime or by survivorship. The paymrpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the taxes are owed on property passing under teritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall create, out of the residue, a separate fund for the puEXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. All taxes (including income taxes and inhany burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of any court. ARTICLE II PAYMENT OF DEBTS AND ENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposition of the ashes or the acquisition of Born on _________________ Name: _______________________________________ Born on _________________ Name: _______________________________________ Born on _________________ ARTICLE I FUNERAL & BURIAL EXPGE & CHILDREN I was married to __________________________________________, who is now deceased. I have the following adult child(ren) from that marriage: Name: _______________________________________ ______ (name), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I MARRIAg matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, _______________________________nd should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planninmation and these forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you a without any federal estate tax liability. This is referred to as the "Marital Deduction". If the recipient spouse is not a U.S. citizen, the deduction is limited (it was $100,000 in 1999). This inforthe face value of any life insurance policy; [] property you are holding in trust; any joint property you own In addition, each individual may leave an unlimited amount to his or her spouse upon deathoperty (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified employee benefit plans; [] his Will, it may be helpful to determine the value of all of the assets in your estate. Assets may include the following: [] real estate; [] stocks and bonds; [] bank accounts; [] tangible personal prng advice If Information about Wills ­ Page 2 your assets come near the $1,000,000 level, you really shouldn't use this will and should consult with tax professionals and an attorney. Before using tates totaling $1,000,000 or more could be subject to federal estate tax. As your estate approaches $1,000,000 in value and exceeds that amount, the greater your need for professional estate tax planniidual's estate. For a person dying in 2003, that credit is $1,000,000. The amount of the credit increases over the next few years. The credit is available to each individual and his or her spouse. Estrs should have an understanding of tax laws. Federal tax law provides that upon the death of an individual, there is a credit against the estate tax otherwise due on a portion of the value of an indivn any life situation where this Will is to be used as the principal estate planning document. If you have a large estate, you may need more complicated planning to reduce or limit death taxes. Testatoses or to require the witnesses to testify. New Hampshire permits self proving, but requires the affidavit to be in a specific format similar to the one included in our wills. The Will is for anyone i"proven" in court, like any other will. In Ohio, Maryland, California and the District of Columbia, the courts have some latitude to accept a will as self proved, to require an affidavit of the witnesit will be of no use in those states. However, including the affidavit in those states will not invalidate the Will (since it is a separate document from the Will). In those states it will have to be ndue influence, lack of testamentary capacity, or prior revocation. A few states like Louisiana, Maryland, Ohio and Vermont (as of 1999).do not have statutes permitting self proving wills. The affidavll were followed. The Affidavit can also be useful if witnesses are not available when they are needed.. However, even with the Affidavit, the Will may still be subject to contest on such grounds as uat each saw the Testator sign the will and that the formalities for signing a Will were followed. The Affidavit may eliminate the need to have witnesses testify, that the formalities in signing the Withe death of the Testator. Before the adoption of more modern laws, all wills were proved by having one or more of the witnesses come into court and testify under oath, or through sworn affidavits, thll required formalities were observed when the Will was signed. The Affidavit does not affect the validity or legality of the Will. However, it can speed up the admission of the Will to probate after ed and will not be governed by this Will. The Will has an enclosed self-proving affidavit, which contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary, that a held jointly with rights of survivorship, assets with beneficiary designations (such as life insurance or employee benefit plans), and assets held in trust generally will not be required to be probator") as specified by the Testator. This Will does not avoid probate for the Testator's estate. It merely directs how the assets which are individually owned by the Testator will be distributed. Assetse and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information about Wills This Will distributes the assets of the person making the Will (the "Testat local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchas state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from aability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and fromecked by a lawyer in their new state to make sure it meets local requirements. