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Georgia ) _________________________________ Name typed, printed, or stamped -5- ipal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Publice of GEORGIA ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Princ______________ Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Stat__________ Signature of Principal Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: _____________________Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), Georgia. ______________________dgment 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 this Power of ion 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 resulting from juocation. 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 is terminated by operatt. 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 knowledge of the rev 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 appointment by my Ageny 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 my Agent; (b)ain 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 disposition of aners 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 shall still remwer 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 definition or scope of powo 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 my Agent. This Poexpenses 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 as my Agent If s 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 all reasonable erminate on my subsequent disability, incapacity or lack of mental competence (except as provided by any applicable statute). As used herein, "disability" or "incapacity" shall mean a lack of capacityve 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 of Attorney shall not t 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 shall become effectiht 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 entitled, if the resultmy 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 document), which migto 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. To transfer any 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) use any of my assets orized 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, or the creditors ofax 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, unless specifically authifts 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 the federal gift tnecessary, 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 pursuant to the Uniform Gitable 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 or otherwise, and if n 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 make gifts and charcuments 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 documents; to obtaias 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, and/or file any do2- 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 business assistance ove, 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 other investments. -es. 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, and to examine, remrm, 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.S. Treasury Securitiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, fiith 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 withdrawals, negotik accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts wd 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, maintain and/or close banplications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, medical, military anayments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare apance 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 sue to recover all ponies 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, including life insur 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, recover and receive all mor 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 includes the right to sellge, 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 or personal property - 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, rent, sell, mortgats, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due -1m, 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 papers, checks, drafkind 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 and settle any clains, 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 writing of whatever oxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutionants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, pre 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, bonds, contracts, coveTo 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, endorse and executitute 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 be limited to: 1. , 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, or my Agent's substhave 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, item, transaction________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My Agent shall S BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________y accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- GEORGIA DURABLE POWER OF ATTORNEY Effective Immediately KNOW ALL PERSONtain 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 wish to do so. AGENT: Br 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 about these powers, obocument, consider its consequences. 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 o 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. Before signing this dot 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 included with the formsrded 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 this information is n 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 of Attorney to be recoGrantor. 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 if the Agent will be 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 binding upon the erson 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 be a competent adult. A 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 to mean "lawyer". 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 particular Form becomes 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 person (called the "Psed 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 subject to the Disclaimersusiness 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 you and should not be uhe 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 the power to handle bginal 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-fact) as to the tasks tults and at least one may not be related by blood or marriage to the principal. The Agent, the Agent's spouse or children, and the Notary should not be witnesses. [_] The Principal should keep the oriization will allow the Durable Power of Attorney to be recorded as a public record, if necessary. [_] In Georgia, two witnesses need to sign the Power of Attorney. The witnesses should be competent ad 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 Georgia Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) Informa GeorgiaGeorgia wledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- _________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking ackno to the Principal State of GEORGIA ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by _________________________________________________ City: __________________________________ State: ___________________________________ * must be competent adults and at least one may not be related by blood or marriage_______ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___ice to my Agent. Signed on ________________ (date), at _______________________ (city), Georgia. ________________________________ Signature of Principal Witness Signature*: ____________________________ciary 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 written notthout notice 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 fidue third party 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, wion 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 arise against thies 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 under it. Revocati 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 insurance policson needs to 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 Agentid, 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 invalidity. No perlisting 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 held to be invalg 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 as broadly as a General Power of Attorney. The ney. 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 or fiduciary actin, as certified 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 Attorrein, "disability" 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 properlyect thereafter 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 hebecome effective 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 effuld be entitled, 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 all rights and powers therein shall s 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 disclaim assets, to which I wopport. 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 interest (subject to other provision, 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 I am legally obligated to sucreditors, 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 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, my Agent's estate, my Agent's ed in value 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 mayr 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 annual exclusion, shall not exceplanning 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, guardian or close friend of the minocy. 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 gifts are a part of my estate 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 settle any matter with such agenared, 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 tax returns and necessary and/al and/or 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 prepoptions 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. 13. To employ any profession contents, and to examine, remove, keep or otherwise dispose of the contents. -2- 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, cluding 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 person, including access to theirayable 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 the United States of America, inposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers p, 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, but not limited to, making depen, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accountsmited 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 Social Security benefits. 9. To oty and Medicare; 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 lith and/or 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 Securipolicies, 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 wiect, 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 annuity contracts, insurance his 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 ask for, demand, sue for, collany 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 deed for such transactions. Ture, 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, any part or any interest in d 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. 