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Georgia _________________ 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 ________________ as identification, this _______ day of __________________, 20____. __________________________________________ Notary public [SEAL] Self-proved Will Affidavit nally known to me or who has produced ______________________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced _________________________, a witness, who is personally known to me or who has produced ______________________ as identification, and by ____________________________________________, a witness, who is persoworn to before me by _____________________________________, the testator, who is personally known to me or who has produced _____________________ as identification, and by ___________________________________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed and s_______________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: _______each witness was and is competent and of proper age to witness a will. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ____witness, the testator was, at the time of signing, of 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) ce of the witnesses; 3) the witnesses signed the will 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 each then declared to me that: 1) the attached or foregoing instrument is the last will of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presen____________________, the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, tify that _______________________________________________________________, the testator and _______________________________________, and __________________________________, and ______________________________ Witness Page 7 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ I, the undersigned, an officer authorized to administer oaths, cer________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ Witness ___ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: _______________not procured by duress, menace, fraud or undue influence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his or her_________ Witness __________ Witness __________ Witness Page 6 of ______ We understand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was tator'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. Initials: __________ Testator _ 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 Testator's request and in the Tese 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 the witness signatures, was (3) adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) We, the undersigned, hereby certify and declar the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three__, ______. at ____________________ (city), that I declare this to be my Last Will and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influence and ask unenforceability should affect only that provision and all other provision should remain effective. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of __________________ereunder, free from all matrimonial rights or controls by his or her spouse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality orf sharing or division of property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hd if not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form ot the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, aniary's good faith actions or non-actions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires thabad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduc Testator __________ Witness __________ Witness __________ Witness Page 5 of ______ 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or ropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date of my death. Initials: __________ but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. 2. Thirty Day Survival Requirement. For the purposes of determining the apps shall be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, of this Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronoune supplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a partn or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VII MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall bintenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any questioing an advantage on any one or more of the beneficiaries or would otherwise, but for the foregoing, be considered as being other than an impartial exercise of their duties hereunder or as not being maauthority and discretion granted herein in what Executor deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have the effect of conferrranted to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor shall exercise the powers, ection with administering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor shall be fully protected in exercising any discretion g conditions as the Executor may deem advisable and to refer to arbitration all such claims if the Executor deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connh. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and__________ Witness __________ Witness __________ Witness Page 4 of ______ 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my deatenced by any such person or by my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor in good faith. Initials: __________ Testator ll be conclusive and binding upon all the beneficiaries hereof. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experif America, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor sha refrain from making, in Executor's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States ong any bond or security and without liability for any loss or damage. The Executor shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make ort actually producing income shall be treated as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property or real property, without paying any rent, without givir assets so retained shall be deemed to be authorized investments for all purposes of my Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest noe in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's absolute discretion without responsibility for loss to the intent that investments ostribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and cause any share to be composed of money, property or undivided fractional shart as they may in their absolute discretion decide upon, or to postpone such conversion of my estate or any part or parts thereof for such length of time as they may think best. Make any division or dil, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cash or credit or for part cash and part credions concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor may be beneficially interested in the property or any part thereof so valued. 5. Seliscretion fix the value of my estate or any part thereof for the purpose of making any such division, setting aside or payment and the decision of the Executor shall be final and binding upon all pers in part in the assets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and declare that the Executor shall in their absolute dgage or mortgages which may be in existence at any time forming part of my estate. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly ormortgage or mortgages upon any real estate forming part of my estate or any part thereof, to borrow money on any such real estate upon the security of any mortgage or mortgages and to pay off any mortses and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor shall also have the right to renew and keep renewed any r and to the extent that the Executor shall deem advisable. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 3 of ______ 3. To accept surrenders of leaperiod as the Executor shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the manneale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate administration of my estate for such of court and without notice to anyone. I also give to the Executor power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a sreal or personal property that may be included in my estate in such manner and for such purposes, for such prices, and upon such terms, credits and conditions as may be deemed advisable, without orderroper administration of my estate, the Executor shall have the right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of any r serving hereunder. ARTICLE VI POWERS OF EXECUTOR In addition to the existing authority of the Executor and in addition to other powers and authority granted by law or necessary or appropriate for pnsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any ExecutoTo the extent permitted by law, the Executor shall have the right to administer my estate without adjudication, order or direction of the court having jurisdiction over my estate, using "informal", "uach Executor, Executrix, and Personal Representatives of my Will, my estate or any portion thereof who may be acting as such from time to time whether original or substituted and whether one or more. appoint ___________________________________, , to be the Executor of this my Will in the place and stead of the first aforementioned Executor. References to "Executor" in this my Will shall include ent ___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or is unable to serve or continue to serve as Executor for any reason, Iany other person the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE V NOMINATION OF EXECUTOR I appoiuch person, person with whom the beneficiary resides at Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 2 of ______ the time of the distribution or to disability, I authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of say be specifically otherwise provided herein or directed otherwise by law, if any person should become entitled to any share in my estate before attaining the age of majority or while under any other pective shares to be determined under the laws of the State of ________________________, then in effect, as if I had died intestate at the time fixed for distribution under this provision. Except as m_____________________________________________________________________ If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and resthat my residuary estate be distributed in equal shares per stirpes to: ___________________________________________ ____________________________________________________________________________ ___________________________ (name(s)). If more than one child is named, then the distribution shall be in equal shares per stirpes. If none of the named child(ren) or their descendants, survive me, I direct ary Estate I direct that my residuary estate, including any real property and personal property, be distributed, bequeathed and given to my child(ren) _________________________________________________estead, if any, shall be distributed to my child(ren) ___________________________________ (name(s)). If more than one child is named, then the distribution shall be in equal shares per stirpes. Residu_________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. Primary Residence All my interest in my primary residence or hom_________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to ___________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to __________DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. _____________________________________________ shall be distributed to __________________er or transferee in connection with any property transferred to or acquired by such purchaser or transferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV itials: __________ Testator __________ Witness __________ Witness __________ Witness Page 1 of ______ This direction shall not extend to or include any such taxes that may be payable by a purchasof the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. InWill or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me either during my lifetime or by survivorship. The payment e of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the taxes are owed on property passing under this ance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall create, out of the residue, a separate fund for the purposNSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. All taxes (including income taxes and inheritrial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPEI authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposition of the ashes or the acquisition of any bu_________________ Name: _______________________________________ Born on _________________ Name: _______________________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES s to be my Last Will and Testament. ARTICLE I MARRIAGE & CHILDREN I am single. I have never been married. I have the following adult child(ren): Name: _______________________________________ Born on _________________ I, _____________________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare thi always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of _____hese forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney ision is limited (it was $100,000 in 2006). 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. T an unlimited amount to his or her 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 deductt accounts and qualified employee benefit 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 leaveand bonds; [] bank accounts; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirementh tax professionals and an attorney. 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 reater your need for professional estate tax planning advice. If your assets come near the $2,000,000 level, Information about Wills ­ Page 2 you really shouldn't use this will and should consult wilable to each individual and his or her spouse. Estates totaling $2,000,000 or more could be subject to federal estate tax. As your estate approaches $2,000,000 in value and exceeds that amount, the gividual, there is a credit against the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying from 2006 to 2008, that credit is $2,000,000. The credit is avaiu have a large estate, you may need more complicated planning to reduce or limit death taxes. Testators should have an understanding of tax laws. Federal tax law provides that upon the death of an indfidavit to be in a specific format similar to the one included in our wills. The Will is for anyone in any life situation where this Will is to be used as the principal estate planning document. If yo the courts have some latitude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. New Hampshire permits self proving, but requires the afalidate the Will (since it is a separate document from the Will). In those states it will have to be "proven" in court, like any other will. In Ohio, Maryland, California and the District of Columbia,ryland, Ohio and Vermont (as of 2003) do not have statutes permitting self proving wills. The affidavit will be of no use in those states. However, including the affidavit in those states will not invded.. However, even with the Affidavit, the Will may still be subject to contest on such grounds as undue influence, lack of testamentary capacity, or prior revocation. A few states like Louisiana, Mahe Affidavit may eliminate the need to have witnesses testify, that the formalities in signing the Will were followed. The Affidavit can also be useful if witnesses are not available when they are nee one or more of the witnesses come into court and testify under oath, or through sworn affidavits, that each saw the Testator sign the will and that the formalities for signing a Will were followed. Talidity or legality of the Will. However, it can speed up the admission of the Will to probate after the death of the Testator. Before the adoption of more modern laws, all wills were proved by havingntains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary, that all required formalities were observed when the Will was signed. The Affidavit does not affect the vance or employee benefit plans), and assets held in trust generally will not be required to be probated and will not be governed by this Will. The Will has an enclosed self-proving affidavit, which coerely directs how the assets which are individually owned by the Testator will be distributed. Assets held jointly with rights of survivorship, assets with beneficiary designations (such as life insur Information about Wills This Will distributes the assets of the person making the Will (the "Testator") as specified by the Testator. This Will does not avoid probate for the Testator's estate. It monsequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.comed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax ct intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signprovided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are no lawyer before they are signed. If the Testator moves to another state, the current will should be checked by a lawyer in their new state to make sure it meets local requirements. [_] These forms are es' percentage's equal 100%. Check the totals before signing the Will. State and federal laws which affect estate planning can vary over time and from place to place. All wills should be reviewed by aof the estate. Consult an attorney if you wish to disinherit a spouse or any children. If any part of the Will calls for distribution in percentages, make sure that the total of all of the beneficiari one of the Executors dies. Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Will may be invalid if a spouse receives nothing or only a small portion d an entirely new Will should be written and signed. New wills are commonly necessary when, for example, the Testator's marital status changes, if the Testator has a child or if a named beneficiary oreleting, or changing words on the face of the Will. Such changes are usually disregarded. If changes are desired, the Checklist & Instructions ­ Page 4 original and all copies should be destroyed ane estate and other matters. The tax results of the choices made in this Will should be discussed with a competent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, dd survivor benefits arising in other contracts and plans are not normally governed by a will. This Will is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxablthe Will does not dispose of property held in joint tenancy with rights of survivorship or property held in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds anr / Personal Representative. This Will does not dispose of property that, on the death of the Testator, would automatically pass to another person by operation of law or by any contract. For example, y the original can be admitted to probate. Copies are rarely accepted. A copy of the Will should be kept by the Testator and may also (if Testator so wishes) be provided to the person named as Executo lawyer's office. Unlike other legal instruments where multiple originals are prepared, only one original "copy" of a will should be prepared. While photocopies may be used for reference purposes, onln serve. If you select a bank or trust company, be sure to check into their fees for such services. The original of the Will should be kept in a secure location such as a safe deposit box at a bank orrs and to deal appropriately with family members. It is best to talk to people (and banks or trust companies) before naming them as a Personal Representative, to make sure that they are willing and cam right of each page. The Personal Representative / Executor, should be picked carefully. It is very important to pick a person (or bank or trust company) that can be trusted to handle financial mattet states that all required formalities were observed when the Will was signed. The total number of pages (excluding i.e. not counting the self-proving affidavit) should be entered by hand in the bottoill. The Affidavit contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary or other person authorized to take acknowledgments and administer oaths. The affidavi because the affidavit is not a part of the Will itself. The Testator and the witnesses should sign the self-proving affidavit (called "Proof of Will" in some states) and attach it to the end of the Wpages in the Will, including the page(s) on which the witness signature lines appear, should be indicated by the Witnesses. The page with the self-proving affidavit, if included, should not be countederably 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 revokes an earlier Will). The total number of e notary public. The witnesses must be satisfied that the Testator is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever requested, the date should be filled in (pref The witnesses should also initial the bottom of each page of the Will. Checklist & Instructions ­ Page 3 All witnesses must sign their names in the presence of the Testator and each other and of thuntarily," or similar words. Although not required in most states, it is a good idea for the Testator to initial the bottom of each page of the Will. This can prevent subsequent substitution of pages.er, the witnesses don't need to read or know the contents of the Will. For example, the Testator can say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and volfor the self proved affidavit. Before signing the Will, the Testator should orally declare that the document that is about to be signed, is intended to be the Testator's Last Will and Testament. Howeveficiaries under the Will. For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testator sign the Will. The notary public is needed d 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't be located. The witnesses should not be ben only require two witnesses, the Will should be signed by the Testator in the presence of three (3) qualified, competent, disinterested and adult witnesses and a notary public. The signature of a thirtator 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 entitled to a share of the estate. Although most statesstator (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 states). Being of "sound mind" usually means that the Tesstates that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signed, by the Testator, all Witnesses and a Notary in front of each other. The Teesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; []witness signatures and info Affidavit: The enclosed Affidavit (although technically not part of the Will) y, and making distributions to the beneficiaries Article VII: Contains miscellaneous provisions Signature Block: Testator needs to fill out: [] day month year city; []Signature; []name Witnesses: Witnmust provide and fill out [] the name of executor; [] name of alternate executor. Article VI: Powers of Executor empowers the representative to deal with matters like taxes, taking care of the propertadministration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Representative will pay whatever is left to the beneficiaries named in the will. Testator the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is also responsible for paying outstanding debts, Checklist & Instructions ­ Page 2 rsonal Representative (i.e. Executor) and alternate; It allows the Testator to name an Executor to administer the estate, and an alternate in case the first choice cannot serve. The Executor will havernate" beneficiaries to whom the residuary estate will be given if child(ren) predecease Testator. [] state under whose laws the will is made Article V: Deals with the appointment of the Testator's Pee provided, but you can add as many as you need). []name of child(ren) to whom the primary residence (if any) is given; []name of child(ren) to whom the residuary estate will be given; []name of "alted the residuary estate to the child(ren). Testator must provide and fill out: [] description of property (or dollar amount); [] name(s) of person/entity property is given to (three blank paragraphs ars of specific property, primary residence and residuary property.. Allows Testator to give specific dollar amounts or other property to specific persons or charities and gives any primary residence anhildren. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and Burial expenses. Article III: Authorizes payments of debts and expenses. Article IV: Disposeounty and []state Article I: Gives the name(s) of the child(ren). Testator must provide and fill out [] name(s) of child(ren) and date of birth for each child. Three spaces are provided for names of c Title: Enter name of Testator in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator must provide and fill out: [] name, [] cdivided into various sections. The content of each section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also needs to be completed. the assets of the Testator (i.e. person making the will) to the child(ren) and to specific beneficiaries named in the Will. This Will is suitable for estates worth less than $2,000,000. This Will is ill ­ Single Person with Adult Children and selfproved affidavit. This Will is for a Single Person with Adult Children, who has never been married, and includes a self-proved affidavit. It distributesChecklist and Instructions Will ­ Single Person with Adult Children This package contains (1) Checklist and Instruction for Will ­ Single Person with Adult Children; (2) Information about Wills; (3) W 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