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitffect estate planning can vary over time and from place to place. All wills should be reviewed by a lawyer before they are signed. If the Testator moves to another state, the current will should be chf the Will calls for distribution in percentages, make sure that the total of all of the beneficiary's percentage's equal 100%. Check the totals before signing the Will. State and federal laws which athe other spouse dies. The Will may be invalid if a spouse receives nothing or only a small portion of the estate. Consult an attorney if you wish to disinherit a spouse or any children. If any part ole, the Testator's marital status changes, if the Testator has a child or if a named beneficiary or one of the Executors dies.. Most state laws guarantee a minimum share of an estate to a spouse when are desired, the Checklist & Instructions ­ Page 4 original and all copies should be destroyed and an entirely new Will should be written and signed. New wills are commonly necessary when, for examp a competent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or changing words on the face of the Will. Such changes are usually disregarded. If changes ll is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and other matters. The tax results of the choices made in this Will should be discussed witheld in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benefits arising in other contracts and plans are not normally governed by a will. This Wir, would automatically pass to another person by operation of law or by any contract. For example, the Will does not dispose of property held in joint tenancy with rights of survivorship or property hept by the Testator and may also (if Testator so wishes) be provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Testatoriginal "copy" of a will should be prepared. While photocopies may used for reference purposes, only the original can be admitted to probate. Copies are rarely accepted. A copy of the Will should be k. The original of the Will should be kept in a secure location such as a safe deposit box at a bank or lawyer's office. Unlike other legal instruments where multiple originals are prepared, only one o companies) before naming them as a Personal Representative, to make sure that they are willing and can serve. If you select a bank or trust company, be sure to check into their fees for such servicesry important to pick a person (or bank or trust company) that can be trusted to handle financial matters and to deal appropriately with family members. It is best to talk to people (and banks or trust pages (excluding i.e. not counting the self-proving affidavit) should be entered by hand in the bottom right of each page. The Personal Representative / Executor, should be picked carefully. It is ve before a Notary or other person authorized to take acknowledgments and administer oaths. The affidavit states that all required formalities were observed when the Will was signed. The total number ofn the self-proving affidavit (called "Proof of Will" in some states) and attach it to the end of the Will. The Affidavit contains the Testator's acknowledgment and the affidavit of the witnesses, madedicated by the Witnesses. The page with the self-proving affidavit, if included, should not be counted because the affidavit is not a part of the Will itself. The Testator and the witnesses should sigvalidity of the Will at a later date (i.e. if this Will revokes an earlier Will). The total number of pages in the Will, including the page(s) on which the witness signature lines appear, should be ine/she is signing the Will freely and willingly. Wherever requested, the date should be filled in (preferably by hand), with the date of the actual signing. This step could be crucial to determine the ­ Page 3 All witnesses must sign their names in the presence of the Testator and each other and of the notary public. The witnesses must be satisfied that the Testator is an adult of sound mind and htor to initial the bottom of each page of the Will. This can prevent subsequent substitution of pages. The witnesses should also initial the bottom of each page of the Will. Checklist & Instructions an say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and voluntarily", or similar words. Although not required in most states, it is a good idea for the Testae document that is about to be signed, is intended to be the Testator's Last Will and Testament. However, the witnesses don't need to read or know the contents of the Will. For example, the Testator ces. All witnesses and the notary should watch the Testator sign the Will. The notary public is needed for the self proved affidavit. Before signing the Will, the Testator should orally declare that thbe invalid for any reason or if one of the witnesses can't be located. The witnesses should not be beneficiaries under the Will. For example children, spouses, heirs or executors should not be witness) qualified, competent, disinterested and adult witnesses and a notary public. The signature of a third witness can provide additional protection if the signature of one of the witnesses is deemed to knows about relatives and others who might be entitled to a share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in the presence of three (3 must be of legal age (i.e. eighteen in most states). Being of "sound mind" usually means that the Testator knows that he/she is signing a Will, is familiar with the property and the value thereof and be completed and signed , by the Testator, all Witnesses and a Notary in front of each other. The Testator (i.e. the person who is writing the Will) must be of "sound mind" when signing the Will andss signatures and info Affidavit: The enclosed Affidavit (although technically not part of the Will) states that all required formalities were observed when the Will was signed. The Affidavit needs tonature Block: Testator needs to fill out: [] day month year city; []Signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; []witnes of Executor empowers the representative to deal with matters like