6. To maintain, manage, insnds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreecompromise and 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, bouments 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 debt owed to me. 4. To adjust, companies 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 instrcredit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fundlading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of nd 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, assignments, bills of sale or de, 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 binding contracts on my behalf a 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 powers and authority shall inclu 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 ratify and confirm all acts thatd discretions. 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____________________________ maintaining an address at: _____________________________________________________ as my alternate or successor Agent, as necessary, to serve with the same powers, rights an___________________________________________ 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 _________rincipal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: __________iduciary and other legal responsibilities of an agent. -3- GEORGIA DURABLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("P 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 appointment, the agent assumes the f, 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 document does not authorize anyoneanother 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 such action undertaken by your agenttions. -2- 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 , this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instruco do so. Two 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 allow the Durable 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 tnot 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 the validity of the Power of Attorney and willthis Power 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 a Durable Power 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 gally binding 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 power of 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 let 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 appointed an attorney-in-fact byr "AttorneyIn-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 tha of Attorney 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" oed before negotiating 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 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 should be consult that the first 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 notre very broad 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 eventl in instructing 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 ar marriage to the Principal. [_] 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 carefupublic record, if necessary. [_] In Georgia, the Power of Attorney needs to be signed in front of two witnesses. The witnesses should be competent adults and at least one may not be related by blood of 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 Georgia Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2) GeorgiaGeorgia _________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5-nstrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ______________________________________________ * must be adults and at least one may not be related by blood or marriage to the Principal State of GEORGIA ) ) ss County of ________________________ ) The foregoing i_____ State: ___________________________________ Witness Signature*: ___________________________________ Name: ___________________________________ City: __________________________________ State: ____Georgia. ________________________________ Signature of Principal Witness Signature*: ___________________________________ Name: ___________________________________ City: _____________________________the authority of this 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), le for losses 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 ttorney is 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 liabhas actual 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 General Power of Apower of appointment 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 to be taxable 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 or as to the 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 incomeof the document 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 the definition 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 cts performed as my 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 limitservices provided 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 ao reimbursement 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 ity" 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. My Agent shall be entitled t The rights, powers, 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 "incapac or indirectly to my 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.any other person, estate, 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 directlyust created by me, if 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 ions, including any 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 trof 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) use any of my assets to discharge any of my Agent's legal obligatassign or designate 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 ar year, and this annual 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, 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 the federal gift tax annual exclusion amount in any one calendt tax returns and documents. 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 angible or intangible 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 gifncy, including governmental 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, ther governmental body, 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 ageited to, attorneys, 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 otess 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 business assistance as may be appropriate, including but not limts. 11. To exercise 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 businox, vault or other storage 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 contenorm any act necessary 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 buments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perfusiness with any banking 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 instrhecking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any banyone, including my 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, c any other reasonable 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 retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and performppropriate person and 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,y reason of such transaction. 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 a may own in the future; 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 b(now owned or acquired 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 orest 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 or personal property or asset whatsoever, tangible or intangible le, 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, rent, sell, mortgage, improve, repair, exchange, invest, reinvtes, interests, dividends, 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 payabst any other person 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, nok, 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 and settle any claim, against me or asserted on my behalf againases, and satisfaction 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, asal and deposit slips, 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, releeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawry to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deall 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, endorse and execute any written agreement and document necessaause 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 be limited to: 1. To conduct, engage in, and transact any and l, tangible or intangible, 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 c act, power, duty, 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 personadress at: _____________________________________________________ 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________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an adunder the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- GEORGIA GENERAL POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________vice. 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 wish to do so. AGENT: By accepting or acting rty. 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 about these powers, obtain competent legal adonsequences. 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 propeale, generally 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 cot a substitute 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 sPower of Attorneys (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 nic record, if 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 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 General Power of Attorney to be recorded as a publrantor can 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 rney 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 binding upon the Grantor. The Gs 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 be a competent adult. A Power of Attoiately and 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 aly" competent 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 immedchase and use 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 "mentalhould only be 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 purbroad and sweeping, 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 structing 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 ge to the Principal. [_] 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 insrded as a public record, if necessary. [_] In Georgia, two witnesses need to sign the Power of Attorney. The witnesses should be competent adults and at least one may not be related by blood or marria 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 Georgia General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) Gen GeorgiaGeorgia GeorgiaGeorgia of __________________, 20____. __________________________________________ Notary public Self-proved Will Affidavit [SEAL] _______ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced ______________________ as identification, this _______ day wn to me or who has produced ______________________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced ____________________, the testator, who is personally known to me or who has produced _____________________ as identification, and by _______________________________________________, a witness, who is personally kno________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed and sworn to before me by __________________________________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________o witness a will. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ____________ the age of majority (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of proper age t upon the request of the testator, in the presence and hearing of the testator and in the presence of each other; 4) to the best knowledge of each witness, the testator was, at the time of signing, ofegoing instrument is the last will of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presence of the witnesses; 3) the witnesses signed the willsigned to the attached or foregoing instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, each then declared to me that: 1) the attached or for____________________, the testator and _______________________________________, and __________________________________, and ___________________________________________, the witnesses, whose names are Affidavit STATE OF __________________________ COUNTY OF ________________________ I, the undersigned, an officer authorized to administer oaths, certify that __________________________________________________________________________ ___________________________________ Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 9 of ______ Self-Proved Will _______________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ____________________ture: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ ; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his or her name. Dated: ____________________, ______ Witness Signahe date shown above. We understand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue influenceament and 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 t the page(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 Test______ We, 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, includinge following clause before signing. The witnesses should not receive assets under this Will.) Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 8 of or's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read th this to be my Last Will and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influence and ask the Witnesses named below to witness my signature. Testatls, except where otherwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declarehe other Spouse or who died first, I direct that it be determined that my Husband survived me. In that case, the terms of his Will shall then take precedence over the terms of this Will or it's Codiciion should remain effective. 7. Survival If my Husband and I die under circumstances whereby it is difficult or impractical to determine the order of deaths or to determine who survived the death of tuse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all other provisy and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereunder, free from all matrimonial rights or controls by his or her spotherefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of sharing or division of property which may exist between any beneficiar the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. 5. Matrimonial Rights. No gift, or the income ch actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries,my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions as the fiduciary, except for sudate of my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and For the purposes of determining the appropriate 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 the court order granting such adoption. Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 7 of ______ 2. Thirty Day Survival Requirement. nder or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on thef any gender shall be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless of gegiven to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. Throughout this Will the use oever or whomsoever. ARTICLE X MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender. The titles f their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsose, but for the foregoing, be considered as being other than an impartial exercise of their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such exercise obest interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have the effect of conferring an advantage on any one or more of the beneficiaries or would otherwial representatives by reason of the exercise of such discretion. The Executor or Trustee shall exercise the powers, authority and discretion granted herein in what Executor or Trustee deems to be the other professional fees. The Executor or Trustee shall be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or persone deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with administering my estate, including but not limited to attorney, accountant, agent, broker andothers for such consideration or no consideration and upon such terms and conditions as the Executor or Trustee may deem advisable and to refer to arbitration all such claims if the Executor or Trusteership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against by my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor or Trustee in good faith. 9. Windup, dissolve, settle or continue any partnhe beneficiaries hereof. The Executor or Trustee shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or uch exercise of discretion by the Executor shall be Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 6 of ______ conclusive and binding upon all t the federal government of the United States of 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 ssuch property so used. 8. Make or refrain from making, in Executor's or Trustee's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted byany rent, without giving any bond or security and without liability for any loss or damage. The Executor or Trustee shall not be liable or responsible for any injury to, consumption of or loss of any nd no such interest not 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 ent that investments or 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 aonal share in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's or Trustee's absolute discretion without responsibility for loss to the intion or distribution 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 fractiart credit 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 divisd. 5. Sell, 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 ps concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor or Trustee may be beneficially interested in the property or any part thereof so value 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 or Trustee shall be final and binding upon all personorming 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 or Trustee shall in their absolute discretion fixmay 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 or in part in the assets fon 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 mortgage or mortgages which in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor or Trustee shall also have the right to renew and keep renewed any mortgage or mortgages uping such property in adequate condition and repair, in the manner and to the extent that the Executor or Trustee shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend money income Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 5 of ______ therefrom; and pay the taxes and expenses thereof, including the cost of keeperein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate administration of my estate for such period as the Executor or Trustee shall determine; collect anyustee power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale hr and for such purposes, for such prices, and upon such terms, credits and conditions as may be deemed advisable, without order of court and without notice to anyone. I also give to the Executor or Trpower to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of any real or personal property that may be included in my estate in such mannel, and in addition to other powers and authority granted by law or necessary or appropriate for proper administration of my estate and the Trust, the Executor and the Trustee shall have the right and LE IX POWERS OF EXECUTOR & TRUSTEE In addition to the existing authority of the Executor with regards to the Will and of any Trustee with regards to the administration of any Trust created by this Wilent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any Executor serving hereunder. ARTIC 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", "unsupervised", or "independnd 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 more. To the extent permitted byappoint ___________________________________, to be the Executor of this my Will in the place and stead of my Husband. References to "Executor" in this my Will shall include each Executor, Executrix, aUTOR I appoint my Husband ___________________________________, as the Executor of this my Will. If my Husband cannot, does not or is unable to serve or continue to serve as Executor for any reason, I eath the appointed Guardian apply to have custody of such child(ren) and act as the guardian of the property of such child pursuant to the provisions of applicable law. ARTICLE VIII NOMINATION OF EXEC________________________, as the Guardian of my minor child(ren) in the place and stead of the first aforementioned Guardian. It is my wish that before the expiration of ___ days from the date of my d/Wife __________ Witness __________ __________ Witness Witness Page 4 of ______ person cannot, does not or is unable to serve or continue to serve as Guardian for any reason, I appoint ___________ Guardian for any of my minor child(ren) under the age of eighteen years, I appoint ___________________________________, as the Guardian of my minor child(ren). If such Initials: __________ Testatrixity, the Trustee may provide such accounting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE VII GUARDIAN If my Husband predeceases me or if it becomes otherwise necessary to appoint aity or surety shall be required of any Trustee serving hereunder. The Trustee shall provide an accounting to the beneficiaries under the Trust once a year. If a beneficiary is a minor or has a disabiltinue to serve as Trustee for any reason, I appoint ___________________________________, , to be the Trustee under this Will in the place and stead of the first aforementioned Executor. No bond, securzure or other legal proceeding. ARTICLE VI TRUSTEE I appoint ___________________________________, as the Trustee under this Will. If such person or entity cannot, does not or is unable to serve or conwithhold the distribution of any income or principal to any beneficiaries under the Trust if Trustee, in Trustee's own opinion and judgment, feels that the `proceeds' may be subject to any type of seiiary predeceased me if the beneficiary's renunciation occurred within nine months following the date of my death and the beneficiary has not accepted any of the benefits so renounced. The Trustee may st for the benefit of such beneficiary, or upon any power of appointment herein granted. As to any interest in the trust renounced by a beneficiary, the trust shall be construed as though such beneficeizure, attachment or other manner of legal process. this provision shall not be deemed to be a limitation upon the right of any beneficiary to renounce, in whole or in part, any provisions of the truent of the state of ___________________ at such time and owning such property. 5. The interest of any beneficiary in the Trust shall not be subject to any assignment, anticipation, creditor's claim, srust is living, the Trustee shall distribute the property to whomever and in the same proportions as, my Executor would have been required to distribute it had I died intestate, unmarried, and a resideath of such child, in equal shares per stirpes. 