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Illinois _________________ Name typed, printed, or stamped -5- onally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) ________________s County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is perss Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ State of ILLINOIS ) ) sof Principal Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witnes this Power of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), Illinois. ________________________________ Signature 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 Attorney. I may revoke 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 judgment errors made in demnify 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 operation of law, any person 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 revocation. I agree to inrights 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 Agent. Any third party whoAgent 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) my Agent to have any 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 any proceeds paid to my 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 remain in full force and 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 powers granted herein in 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 Power of Attorney shall 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 so requested by myself te 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 expenses incurred as aent 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 capacity to receive and evaluaecution 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 terminate on my subsequclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and the rights, powers, and authority of my Agent shall become effective immediately upon existributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to -3- which I would be entitled, if the result is that the disee 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 might be transferred or d 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 assets to the trust) 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 to discharge any of myt, (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 of my Agent's estate, (bount 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 authorized by this documenthe 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 tax annual exclusion am 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 Gifts to Minors Act or f 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 necessary, to file anyon 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 charitable contributions oal, 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 obtain or provide informati 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 documents with any federd/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 as may be appropriate,erwise 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. 12. To maintain anaccess 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, remove, keep or othitical 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 Securities. -2- 10. To have checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or polions; 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, negotiating or endorsing any but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutfits), 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 bank accounts, including,formation, and perform 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 bene any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide inhe 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 payments I receive from 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 insurance upon my life or ttead 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 monies which may becomeangible 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 sell or encumber any homesxchange, 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 or asset whatsoever, td 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, mortgage, improve, repair, etion, 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 in the future, ownerted on my behalf against any other person or entity. -1- 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of acy 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 claim, against me or assevidences of debts, releases, 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 maercial papers, withdrawal 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, eeeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commnt 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, covenants, conveyances, d, 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 execute any written agreeme 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. To conduct, engage inoperty, 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 substitute or substitutes,uthority 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, thing, business, prent") maintaining an address 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 aI, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Ag___________________________ Address: _______________________________________ Phone:______________________ ILLINOIS DURABLE POWER OF ATTORNEY Effective Immediately KNOW ALL PERSONS BY THESE PRESENTS: later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- Document Prepared by: Name: ______________stions about these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisions for you. You may revoke this power of attorney if you the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. If you have any queeeping. Before signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on your behalf, including tions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and swte that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instruc Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Please nopecially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable be legally binding upon the Grantor. The Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always be notarized, even if your state does not require it, eshould be a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. The Agent s This particular Form becomes effective immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes incapacitated. Note that the word "attorney" is not usedmpetent person (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf, even if the Principal later becomes incapacitated.is subject to the Disclaimers and Terms of Use found at findlegalforms.com. -1- Information Durable Power of Attorney Effective Immediately A Durable Power of Attorney allows a natural "mentally" cot for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms ent has the power to handle business and legal matters on the Principal's behalf. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting poiney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the AgPrincipal should keep the original document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attornent's spouse or children, and the Notary should not be witnesses. [_] The name of the person who prepared the Power of Attorney should be entered at the top of the Power of Attorney document. [_] The l allow the Durable Power of Attorney to be recorded as a public record, if necessary. [_] Two witnesses need to sign the Power of Attorney. The witnesses should be competent adults. The Agent, the Agen 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 wilation 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 evInstructions & Checklist Illinois Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) Inform IllinoisIllinois typed, printed, or stamped -5- who has produced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name______________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or ____________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ State of ILLINOIS ) ) ss County of __________ Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: _______ney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), Illinois. ________________________________ Signature of Principal Witness 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 Attorney. I may revoke this Power of Attorod faith on the authority of this document, without notice of such termination, shall be held harmless. Agent shall not be liable for losses resulting from judgment errors made in good faith. However,rty for any claims that arise -4- against the 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 gothis document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third pawith 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 Agent. Any third party who receives a copy of 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) my Agent to have any rights or ownership fected 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 any proceeds paid to my Agent based on this art of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be afdly 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 powers granted herein in any manner. If any prsonal 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 Power of Attorney shall be construed as broaout 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 so requested by myself or any authorized pefinancial resources and affairs properly, 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 ed by any applicable statute. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my ument shall remain in full force and effect thereafter until my death. This Power of Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence, except as providand all rights and powers therein shall become effective upon my subsequent disability or incapacity as certified in writing by a licensed medical doctor. The rights, powers, and authority of this doc, Agent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney claim any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. -3- 17. To diss, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excludingmy Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditorach calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to ift tax annual exclusion, shall not exceed 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 ent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gther such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or paremise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whencome and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compronts. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other ithe future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agestocks, bonds, debentures, commodities, options or any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in th any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to , or draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction wiates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, -2- negotiate, sell or transfer any note, securityincluding, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, eiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokernmental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of recuding, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with gov receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program inclurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and thel with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, insave, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deale and demands whatsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to hd all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of tit any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hold, possess and/or invest any anbts and obligations and such other instruments in writing of whatever kind and nature as may be. -1- 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other dee documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banksications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, titler into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applAgent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To ent hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My cquire in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. Ito serve with the same powers, rights and 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 aerve for any reason, I appoint _____________________________________ maintaining an address at: _____________________________________________________ as my alternate or successor Agent, as necessary, ") maintaining an address at: _____________________________________________________ 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 s____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent____________________ Address: _______________________________________ Phone:______________________ ILLINOIS DURABLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESENTS: I, ish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- Document Prepared by: Name: _____________________about these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisions for you. You may revoke this power of attorney if you later wer to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions Before signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on your behalf, including the powncluded with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions in't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Two witnesses are necessary, if the Agent will deal with any real estate in Florida. Please note that difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable Power of Attorney to be recorded as a public record, if necessary. Although, some states dohe Agent. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization will make it morencipal becomes disabled or incompetent, an alternate Agent can be designated, at the time this Power of Attorney is signed, in the event the original Agent is unable to serve or continue to serve as tr of Attorney goes into effect, or the Agent undertakes the acts. The Principal can revoke a Durable Power of Attorney at any time. Since this Durable Power of Attorney takes effect only after the Prion undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Principal. This is especially important if the Principal is incapacitated when the Powencipal does not need to be a lawyer. Almost anyone can be appointed an attorney-in-fact by a power of attorney. A Power of Attorney is a "powerful" instrument and should be granted with care. Any actiicular Form becomes effective upon the disability or incapacity of the Principal. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the attorney-in-fact for the Prion (called the "Principal" or "Principal") to authorize someone else (called the "Agent" or "AttorneyIn-Fact") to act on his or her behalf, even if the Principal later becomes incapacitated. This parte Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attorney Effective upon Disability A Durable Power of Attorney allows a natural "mentally competent " pershould not be used without consulting with an attorney first. An Attorney should be consulted before negotiating a document with another party. [_] The purchase and use of these forms, is subject to thved, deleted (and initialed) or the words "no one" can be entered. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and s behalf. [_] This document offers the option of nominating an alternate Agent in the event that the first choice as Agent is unable to serve or continue to serve as the Agent. This section can be remo also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should name of the person who prepared the Power of Attorney should be entered at the top of the Power of Attorney document. [_] The Principal should keep the original document, as well as a copy. The Agent with any real estate in Florida. The witnesses should be adults. Generally, anyone related by blood or marriage to the Principal, the Agent or the Notary should not be a witness. [_] In Illinois, the public record, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. Two witnesses are necessary if the Agent will be dealingof 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 Instructions & Checklist Illinois Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2 IllinoisIllinois tion. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- re me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identifica____ City: __________________________________ State: ___________________________________ State of ILLINOIS ) ) ss County of ________________________ ) The foregoing instrument was acknowledged befo______________________ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: _____________________________________________ (date), at _______________________ (city), Illinois. ________________________________ Signature of Principal Witness Signature: ___________________________________ Name: _____________ good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. Signed on __ion, shall be held harmless. -4- Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act inance on this power of attorney. If this General Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without notice of such terminats not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of relimy Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy of this document may act under it. Revocation of the power of attorney ie limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policies I may own on the life of e reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by this power-of-attorney arunder applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person needs to inquire as to thghts, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, illegal or unenforceable hall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed broadly as a General Power of Attorney. The listing of specific terms, rishall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on my behalf, my Agent ssources and affairs properly. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desired, my Agent ty or incapacity. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial re become effective immediately upon execution of this instrument. The rights, powers, and authority of this document shall remain in full force and effect thereafter until my death or until my disabiliitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This General Power of Attorney and the rights, powers, and authority of my Agent shallnt), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to -3- which I would be entansfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this docume of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To tre creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use anycifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or thfederal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unless spe the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the rwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuant togifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning or otheents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related documss assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/ther investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or busine and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any oasury Securities. -2- 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their contents,any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Trerawals, negotiating 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 lar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdd/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other simil, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain an to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, medica recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare;ing life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, includ right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recover andonal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This includes the, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real or pers, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rentpapers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputedettle any claim, against me or asserted on my behalf against any other person or entity. -1- 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial g of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and sher institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obligations and such other instruments in writinrtificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or otontracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock cerse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, cimited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endo Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not be lm, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or myy Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, ite______________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. MNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint __________n agent. -3- Document Prepared by: Name: _________________________________________ Address: _______________________________________ Phone:______________________ ILLINOIS GENERAL POWER OF ATTORNEY Ks for you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of acument, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisionle business and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney donted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handis not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers graantor later becomes disabled or incapacitated. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that y be witnessed, it is always a very good idea to do so. Another type of Power of Attorney, called a Durable Power of Attorneys (available at findlegalforms.com as well), stays in effect even if the Gr the validity of the Power of Attorney and will allow the General Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a General Power of Attorned always be notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challengee Agent, within the scope of the Power of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a General Power of Attorney at any time. A General Power of Attorney shoulappointed an Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by thabled or incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be the "Agent" or "Attorney-InFact") to act on his or her behalf. This particular Form becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disalforms.com -1- Information General Power of Attorney A General Power of Attorney allows a natural "mentally" competent person (called the "Principal" or "Grantor") to authorize someone else (calledorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegrincipal's behalf. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an atttor 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 business and legal matters on the P 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 the Agent should complete. The Graninois, the name of the person who prepared the Power of Attorney should be entered at the top of the Power of Attorney document. [_] The Principal should keep the original document, as well as a copy.be dealing with any real estate in Florida. The witnesses should be adults. Generally, anyone related by blood or marriage to the Principal, the Agent or the Notary should not be a witness. [_] In Illorded as a public record, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. Two witnesses are necessary if the Agent will ] 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 recneral 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 Illinois General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) Ge IllinoisIllinois ______________, 20____. __________________________________________ Notary public [SEAL] Self-proved Will Affidavit ___________________________________, the testator, and by ___________________________________ , __________________________ , and ___________________________________ witnesses, this _______ day of ____Name: ___________________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before me ________________________________ a notary public, and by _____________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness) Print ______________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ______________ time 18 years of age or older, of sound mind, and under no constraint or undue influence and that each witness is over 18 years of age and otherwise competent to be a witness. _______________________ purposes expressed in it, that each of the witnesses, in the presence and hearing of the testator, signed the will as witness, and that to the best of the witness's knowledge the testator was at thatment as the testator's will, that the testator signed willingly (or willingly directed another to sign for the testator), that the testator executed it as the testator's free and voluntary act for thecities, personally appearing before the undersigned authority and being first duly sworn, declare to the undersigned authority under penalty of perjury that the testator signed and executed the instru_, and ________________________________ and ________________________________, the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument in those capa__ Witness Page 7 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ________________________________, and _________________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ Witness _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ____. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ____________________rocured 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 nameer, do hereby subscribe our names as witnesses on the 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 pr's sight Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 6 of ______ and presence and at Testator's request, and in the sight and presence of each othned 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 Testatoder 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 sig 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 declare un Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3)______. 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 thenforceability 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 ____________________, nder, free from all matrimonial rights or controls by his or her spouse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unearing or division of property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereu not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of she bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if's good faith actions or non-actions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that thfaith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciaryme unless the beneficiary is living on the thirtieth day after the date of my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad ___ Witness Page 5 of ______ 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. Initials: __________ Testator __________ Witness __________ Witness _______all be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, butthis Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronouns shpplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of 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 be sunance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question oran 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 mainteority 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 conferring ed 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, authon 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 grantditions 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 connecti0. 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 conon or exercise of discretion, entered into by the Executor in good faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. 1ed by Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 4 of ______ any such person or by my estate resulting from any election, determination, designatibe 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 experiencmerica, 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 shall frain 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 of Aany 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 or rectually 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 giving ssets 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 not an 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 or aibution 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 share is 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 distrcall 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 credit a 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. Sell, retion 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 persons 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 disce 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 or intgage 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 mortgag 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 mor_____ Witness __________ Witness __________ Witness Page 3 of ______ condition and repair, in the manner and to the extent that the Executor shall deem advisable. 