taxes, taking care of the property, and making distributions to the beneficiaries Article VII: Contains miscellaneous provisions Sig Representative will pay whatever is left to the beneficiaries named in the will. Testator must provide and fill out [] the name of executor; [] name of alternate executor. · · · · · Article VI: Powerctions ­ Page 2 Personal Representative is also responsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personale, and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The · · · · Checklist & Instru laws the will is made Article V: Deals with the appointment of the Testator's Personal Representative (i.e. Executor) and alternate; It allows the Testator to name an Executor to administer the estat []name of child(ren) to whom the residuary estate will be given; []name of "alternate" beneficiaries to whom the residuary estate will be given if child(ren) predecease Testator. [] state under whoseunt); [] name(s) of person/entity property is given to (three blank paragraphs are provided, but you can add as many as you need). []name of child(ren) to whom the primary residence (if any) is given;ther property to specific persons or charities and gives any primary residence and the residuary estate to the child(ren). Testator must provide and fill out: [] description of property (or dollar amonses. Article III: Authorizes payments of debts and expenses. Article IV: Disposes of specific property, primary residence and residuary property.. Allows Testator to give specific dollar amounts or od(ren) and date of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and Burial expeill out: []name, [] county and []state Article I: Gives the name of deceased spouse and the name(s) of the child(ren). Testator must provide and fill out [] name of deceased spouse; [] name(s) of chilto be completed. · · · Title: Enter name of Testator in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator must provide and f0. This Will is divided into various sections. The content of each section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also needs . It distributes the assets of the Testator (i.e. person making the will) to the child(ren) and to specific beneficiaries named in the Will. This Will is suitable for estates worth less than $1,000,00ill ­ Widow/Widower with Adult Children and selfproved affidavit. This Will is for a Widow or Widower with Adult Children from the marriage, who has not remarried, and includes a self-proved affidavitChecklist and Instructions Will ­ Widow/Widower with Adult Children This package contains (1) Checklist and Instruction for Will ­ Widow/Widower with Adult Children; (2) Information about Wills; (3) W FloridaFlorida im Deed - 2 who did not take an oath. _______________________________ Signature of Notary Public _______________________________ Printed Name of Notary My commission expires: _________________________ Quitclacknowledged before me on ______________________ by ___________________________________________ who is/are personally known by me or who has/have produced:_______________________ as identification and ______ ___________________________________ (Witness Signature) Print Name: ___________________________ State of FLORIDA ) ) County of __________________________ ) ss The foregoing instrument was a_____________________________ Quitclaim Deed - 1 Above reserved for official use only Signed in our presence: ________________________________ (Witness Signature) Print Name: _____________________ture ____________________________________________ Grantor's Printed Name Grantee's Address: _____________________________ _____________________________ Grantors Address: _____________________________ d any right or title to the aforesaid property, premises or appurtenances or any part thereof. EXECUTED this day of ________, 20 _______ . ____________________________________________ Grantor's Signantee's heirs, administrators, executors, successors and/or assigns forever; so that neither Grantor nor Grantor's heirs, administrators, executors, successors and/or assigns shall have, claim or deman______________, State of Florida with the following legal description: TO HAVE AND TO HOLD all of Grantor's right, title and interest in and to the above described property unto the said Grantee, Gra_____________________________________________ ("Grantee"), all right, title, interest and claim to the following real property in the City of ___________________________, County of ___________________tion, the receipt and sufficiency of which is hereby acknowledged, the undersigned, _________________________________________ ("Grantor"), hereby REMISES, RELEASES, AND FOREVER QUITCLAIMS to ______________________________ QUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: FOR A VALUABLE CONSIDERATION, in the amount of TEN AND NO/100 DOLLARS ($10.00) in hand and other good and valuable consideraed by: and when recorded, please return this deed and tax statements to: Above reserved for official use only Grantee's SS No:_______________________ Property Appraiser's Parcel ID # _______________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 findlegalforms.com Recording preparese 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 attorney first. An attorney the title to the property. If you are a buyer taking a Quitclaim Deed, make sure that it satisfies your needs. Consult a real estate attorney and title insurance company to protect your interests. Thtle. A buyer will rarely accept a Quitclaim Deed as the only form of conveyance when buying a property. Quitclaim deeds are mainly used in family situations or to correct possible technical defects inature or quality of that interest, or even if any interest exists at all. This type of deed may be useful in cases where a party is unable to transfer a fee simple