4. If at any time prior to the termination of the Trust created under this Will or when the trust is ended, none of the intended beneficiaries of the tif such child leaves no descendants surviving him or her, then such share or the amount thereof then remaining shall be divided among any of my other children, who shall be living at the time of the d _____________ years as directed by this Will for any of my minor children. If any of my child(ren) should die before receiving the whole of his or her share under the Trust created by this Will, and are or the amount thereof then remaining shall be divided among the descendants of such child in equal shares per stirpes. The Trustee shall administer such shares for any descendants under the age ofials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 3 of ______ receiving the whole of his or her share under the Trust created by this Will, then such shchild reaches the age of _______ years, this Trust will terminate and the Trustee shall give that child any remaining income and principal of the Trust. If any of my child(ren) should die before Initge of _______ years, the Trust will terminate as to that child alone and the Trustee shall give that child his or her share of the Trust, including any share of undistributed income. When my youngest ust is in effect any portion of the income from the trust is not paid to or applied for the benefit of the child(ren) such portion shall be added to the principal. 3. As each minor child reaches the ality of assets in the trust. Any such payments shall not be deducted from or charged to the child(ren)'s share of the final distribution at the termination of the trust. If during any year that the Trd herein. If deemed necessary by the Trustee, such amounts paid to my child(ren) need not be equal among my children, but should be based on the individual need(s) of my child(ren) and on the availabi Trust as the Trustee deems appropriate for their maintenance, support, health and education (including college and professional education) until such time as each child is no longer a minor as defineinto cash or other instruments in order to make the administration of the Trust easier. 2. The Trustee shall pay any minor child(ren) or their descendants such sums from the income or principal of the plan, contract or other policy passing to any minor children shall be held in trust by the Trustee and treated as part of the Trust assets. In Trustee's discretion, the Trust assets may be converted sions of this Will, in order to provide for the care, health, support, maintenance and education of any minor child(ren). The share of the proceeds of any life insurance policy on my life, any pensionreferred to as "Trust" or "Trust assets") for the benefit of my child(ren). 1. The Trust assets shall be retained, held, managed, invested, administered and distributed by the Trustee, under the proviy. I direct the Executor to transfer all assets that have passed under this Will to any minor child(ren) to the Trustee named in this Will, to invest and to hold in trust, as a private trust, (herein e of my death, any of my child(ren) are under the age of ____________ years, those children shall be deemed and referred to as "minor child(ren)" for purposes of this Will and the Trust created therebider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE V TRUST FOR MINOR CHILDREN If my Husband predeceases me and, at the tima parent, guardian, conservator, committee of such person, trustee of such person, person with whom the beneficiary resides at the time of the distribution or to any other person the Executor may consy estate before attaining the age of majority or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to te at the time fixed for distribution under this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, if any person should become entitled to any share in mnitials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 2 of ______ the laws of the State of ____________________, then in effect, as if I had died intesta per stirpes. If any such above mentioned beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective shares to be determined under I_____________ _____________________________________________________________________ (name(s) of beneficiary(ies)). If more than one beneficiary is named, then the distribution shall be in equal sharesdren or their descendants survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed to: _________________________________________________stirpes. If any child predeceases me and leaves no descendants, then that child's share shall be distributed equally among any surviving child(ren) or their descendants per stirpes. If none of my chilfor each child's preference. Each share created for a deceased child of mine who has one or more descendants then living shall be distributed to the then living descendants of the deceased child, per es to my child(ren) ___________________________________________________________________ _____________________________________________________________________(name(s)), while trying to maintain regard ____________________________. If my Husband does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed in equal shares per stirps bequest shall be distributed with my residuary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed, and given to my Husband.duary estate. Primary Residence My interest in my primary residence or homestead, if any, shall be distributed to my Husband ___________________________________. If my Husband does not survive me, thitate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my resi___________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary es___________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. __ my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. __________ shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchaser or transferee upon or aftere seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 1 of ______ This directionnferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not bregardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or coxecutor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made ital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Ert and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of cou_________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interen): Name: ____________________________________________ Born on _________________ Name: ____________________________________________ Born on _________________ Name: ___________________________________d to __________________________________________________ (name of husband). All references to "my Husband" refer to _____________________________________ (name of husband). I have the following child(r__________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I SPOUSE & CHILDREN I am marrie________________________________________ Notary public [SEAL] Self-proved Will Affidavit Last Will And Testament Of ______________________ I, _________________________________________ (name), of __ ____________________________________________, a witness, who is personally known to me or who has produced ______________________ as identification, this _______ day of __________________, 20____. ____________________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced ______________________ as identification, and bynally known to me or who has produced _____________________ as identification, and by _______________________________________________, a witness, who is personally known to me or who has produced ____) Print Name: ___________________________________ Address: ______________________________________ Subscribed and sworn to before me by _____________________________________, the testator, who is perso_______________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness______________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ______e legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of proper age to witness a will. _______________, in the presence and hearing of the testator and in the presence of each other; 4) to the best knowledge of each witness, the testator was, at the time of signing, of the age of majority (or otherwisl of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presence of the witnesses; 3) the witnesses signed the will upon the request of the testatorng instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, each then declared to me that: 1) the attached or foregoing instrument is the last wilr and _______________________________________, and __________________________________, and ___________________________________________, the witnesses, whose names are signed to the attached or foregoi____________ COUNTY OF ________________________ I, the undersigned, an officer authorized to administer oaths, certify that _______________________________________________________________, the testato____ ___________________________________ Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 9 of ______ Self-Proved Will Affidavit STATE OF ______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ ___________________________der. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: erstand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue influence; The maker is age 18 or olor'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 shown above. We undthe witness signatures, was signed in our sight and presence by _____________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testat, 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 page(s) which contain fore signing. The witnesses should not receive assets under this Will.) Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 8 of ______ We, the undersigned__________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the following clause beill and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influence and ask the Witnesses named below to witness my signature. Testator's Signature: _____rwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare this to be my Last Wpouse or who died first, I direct that it be determined that I survived my Wife. In that case, the terms of this Will shall then take precedence over any Will or Codicils of my Wife, except where otheuld remain effective. 7. Survival If my Wife and I die under circumstances whereby it is difficult or impractical to determine the order of deaths or to determine who survived the death of the other S Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all other provision shois or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereunder, free from all matrimonial rights or controls by his or her spouse. 6.om, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of sharing or division of property which may exist between any beneficiary and hecific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrons or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the spte shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions as the fiduciary, except for such acti my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my esta purposes of determining the appropriate 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 ofdate of the court order granting such adoption. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 7 of ______ 2. Thirty Day Survival Requirement. For theder or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on the any gender shall be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless of geniven to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. Throughout this Will the use ofver or whomsoever. ARTICLE X MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender. The titles g their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoee, but for the foregoing, be considered as being other than an impartial exercise of their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such exercise ofest interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have the effect of conferring an advantage on any one or more of the beneficiaries or would otherwisl representatives by reason of the exercise of such discretion. The Executor or Trustee shall exercise the powers, authority and discretion granted herein in what Executor or Trustee deems to be the bother professional fees. The Executor or Trustee shall be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or persona deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with administering my estate, including but not limited to attorney, accountant, agent, broker and thers for such consideration or no consideration and upon such terms and conditions as the Executor or Trustee may deem advisable and to refer to arbitration all such claims if the Executor or Trusteership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against oy my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor or Trustee in good faith. 9. Windup, dissolve, settle or continue any partnee beneficiaries hereof. The Executor or Trustee shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or band such exercise of discretion by the Executor shall be Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 6 of ______ conclusive and binding upon all thed by the federal government of the United States of America, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, any such property so used. 8. Make or refrain from making, in Executor's or Trustee's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enactying any rent, without giving any bond or security and without liability for any loss or damage. The Executor or Trustee shall not be liable or responsible for any injury to, consumption of or loss ofion and no such interest not 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 pae intent that investments or 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 possessractional share in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's or Trustee's absolute discretion without responsibility for loss to thdivision or distribution 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 fand part credit 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 valued. 5. Sell, 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 ersons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor or Trustee may be beneficially interested in the property or any part thereof so n 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 or Trustee shall be final and binding upon all pets 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 or Trustee shall in their absolute discretiohich 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 or in part in the asses 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 mortgage or mortgages woney in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor or Trustee shall also have the right to renew and keep renewed any mortgage or mortgag keeping such property in adequate condition and repair, in the manner and to the extent that the Executor or Trustee shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend mcollect any income Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 5 of ______ therefrom; and pay the taxes and expenses thereof, including the cost ofr 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 such period as the Executor or Trustee shall determine; cutor or Trustee power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The powe such manner and for such purposes, for such prices, and upon such terms, credits and conditions as may be deemed advisable, without order of court and without notice to anyone. I also give to the Exe right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of any real or personal property that may be included in my estate inby this Will, and in addition to other powers and authority granted by law or necessary or appropriate for proper administration of my estate and the Trust, the Executor and the Trustee shall have thender. ARTICLE IX POWERS OF EXECUTOR & TRUSTEE In addition to the existing authority of the Executor with regards to the Will and of any Trustee with regards to the administration of any Trust created r "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 Executor serving hereuermitted 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", "unsupervised", oxecutrix, 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 more. To the extent pppoint __________________________________________________, to be the Executor of this my Will in the place and stead of my Wife. References to "Executor" in this my Will shall include each Executor, E EXECUTOR I appoint my Wife ___________________________________, as the Executor of this my Will. If my Wife cannot, does not or is unable to serve or continue to serve as Executor for any reason, I a my death the appointed Guardian apply to have custody of such child(ren) and act as the guardian of the property of such child pursuant to the provisions of applicable law. ARTICLE VIII NOMINATION OF_____________________________, as the Guardian of my minor child(ren) in the place and stead of the first aforementioned Guardian. It is my wish that before the expiration of ___ days from the date of_ Testator __________ Witness __________ __________ Witness Witness Page 4 of ______ person cannot, does not or is unable to serve or continue to serve as Guardian for any reason, I appoint ______o appoint a Guardian for any of my minor child(ren) under the age of eighteen years, I appoint ___________________________________, as the Guardian of my minor child(ren). If such Initials: _________ has a disability, the Trustee may provide such accounting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE VII GUARDIAN If my Wife predeceases me or if it becomes otherwise necessary tNo bond, security or surety shall be required of any Trustee serving hereunder. The Trustee shall provide an accounting to the beneficiaries under the Trust once a year. If a beneficiary is a minor oro serve or continue to serve as Trustee for any reason, I appoint ___________________________________, , to be the Trustee under this Will in the place and stead of the first aforementioned Executor. ny type of seizure or other legal proceeding. ARTICLE VI TRUSTEE I appoint ___________________________________, as the Trustee under this Will. If such person or entity cannot, does not or is unable te Trustee may withhold the distribution of any income or principal to any beneficiaries under the Trust if Trustee, in Trustee's own opinion and judgment, feels that the `proceeds' may be subject to ah such beneficiary predeceased me if the beneficiary's renunciation occurred within nine months following the date of my death and the beneficiary has not accepted any of the benefits so renounced. Thons of the trust for the benefit of such beneficiary, or upon any power of appointment herein granted. As to any interest in the trust renounced by a beneficiary, the trust shall be construed as thougtor's claim, seizure, attachment or other manner of legal process. this provision shall not be deemed to be a limitation upon the right of any beneficiary to renounce, in whole or in part, any provisid, and a resident of the state of ___________________ at such time and owning such property. 5. The interest of any beneficiary in the Trust shall not be subject to any assignment, anticipation, crediaries of the trust is living, the Trustee shall distribute the property to whomever and in the same proportions as, my Executor would have been required to distribute it had I died intestate, unmarrie time of the death of such child, in equal shares per stirpes. 4. If at any time prior to the termination of the Trust created under this Will or when the trust is ended, none of the intended beneficihis Will, and if such child leaves no descendants surviving him or her, then such share or the amount thereof then remaining shall be divided among any of my other children, who shall be living at theder the age of _____________ years as directed by this Will for any of my minor children. If any of my child(ren) should die before receiving the whole of his or her share under the Trust created by t, then such share or the amount thereof then remaining shall be divided among the descendants of such child in equal shares per stirpes. The Trustee shall administer such shares for any descendants unuld die before Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 3 of ______ receiving the whole of his or her share under the Trust created by this Wille. When my youngest child reaches the age of _______ years, this Trust will terminate and the Trustee shall give that child any remaining income and principal of the Trust. If any of my child(ren) sho child reaches the age of _______ years, the Trust will terminate as to that child alone and the Trustee shall give that child his or her share of the Trust, including any share of undistributed incomany year that the Trust is in effect any portion of the income from the trust is not paid to or applied for the benefit of the child(ren) such portion shall be added to the principal. 3. As each minor and on the availability of assets in the trust. Any such payments shall not be deducted from or charged to the child(ren)'s share of the final distribution at the termination of the trust. If during er a minor as defined herein. If deemed necessary by the Trustee, such amounts paid to my child(ren) need not be equal among my children, but should be based on the individual need(s) of my child(ren) or principal of the Trust as the Trustee deems appropriate for their maintenance, support, health and education (including college and professional education) until such time as each child is no longts may be converted into cash or other instruments in order to make the administration of the Trust easier. 2. The Trustee shall pay any minor child(ren) or their descendants such sums from the incomemy life, any pension plan, contract or other policy passing to any minor children shall be held in trust by the Trustee and treated as part of the Trust assets. In Trustee's discretion, the Trust assetee, under the provisions of this Will, in order to provide for the care, health, support, maintenance and education of any minor child(ren). The share of the proceeds of any life insurance policy on vate trust, (herein referred to as "Trust" or "Trust assets") for the benefit of my child(ren). 