estate or make promises about the ti Quitclaim Deed This Quitclaim Deed form is used to convey an interest in real estate. A Quitclaim Deed does not include any promise or guarantee by the person making it (i.e. the Grantor) about the nuld 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 findlegalforms.com Information for 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 attorney first. An Attorney shoRecorder's (or similar) office. [_] Depending on the type of document, additional requirements may apply. Nonconforming documents may be returned unrecorded or may be charged additional fees [_] Theselegal description of the land. Verify that the legal description is correct. [_] A Quitclaim Deed may require other documents to be filed with it. Please check your local requirements with your local Quitclaim Deed may not be effective against third parties. Although witnesses are not required in all states, it is generally a good idea to use them. [_] Documents referencing land should include a Grantor should date and sign the Quitclaim Deed before a Notary and two witnesses. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, theInstructions & Checklist for Quitclaim Deed [_] This package includes: (1) Instructions and Checklist for Quitclaim Deed; (2) General Information about Quitclaim Deeds; and (3) Quitclaim Deed [_] The FloridaFlorida Phone: _______________________________________ 2 ____________________________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ __ (Declarant's Signature) _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ Phone: _______ ____________________________________________________________________________ ____________________________________________________________________________ __________________________________________________________________________________________ ____________________________________________________________________________ _______________________________________________________________________________________ I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration. Additional Instructions (optional): ________________________________________________________________________________________ ______________________________________ Zip Code: ___________________________ Phone: _____________________________________________________arry out the provisions of this declaration should my surrogate be unwilling or unable to act on my behalf: 1 Name: ____________________________________________________________________ Address: ________________ Zip Code: ___________________________ Phone: ____________________________________________________________________ I wish to designate the following person as my alternate surrogate, to cs of this declaration: Name: ____________________________________________________________________ Address: __________________________________________________________________ __________________________ be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to carry out the provisiony my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal. In the event that I have been determined tohe administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain. It is my intention that this declaration be honored bolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only tal) and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that lifepr if at any time I am incapacitated and _________ I have a terminal condition; or (initial) _________ I have an end-stage condition; or (initial) _________ I am in a persistent vegetative state (initif _____, ______ (year), I, __________, willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare that, be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will Declaration made this _____ day o sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document shouldnd/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to makeanties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal astate. (c) Any limitations or conditions expressed orally or in a written declaration have been carefully considered and satisfied. [_] These forms are provided "as is" and no implied or express warrability of recovering capacity so that the right could be exercised directly by the principal. (b) The principal has a terminal condition, has an end-stage condition, or is in a persistent vegetative tions. Information & Instructions ­ Page 4 (2) Before proceeding in accordance with the principal's living will, it must be determined that: (a) The principal does not have a reasonable medical probnot sought within 7 days following the attending physician's decision to withhold or withdraw life-prolonging procedures, the attending physician may proceed in accordance with the principal's instrucithdraw life-prolonging procedures, the attending physician shall not withhold or withdraw life-prolonging procedures pending review under s. Ch765. Section 105. If a review of a disputed decision is r part II, the attending physician may proceed as directed by the principal in the living will. In the event of a dispute or disagreement concerning the attending physician's decision to withhold or wexpressing his or her desires concerning lifeprolonging procedures, but has not designated a surrogate to execute his or her wishes concerning life-prolonging procedures or designated a surrogate unde rebuttable presumption of clear and convincing evidence of the principal's wishes. Florida Statutes Title 44 Chapter 765 Section 304: Procedure for living will (1) If a person has made a living will care facility which is so notified shall promptly make the living will or a copy thereof a part of the principal's medical records. (3) A living will, executed pursuant to this section, establishes athe principal is admitted to a health care facility, any other person may notify the physician or health care facility of the existence of the living will. An attending or treating physician or health principal to provide for notification to her or his attending or treating physician that the living will has been made. In the event the principal is physically or mentally incapacitated at the time ysically unable to sign the living will, one of the witnesses must subscribe the principal's signature in the principal's presence and at the principal's direction. (2) It is the responsibility of theetative state. A living will must be signed by the principal in the presence of two subscribing witnesses, one of whom is neither a spouse nor a blood relative of the principal. If the principal is pharation and direct the providing, withholding, or withdrawal of life-prolonging procedures in the event that such person has a terminal condition, has an end-stage condition, or is in a persistent vego Living Wills. Florida Statutes Title 44 Chapter 765 Section 302: Procedure for making a living will; notice to physician. (1) Any competent adult may, at any time, make a living will or written declFlorida Living Will. This Florida Living Will is based on Florida Statutes Title 44 Chapter 765 Section 303. For your convenience, we have included useful excerpts from the Florida Statutes relating tion and Instructions Florida Living Will This package contains (1) Information and Instruction for Florida Living Will, including excerpts from the Florida Statutes relating to Living Will Forms; (2) ______________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ Phone: _______________________________________ -2- Informat____________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ Phone: _______________________________________ ________________________________________________________________________ Signed: ____________________________________________________________________ Dated: ______________________________ ______________________________________________________ Address: __________________________________________________________________ Name: ____________________________________________________________________ Address: _________________e facility. I will notify and send a copy of this document to the following persons other than my surrogate, so they may know who my surrogate is. Name: ___________________________________________________ ____________________________________________________________________________ -1- I further affirm that this designation is not being made as a condition of treatment or admission to a health car__________________________________________________ ____________________________________________________________________________ ________________________________________________________________________to apply for public benefits to defray the cost of health care; and to authorize my admission to or transfer from a health care facility. Additional Instructions (optional): __________________________designee to make health care decisions, except for anatomical gifts, unless I have executed an anatomical gift declaration pursuant to law, and to provide, withhold, or withdraw consent on my behalf; ____________________________ Zip Code: ___________________________ Phone: ____________________________________________________________________ I fully understand that this designation will permit my o designate as my alternate surrogate: Name: ____________________________________________________________________ Address: __________________________________________________________________ _________________ Zip Code: ___________________________ Phone: ____________________________________________________________________ If my surrogate is unwilling or unable to perform his or her duties, I wish t care decisions: Name: ____________________________________________________________________ Address: __________________________________________________________________ _______________________________l) In the event that I have been determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to designate as my surrogate for healthis subject to the Disclaimers and Terms of Use found at findlegalforms.com -3- Designation of Health Care Surrogate Name: ________________________________________________ (Last, First, Middle Initiay whenever a document is negotiated with another party. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms ithout consulting with an attorney first. Before using or signing this document you should have an attorney review it to make sure it fits your particular situation. You should also consult an attorneare not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used w are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their lega l effect or completeness. [_]These forms as modified or revoked the authority of the surrogate pursuant to s. 744.3115. The surrogate may be directed by the court to report the principal's health care status to the guardian. [_] These forms licensed under chapter 400. (3) If, after the appointment of a surrogate, a court appoints a guardian, the surrogate shall continue to make health care decisions for the principal, unless the court h persons to ensure the continuity of the principal's health care and may authorize the admission, discharge, or transfer of the principal to or from a health care facility or other facility or program such application a condition of continued care if the principal, if capable, would have refused to apply. (2) The surrogate may authorize the release of information and medical records to appropriateccess to information regarding the principal's income and assets and banking and financial records to the extent required to make application. A health care provider or facility may not, however, makeician's order not to resuscitate. (d) Be provided access to the