1. The Trust assets shall be retained, held, managed, invested, administered and distributed by the TrusTrust created thereby. I direct the Executor to transfer all assets that have passed under this Will to any minor child(ren) to the Trustee named in this Will, to invest and to hold in trust, as a pris me and, at the time of my death, any of my child(ren) are under the age of ____________ years, those children shall be deemed and referred to as "minor child(ren)" for purposes of this Will and the n the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE V TRUST FOR MINOR CHILDREN If my Wife predecease the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of such person, person with whom the beneficiary resides at the time of the distribution or to any other persoitled to any share in my estate before attaining the age of majority or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person directly tos if I had died intestate at the time fixed for distribution under this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, if any person should become entres to be determined under Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 2 of ______ the laws of the State of ____________________, then in effect, ation shall be in equal shares per stirpes. If any such above mentioned beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective sha__________________________________________ _____________________________________________________________________ (name(s) of beneficiary(ies)). If more than one beneficiary is named, then the distribur stirpes. If none of my children or their descendants survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed to: ____________________s of the deceased child, per stirpes. If any child predeceases me and leaves no descendants, then that child's share shall be distributed equally among any surviving child(ren) or their descendants pele trying to maintain regard for each child's preference. Each share created for a deceased child of mine who has one or more descendants then living shall be distributed to the then living descendantal shares per stirpes to my child(ren) _____________________________________________________________________________ _____________________________________________________________________(name(s)), whid given to my Wife. _______________________________. If my Wife does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed in equoes not survive me, this bequest shall be distributed with my residuary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed anl be distributed with my residuary estate. Primary Residence My interest in my primary residence or homestead, if any, shall be distributed to my Wife ___________________________________. If my Wife dtributed with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shal with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be disde from my estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributedr or transferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be mae 1 of ______ This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchase beneficiary. The Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Pagife or any gift or benefit given or conferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by anyhe payment of the taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my lout of the residue of my estate. The Executor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. Trst paid out of and charged to the capital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid tation fixed by statute or rule of court and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be fifuneral, cremation or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limie: ____________________________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my of wife). I have the following child(ren): Name: ____________________________________________ Born on _________________ Name: ____________________________________________ Born on _________________ Namt. ARTICLE I SPOUSE & CHILDREN I am married to __________________________________________________ (name of wife). All references to "my Wife" refer to __________________________________________ (name ____________________________ (name), of ____________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testamenith estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, _____________ng 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 a local attorney is always recommended when dealing w 1999). This information 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 starti spouse upon death 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 inbenefit plans; [] the 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 herngible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified employee ey. Before using this 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; [] taestate tax planning 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 attornr her spouse. Estates 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 value of an individual'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 oth taxes. Testators 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 l is for anyone in 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 deavit of the witnesses 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 Wil will have to be "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 affidaills. The affidavit 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 itsuch grounds as undue 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 win signing the Will 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 rn affidavits, that 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 to probate after the 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 swo a Notary, that all 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 ired to be probated 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 beforestributed. Assets 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 requWill (the "Testator") 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 di. [_] The purchase 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 on. 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 with a tax professional 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 your particular situati 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 and/or tax advice. Laws vary from timewill should be checked 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 providedwhich affect 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/Testatrix moves to another state, the current ution in percentages, make sure that the total of all of the beneficiary's percentages equal 100%. Check the totals before signing the Will. Checklist & Instructions ­ Page 5 State and federal laws ill 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 of the Will calls for distribtatus 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 the other spouse dies. The Wchanges are desired, the original and all copies should be destroyed and an entirely new Will should be signed. New wills are commonly necessary when, for example, the Testator's/Testatrix's marital scompetent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or modifying words on the face of the Will. Such changes are usually disregarded. Instead when 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 with a 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 Will 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 heldTestator and may also (if Testator/Testatrix so wish) be provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Testator, py" 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 kept by the nal 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 original "co 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 services. The origit 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 companies)luding 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 very importanotary 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 of pages (excdavit (called "Proof of Will" in some states) and attach it to the end of the Will. The Affidavit contains the Testator's/Testatrix's acknowledgment and the affidavit of the witnesses, made before a Nf included, should not be counted because the affidavit is not a part of the Will itself. Checklist & Instructions ­ Page 4 The Testator/Testatrix and the witnesses should sign the self-proving affies an earlier Will). The Witnesses should indicate the total number of pages in the Will, including the page(s) on which the witness signature lines appear. The page with the self-proving affidavit, iested, the date should be filled in (preferably by hand), with the date of the actual signing. This step could be crucial to determine the validity of the Will at a later date (i.e. if this Will revoktatrix and each other and of the notary public. The witnesses must be satisfied that the Testator/Testatrix is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever requ Will. This can prevent subsequent substitution of pages. The witnesses should also initial the bottom of each page of the Will. All witnesses must sign their names in the presence of the Testator/Tesl 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 Testator/Testatrix to initial the bottom of each page of theed 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 v can say: "The document I am about to sign is my Last Wilr sign the Will. The notary public is needed for the self-proved affidavit. Before signing the Will, the Testator/Testatrix should orally declare that the document that is about to be signed is intendt be located. The witnesses should not be beneficiaries under the Will. For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testato 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 be invalid for any reason or if one of the witnesses can'titled to a share of the estate. Although most states only require two witnesses, the Testator should sign the Will in the presence of three (3) qualified, competent, disinterested and adult witnesseses). 