appropriate medical records of the principal. (e) Apply for public benefits, such as Medicare and Medicaid, for the principal and have a proposed treatments are to be withheld or that treatments currently in effect are to be withdrawn. (c) Provide written consent using an appropriate form whenever consent is required, including a physances if the principal were capable of making such decisions. If there is no indication of what the principal would have chosen, the surrogate may consider the patient's best interest in deciding thatusly with appropriate health care providers to provide informed consent, and make only health care decisions for the principal which he or she believes the principal would have made under the circumstssly limited by the principal, shall: -2- (a) Have authority to act for the principal and to make all health care decisions for the principal during the principal's incapacity. (b) Consult expeditiohall apply. Florida Statutes Title 44 Chapter 765 Section 205: Responsibility of the surrogate (1) The surrogate, in accordance with the principal's instructions, unless such authority has been exprending that a princ ipal lacks capacity for any other purpose. 5) In the event the surrogate is required to consent to withholding or withdrawing lifeprolonging procedures, the provisions of part III stly loses capacity as determined pursuant to this section. 4) A determination made pursuant to this section that a principal lacks capacity to make health care decisions shall not be construed as a fi of the surrogate. In the event the attending physician determines that the principal has regained capacity, the authority of the surrogate shall cease, but shall recommence if the principal subsequengained such capacity. Upon commencement of the surrogate's authority, a surrogate who is not the principal's spouse shall notify the principal's spouse or adult children of the principal's designationrogate's authority shall commence upon a determination under subsection (2) that the principal lacks capacity, and such authority shall remain in effect until a determination that the principal has re the facility shall notify such surrogate or attorney in fact in writing that her or his authority under the instrument has commenced, as provided in chapter 709 or Chapter 765 Section 203. 3) The sure principal's medical record. If the principal has designated a health care surrogate or has delegated authority to make health care decisions to an attorney in fact under a durable power of attorney, if the second physician agrees that the principal lacks the capacity to make health care decisions or provide informed consent, the health care facility shall enter both physician's evaluations in th evaluation in the principal's medical record. If the attending physician has a question as to whether the principal lacks capacity, another physician shall also evaluate the principal's capacity, andelf or himself or provide informed consent is in question, the attending physician shall evaluate the principal's capacity and, if the physician concludes that the principal lacks capacity, enter thatnot be inferred from the person's voluntary or involuntary hospitalization for mental illness or from her or his mental retardation. 2) If a principal's capacity to make health care decisions for hers04: Capacity of principal; procedure 1) A principal is presumed to be capable of making health care decisions for herself or himself unless she or he is determined to be incapacitated. Incapacity may xecuted pursuant to this section establishes a rebuttable presumption of clear and convincing evidence of the principal's designation of the surrogate. Florida Statutes Title 44 Chapter 765 Section 2alth treatment. (6) Unless the document states a time of termination, the designation shall remain in effect until revoked by the principal. -1- (7) A written designation of a health care surrogate estates otherwise, the court shall assume that the health care surrogate authorized to make health care decisions under this chapter is also the principal's choice to make decisions regarding mental heent to consent to mental health treatment and a guardian advocate is appointed as provided under Chapter 394 Section 4598. However, unless the document designating the health care surrogate expressly intment of a proxy pursuant to part IV. (5) A principal may designate a separate surrogate to consent to mental health treatment in the event that the principal is determined by a court to be incompetsignated alternate surrogate is able or willing to make health care decisions on behalf of the principal and in accordance with the principal's instructions, the health care facility may seek the appos unwilling or unable to perform his or her duties. The principal's failure to designate an alternate surrogate shall not invalidate the designation. (4) If neither the designated surrogate nor the deurrogate may also designate an alternate surrogate provided the designation is explicit. The alternate surrogate may assume his or her duties as surrogate for the principal if the original surrogate i of the document designating the health care surrogate. At least one person who acts as a witness shall be neither the principal's spouse nor blood relative. (3) A document designating a health care serson sign the principal's name as required herein. An exact copy of the instrument shall be provided to the surrogate. (2) The person designated as surrogate shall not act as witness to the execution for a principal shall be signed by the principal in the presence of two subscribing adult witnesses. A principal unable to sign the instrument may, in the presence of witnesses, direct that another p of Health Care Surrogate Form. Florida Statutes Title 44 Chapter 765 Section 202: Designation of a health care surrogate. (1) A written document designating a surrogate to make health care decisionsrida Designation of Health Care Surrogate is based on Florida Statutes Title 44 Chapter 765 Section 203. The following are useful excerpts from the Florida Statutes relating to the Florida Designationxcerpts from the Florida Statutes relating to the Florida Designation of Health Care Surrogate Form; (2) Florida Designation of Health Care Surrogate (Power of Attorney for Health Care) Form. This Floare Surrogate (Power of Attorney for Health Care) This package contains (1) Information and Instruction for Florida Designation of Health Care Surrogate (Power of Attorney for Health Care) including eith a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information and Instructions Florida Designation of Health Cour particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed we. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits y made or are provided as to their suitability for any specific purpose or as to their legal effect or completene ss. [_]These forms are not intended and are not a substitute for legal and/or tax adviclth Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implied or express warranties have beenFlorida Advance Health Care Directive This package contains both a Florida Power of Attorney for Health Care and a Florida Living Will. Together these forms are also sometimes known as an Advance Hea FloridaFlorida _____________ Name of Survivor: _______________________________ Address: ____________________________________________ City: _______________________________________________ State: __________________________________urposes (strike any of the following you do not want): (1) Transplant (2) Therapy (3) Research (4) Education Date: __________________ Signature of Survivor: __________________________________ Printed_______________ ________________________________________________________________________ ________________________________________________________________________ III. The gift is for the following pthe applicable box): Give any needed organs, tissues, or parts, OR Give the following organs, tissues, or parts only: _______________________ _________________________________________________________ity and state). I. I survive the decedent as (mark the appropriate box): spouse; adult son or daughter; parent; adult brother or sister; grandparent; or guardian of the decedent. II. I hereby (mark this anatomical gift from the body of __________________________________(name of decedent) who died on _____________, 20___ at_______________________________ in ____________________________________ (corney should be consulted for all serious legal matters. Anatomical Gift by Next of Kin or Guardian of the Person Pursuant to the Uniform Anatomical Gift Act and the law of this state, I hereby make rruption) however caused and on any theory of liability, whether in contract, strict liability, or tort (including negligence or otherwise) arising in any way out of the use of these materials. An att direct, indirect, incidental, special, exemplary, or consequential damages (including, but not limited to, procurement of substitute goods or services; loss of use, data, or profits; or business inteals are used at your own risk. In no event will: i) FindLegalForms, Inc, its agents, partners, or affiliates, or ii) the providers, authors or publishers of the forms, be responsible or liable for anym. These materials are provided "AS-IS." We do not give any express or implied warranties of merchantability, suitability or completeness for any of the materials for your particular needs. The materieated by use of these materials. FindLegalForms, Inc. does not provide legal advice. The purchase and use of these materials is subject to the "Disclaimers and Terms of Use" found at findlegalforms.con for the removal of a part from the body of the decedent, the physician, surgeon, technician, or enucleator removing the part knows of the revocation. Disclaimer No Attorney-Client relationship is cr a member of the person's class or a prior class. An anatomical gift by a person authorized under subdivision may be revoked by any member of the same or a prior class if, before procedures have beguoposing to make an anatomical gift knows of a refusal or contrary indications by the decedent. (3) The person proposing to make an anatomical gift knows of an objection to making an anatomical gift byAn anatomical gift may not be made by a person listed above if any of the following occur: (1) A person in a prior class is available at the time of death to make an anatomical gift. (2) The person pre decedent; (3) either parent of the decedent; (4) an adult brother or sister of the decedent; (5) a grandparent of the decedent; and (6) a guardian of the person of the decedent at the time of death ker for an authorized purpose, unless the decedent, at the time of death, has made an unrevoked refusal to make that anatomical gift: (1) the spouse of the decedent; (2) an adult son or daughter of th Gift Form An anatomical gift may be made any member of the following classes of persons, in the order of priority listed, may make an anatomical gift of all or part of the decedent's body or a pacemas made on behalf of the decedent by the next of kin or guardian. Included in this kit are the following: General Instructions for preparing your Anatomical Gift (by next of kin or guardian) Anatomicalt. As the next of kin or guardian, you can prepare and execute an Anatomical Gift on behalf of the decedent. This kit is designed to fulfill the obligations of the Uniform Anatomical Gift Act for giftFindLegalForms.com Information Donation Pursuant to the Uniform Anatomical Gift Act (by Next of Kin or Guardian) A loved one has died and you believe that he/she would desire to make an Anatomical Gif Florida