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 knows about relatives and others who might be enitnesses 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 and must be of legal age (i.e. eighteen in most statffidavit (although technically not part of the Will) states that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signed, by the Testator, all Wonth year city; [] signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; [] witness signatures and info Affidavit: The enclosed Ang a provision dealing with situations of simultaneous death of both husband and wife. · · · · · · Checklist & Instructions ­ Page 3 · · · Signature Block: Testator needs to fill out: [] day ms of Executor and Trustee empowers them to deal with matters like taxes, taking care of the property, and making distributions to the beneficiaries Article X: Contains miscellaneous provisions includitative will pay whatever is left to the beneficiaries named in the will. Testator/Testatrix must provide and fill out [] the name of executor (spouse); [] name of alternate executor. Article IX: Powerty. The 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 Personal Represene an Executor to administer the estate, 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 properpointed as guardian of child(ren). Article VIII: Deals with the appointment of the Testator's/Testatrix's Personal Representative (i.e. Executor) and alternate; It allows the Testator/Testatrix to names the Testator/Testatrix. Testator/Testatrix must provide and fill out [] the name of Guardian; [] name of alternate Guardian; [] number of days within which Guardian has to apply to be officially approvide and fill out [] the name of Trustee; [] name of alternate Trustee. Article VII: Deals with appointment of the Guardian and an alternate for the minor children in the event the spouse predeceass the Testator/Testatrix to name a person and an alternate to act as the Trustee that will administer the assets passing under the Will for any child(ren) under a certain age. Testator/Testatrix must needs to be entered four (4) times in this section); [] state under whose laws the will is made. Article VI: Deals with appointment of Trustee and Trustee's specific duties/responsibilities. It allowy minor children if spouse predeceases Testator/Testatrix. Testator/Testatrix must provide and fill out: [] age when children should not be considered minors any longer for purposes of the Trust (thises in the event that all children predecease the Testator and there are no descendants of the children; [] state under whose laws the will is made. Article V: Deals with the creation of a trust for ans given; [] name of Spouse to whom the Residuary Estate is given to; [] name of child(ren) to whom residuary estate is given in event spouse does not survive Testator; [] name of alternate beneficiari); [] 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 Spouse to whom Testator's interest in any primary residence iAllows Testator/Testatrix to give specific dollar amounts or other property to specific persons or charities. Testator/Testatrix must provide and fill out: [] description of property (or dollar amountrial expenses. Article III: Authorizes payments of debts and expenses. · · Checklist & Instructions ­ Page 2 · Article IV: Disposes of specific property, primary residence and residuary property. e of child(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 buprovide and fill out: [] name, [] county and [] state Article I: Gives the name of the spouse and any child(ren). Testator/Testatrix must provide and fill out [] name of spouse (in two places); [] namompleted. · · · Title: Enter name of Testator/Testatrix in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator/Testatrix must into various sections. The content of each section is explained below. Some sections require information to be provided and filled out in the space provided. The enclosed Affidavit also needs to be csband. The second Will and Affidavit is to be used by the Wife. The instructions for both wills are the same. It is suggested that both Wills be executes/signed at the same time. The Wills are dividedx to make specific gifts to others as well. This Will is suitable for estates worth less than $1,000,000. There are two Wills in this form package. The first Will and Affidavit is to be used by the Hus pre-deceased the Testator, the Will allows the appointment of a Guardian for any minor child(ren) and a Trustee to administer the minor children's assets. This Will also allows the Testator/Testatriath of both husband and wife. If the Spouse does not survive the Testator/Testatrix the assets will go to the children. If the children are minors at the time of the Testator's death and the spouse ha The Wills distribute the assets of the Husband to the Wife and the assets of the Wife to the Husband in the event of their death. They also have a provision dealing with situations of simultaneous deis form package contains two "Mutual Wills" and is for use by a married couple (husband and wife i.e. Testator and Testatrix) with one or more minor children. It also includes a self-proved affidavit.out Wills; (3) Husband's Mutual Will for ­ Married Couple with Minor Children with self-proved affidavit; (4) Wife's Mutual Will for ­ Married Couple with Minor Children with self-proved affidavit. ThChecklist and Instructions Mutual Will - Married Couple with Minor Children This package contains (1) Checklist and Instruction for Mutual Will ­ Married Couple with Minor Children; (2) Information ab GeorgiaGeorgia Print Name: _______________________________________________________________ Address: _______________________________________________________________ Georgia Advance Health Care Directive 8 ___________________________ Address: _______________________________________________________________ ___________________________________________ (Signature of Second Witness) _______________ (Date) care and signed this form willingly and voluntarily. ___________________________________________ (Signature of First Witness) _______________ (Date) Print Name: ____________________________________m in my presence or acknowledged signing this form to me. Based upon my personal observation, the declarant appeared to be emotionally and mentally capable of making this advance directive for health ance directive for health care and that I understand its purpose and effect. ___________________________________________ (Signature of Declarant) _______________ (Date) The declarant signed this ford in your health care).] (REMAINDER OF PAGE INTENTIONALLY LEFT BLANK) Georgia Advance Health Care Directive 7 By signing below, I state that I am emotionally and mentally capable of making this advee, agent, or medical staff member of the hospital, skilled nursing facility, hospice, or other health care facility in which you are receiving health care (but this witness cannot be directly involveit anything from you or otherwise knowingly gain a financial benefit from your death; or · Cannot be a person who is directly involved in your health care. · Only one of the witnesses may be an employ with you when you sign this form. A witness: · Cannot be a person who was selected to be your health care agent or back-up health care agent in PART ONE; · Cannot be a person who will knowingly inherwledge signing and dating this form in the presence of two witnesses. Both witnesses must be of sound mind and must be at least 18 years of age, but the witnesses do not have to be together or presentPART ONE). __________ (Initials) This advance directive for health care will become effective on or upon ________________ and will terminate on or upon _______________. You must sign and date or acknos or events, this advance directive for health care will become effective at the time I sign it and will remain effective until my death (and after my death to the extent authorized in Section (5) of ealth care, durable power of attorney for health care, health care proxy, or living will that I have completed before this date. Unless I have initialed below and have provided alternative future dateATURES This advance directive for health care will become effective only if I am unable or choose not to make or communicate my own health care decisions. This form revokes any advance directive for h_________________ Telephone Numbers: ______________________________________________________________ (Home, Work, and Mobile) Georgia Advance Health Care Directive 6 PART FOUR: EFFECTIVENESS AND SIGN________ (Initials) I nominate the following person to serve as my guardian: Name: ______________________________________________________________ Address: _____________________________________________ling (A) or (B). Choose (A) only if you have also completed PART ONE.] (A) __________ (Initials) I nominate the person serving as my health care agent under PART ONE to serve as my guardian. OR (B) __rdian are not the same person, your health care agent will have priority over your guardian in making your health care decisions, unless a court determines otherwise.] [State your preference by initia your best interest and welfare. If you have selected a health care agent in PART ONE, you may (but are not required to) nominate the same person to be your guardian. If your health care agent and gua significant responsible decisions for yourself regarding your personal support, safety, or welfare. A court will appoint the person nominated by you if the court finds that the appointment will serverson to be your guardian in the event a court decides that a guardian should be appointed, complete PART THREE. A court will appoint a guardian for you if the court finds that you are not able to make not viable. PART THREE: GUARDIANSHIP (10) GUARDIANSHIP [PART THREE is optional. This advance directive for health care will be effective even if PART THREE is left blank. If you wish to nominate a pe effect if I am pregnant unless the fetus is not viable and I indicate by initialing below that I want PART TWO to be carried out. _________ (Initials) I want PART TWO to be carried out if my fetus isdvance Health Care Directive 5 (9) IN CASE OF PREGNANCY [PART TWO will be effective even if this section is left blank.] I understand that under Georgia law, PART TWO generally will have no force and___________________________________________________________ ________________________________________________________________ ________________________________________________________________ Georgia A your health care agent (if you have selected a health care agent in PART ONE) about following your treatment preferences. You may want to state your specific preferences regarding pain relief.] _____usion, or kidney dialysis. Understanding that you cannot foresee everything that could happen to you after you can no longer communicate your treatment preferences, you may want to provide guidance tour personal and religious values about your medical treatment. For example, you may want to state your treatment preferences regarding medications to fight infection, surgery, amputation, blood transfllows you to state additional treatment preferences, to provide additional guidance to your health care agent (if you have selected a health care agent in PART ONE), or to provide information about yohas stopped, I want to have cardiopulmonary resuscitation (CPR) used. (8) ADDITIONAL STATEMENTS [This section is optional. PART TWO will be effective even if this section is left blank. This section ads by mouth, I want to receive fluids by tube or other medical means. _________ (Initials) If I need assistance to breathe, I want to have a ventilator used. _________ (Initials) If my heart or pulse nt to apply to option (C).] _________ (Initials) If I am unable to take nutrition by mouth, I want to receive nutrition by tube or other medical means. _________ (Initials) If I am unable to take flui I do not want any medications, machines, or other medical procedures that in reasonable medical judgment could keep me alive but cannot cure me, except as follows: [Initial each statement that you waal judgment could keep me alive but cannot cure me. I do not want to receive nutrition or fluids by tube or other medical means except as needed to provide pain medication. OR (C) _________ (Initials)ion or fluids by tube or other medical means. OR (B) _________ (Initials) Allow my natural death to occur. I do not want any medications, machines, or other medical procedures that in reasonable medicmedical procedures that in reasonable medical Georgia Advance Health Care Directive 4 judgment could keep me alive. If I am unable to take nutrition or fluids by mouth, then I want to receive nutritn made to communicate with me about my treatment preferences, then: (Choose only one) (A) _________ (Initials) Try to extend my life for as long as possible, using all medications, machines, or other n relief in the next section.] If I am in any condition that I initialed in Section (6) above and I can no longer communicate my treatment preferences after reasonable and appropriate efforts have beeinstructions about your treatment preferences in the next section. You will be provided with comfort care, including pain relief, but you may also want to state your specific preferences regarding paitialing (A), (B), or (C).(you can choose only one) If you choose (C), state your additional treatment preferences by initialing one or more of the statements following (C). You may provide additional g after personal examination by my attending physician and a second physician in accordance with currently accepted medical standards. (7) TREATMENT PREFERENCES [State your treatment preference by ini means I am in an incurable or irreversible condition in which I am not aware of myself or my environment and I show no behavioral response to my environment. My condition will be determined in writincondition, which means I have an incurable or irreversible condition that will result in my death in a relatively short period of time. _________ (Initials) A state of permanent unconsciousness, whichf PART ONE.] (6) CONDITIONS PART TWO will be effective if I am in any of the following conditions: [Initial each condition in which you want PART TWO to be effective.] _________ (Initials) A terminal hority to make all health care decisions for you regarding matters covered by PART TWO. Your health care agent will be guided by your treatment preferences and other factors described in Section (4) oART TWO will provide your physician and other health care providers with your treatment preferences. If you have selected a health care agent in PART ONE, then your health care agent will have the autour treatment preferences. PART TWO will be effective even if PART ONE is not completed. If you have not selected a health care agent in PART ONE, or if your health care agent is not available, then PEATMENT PREFERENCES [PART TWO will be effective only if you are unable to communicate your treatment preferences after reasonable and appropriate efforts have been made to communicate with you about y______________________________ (Home, Work, and Mobile) I wish for my body to be: __________ (Initials) Buried OR __________ (Initials) Cremated Georgia Advance Health Care Directive 3 PART TWO: TRody: Name: _______________________________________________________________ Address: _______________________________________________________________ Telephone Numbers: _________________________________he power to make decisions about the final disposition of my body unless I have initialed below. __________ (Initials) I want the following person to make decisions about the final disposition of my by body for use in a medical study program. __________ (Initials) My health care agent will not have the power to donate any of my organs. (C) FINAL DISPOSITION OF BODY My health care agent will have tlimited my health care agent's power by initialing below. [Initial each statement that you want to apply.] __________ (Initials) My health care agent will not have the power to make a disposition of mATION AND DONATION OF BODY My health care agent will have the power to make a disposition of any part or all of my body for medical purposes pursuant to the Georgia Anatomical Gift Act, unless I have alth care agent's power by initialing below. __________ (Initials) My health care agent will not have the power to authorize an autopsy of my body (unless an autopsy is required by law). (B) ORGAN DONent circumstances and treatment options. (5) POWERS OF HEALTH CARE AGENT AFTER DEATH (A) AUTOPSY My health care agent will have the power to authorize an autopsy of my body unless I have limited my heould decide is still unclear, then my health care agent should make decisions for me that my health care agent believes are in my best interest, considering the benefits, burdens, and risks of my curr(if I have filled out PART TWO), my religious and other beliefs and values, and how I have handled Georgia Advance Health Care Directive 2 medical and other important issues in the past. If what I when making health care decisions for me, my health care agent should think about what action would be consistent with past conversations we have had, my treatment preferences as expressed in PART TWO r me regarding psychosurgery, sterilization, or treatment or involuntary hospitalization for mental or emotional illness, mental retardation, or addictive disease. (4) GUIDANCE FOR HEALTH CARE AGENT Wcourt can take away the powers of my health care agent if it finds that my health care agent is not acting properly; and · My health care agent does not have the power to make health care decisions fo in lieu of the original and the copy will have the same meaning and effect as the original. I understand that under Georgia law: · My health care agent may refuse to act as my health care agent; · A pital, skilled nursing facility, hospice, or other health care facility or service if its protocol permits visitation. My health care agent may present a copy of this advance directive for health careompany me in an ambulance or air ambulance if in the opinion of the ambulance personnel protocol permits a passenger and my health care agent may visit or consult with me in person while I am in a hoslity Act of 1996) and will have the same access to my medical records that I have and can disclose the contents of my medical records to others for my ongoing health care. My health care agent may accalf). My health care agent will be my personal representative for all purposes of federal or state law related to privacy of medical records (including the Health Insurance Portability and Accountabiny health care facility or service for me, and to obligate me to pay for these services (and my health care agent will not be financially liable for any services or care contracted for me or on my beho or discharge me from any hospital, skilled nursing facility, hospice, or other health care facility or service; Request, consent to, withhold, or withdraw any type of health care; and Contract for adecisions. My health care agent will have the same authority to make any health care decision that I could make. My health care agent´s authority includes, for example, the power to: · · · Admit me tLTH CARE AGENT My health care agent will make health care decisions for me when I am unable to communicate my health care decisions or I choose to have my health care agent communicate my health care _______________________ Telephone Numbers: ________________________________________________________________ (Home, Work, and Mobile) Georgia Advance Health Care Directive 1 (3) GENERAL POWERS OF HEA____________________________________________________ (Home, Work, and Mobile) Name: ________________________________________________________________ Address: _________________________________________p health care agent(s): Name: ________________________________________________________________ Address: ________________________________________________________________ Telephone Numbers: ____________orts or for any reason my health care agent is unavailable or unable or unwilling to act as my health care agent, then I select the following, each to act successively in the order named, as my back-us section is optional. PART ONE will be effective even if this section is left blank.] If my health care agent cannot be contacted in a reasonable time period and cannot be located with reasonable eff_______________________________________________________ Telephone Numbers: ________________________________________________________________ (Home, Work, and Mobile) (2) BACK-UP HEALTH CARE AGENT [Thi HEALTH CARE AGENT I select the following person as my health care agent to make health care decisions for me: Name: ________________________________________________________________ Address: _________orm. GEORGIA STATUTORY SHORT FORM ADVANCE DIRECTIVE FOR HEALTH CARE By: ________________________________ Date of Birth: ________________ (Print Name) (Month/Day/Year) PART ONE: HEALTH CARE AGENT (1)e. This completed form will replace any advance directive for health care, durable power of attorney for health care, health care proxy, or living will that you have completed before completing this fe. Using this form of advance directive for health care is completely optional. Other forms of advance directives for health care may be used in Georgia. You may revoke this completed form at any timan easily be found if it is needed. Review this completed form periodically to make sure it still reflects your preferences. If your preferences change, complete a new advance directive for health carshould give a copy of this completed form to people who might need it, such as your health care agent, your family, and your physician. Keep a copy of this completed form at home in a place where it c of this form. PART TWO PART THREE PART FOUR You may fill out any or all of the first three parts listed above. You must fill out PART FOUR of this form in order for this form to be effective. You ardian should one ever be needed. EFFECTIVENESS AND SIGNATURES. This part requires your signature and the signatures of two witnesses. You must complete PART FOUR if you have filled out any other partrences before PART TWO becomes effective. You should talk to your family and others close to you about your treatment preferences. GUARDIANSHIP. This part allows you to nominate a person to be your guess. PART TWO will become effective only if you are unable to communicate your treatment preferences. Reasonable and appropriate efforts will be made to communicate with you about your treatment prefeare agent about this important role. TREATMENT PREFERENCES. This part allows you to state your treatment preferences if you have a terminal condition or if you are in a state of permanent unconsciousnalso have your health care agent make decisions for you after your death with respect to an autopsy, organ donation, body donation, and final disposition of your body. You should talk to your health cs you to choose someone to make health care decisions for you when you cannot (or do not want to) make health care decisions for yourself. The person you choose is called a health care agent. You may d be consulted for all serious legal matters. Instructions for Georgia Advance Health Care Directive This advance directive for health care has four parts: PART ONE HEALTH CARE AGENT. This part allowowever 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 attorney shouldirect, 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 interruption) hd 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 any direct, interials 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 materials are usee 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.com. These maapacity. A power of attorney for health care appoints an individual to make health care decisions, should the principal be unable to do so. Disclaimer No Attorney-Client relationship is created by usill covers specific directions as to the course of treatment that is to be taken by caregivers, or in some cases forbidding treatment should the principal be unable to give informed consent due to incGeorgia Advance Health Care Directive This package contains a Georgia Advance Health Care Directive. It combines provisions of a living will and a durable power of attorney for health care. A living w GeorgiaGeorgia _____________ 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 Georgia