3. To accept surrenders of leasesiod 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 Initials: __________ Testator _____, 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 per 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 salel 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 order ofer 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 reaerving 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 proppervised", 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 Executor sthe 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", "unsu 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. To point ___________________________________, , 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 each___________________________________, ("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, I ap 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 appoint directly to 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 anyability, I authorize the Executor to nevertheless make any Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 2 of ______ distribution for any such personbe 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 distive 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 may ___, ____________________________________________________________, If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respecares per stirpes. If none of the named child(ren) survive me, I direct that my residuary estate be distributed in equal shares per stirpes to: _________________________________________________________uted, bequeathed and given to my child(ren) _____________________________________________________________________ (name(s)). If more than one child is named, then the distribution shall be in equal she than one child is named, then the distribution shall be in equal shares per stirpes. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distribed with my residuary estate. Primary Residence All my interest in my primary residence or homestead, if any, shall be distributed to my child(ren) ___________________________________ (name(s)). If mormy residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with ate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my resid 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 made from my estThis 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 purchaser or transfereee Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 1 of ______ 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 any beneficiary. 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 life or any gift ue 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. The payment of thand 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 out of the residtatute 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 first paid out of n 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 limitation fixed by s_____________________________ 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, crematio I have the following adult child(ren): Name: _______________________________________ Born on _________________ Name: _______________________________________ Born on _________________ Name: __________d Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I MARRIAGE & CHILDREN I am divorced from _____________________________________ (name of ex-spouse). I am not married.nal. Last Will And Testament Of ______________________ I, _____________________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills anation. 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 professioime 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 situouse is not a U.S. citizen, the deduction is limited (it was $100,000 in 2003). This information and these forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from tIn addition, each individual may leave 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 spss) interests; [] individual retirement 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 following: [] real estate; [] stocks and bonds; [] bank accounts; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (busine't use this will and should consult with 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 thein value and exceeds that amount, the greater your need for professional estate tax planning advice If your assets come near the $1,000,000 level, Information about Wills ­ Page 2 you really shouldnredit is $2,000,000. The credit is available 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 aw provides that upon the death of an individual, there is a credit against the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying in 2006 to 2008, that cprincipal estate planning document. If you 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 lpermits self proving, but requires the affidavit to be in a specific format similar to the one included in our wills. The Will is for anyone in any life situation where this Will is to be used as the California and the District of Columbia, 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 he affidavit in those states will not invalidate the Will (since it is a separate document from the Will). In those states it will have to be "proven" in court, like any other will. In Ohio, Maryland,vocation. A few states like Louisiana, Maryland, 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 tesses are not available when they are needed.. 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 reities for signing a Will were followed. The 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 witnern laws, all wills were proved by having 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 formalgned. The Affidavit does not affect the validity or legality of the Will. However, it can speed up the admission of the Will to probate after the death of the Testator. Before the adoption of more modenclosed self-proving affidavit, which contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary, that all required formalities were observed when the Will was sieficiary designations (such as life insurance 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 d probate for the Testator's estate. It merely directs how the assets which are individually owned by the Testator will be distributed. Assets held jointly with rights of survivorship, assets with ben Terms of Use found at findlegalforms.com 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 avoitate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers andnt 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 with esct or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting poi local requirements. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effe place. All wills should be reviewed by a lawyer before they are signed. If the Testator moves to another state, the current will should be checked by a lawyer in their new state to make sure it meetse that the total of all of the beneficiary's percentage's equal 100%. Check the totals before signing the Will. State and federal laws which affect estate planning can vary over time and from place to 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 distribution in percentages, make surry or one of the Executors dies.. Checklist & Instructions ­ Page 4 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 spouseed and 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 beneficiae the Will, do not modify it by adding, deleting, or changing words on the face of the Will. Such changes are usually disregarded. If changes are desired, the original and all copies should be destroyare 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 competent tax advisor. If it becomes necessary to changplan benefits, life insurance proceeds and 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, 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 held in trust. In addition, the distribution of retirement e provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Testator, would automatically pass to another person by operations may be 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 Testator and may also (if Testator so wishes) bn 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 "copy" of a will should be prepared. While photocopieto 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 original of the Will should be kept in a secure locatio 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) before naming them as a Personal Representative, t) should be entered by hand in the bottom 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) thatgments and administer oaths. The affidavit 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 affidavistates) and attach it to the end of the Will. The Affidavit contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary or other person authorized to take acknowleddavit, if included, should not be counted 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 es an earlier Will). The total number of pages 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 affiested, 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 revokof the 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. Checklist & Instructions ­ Page 3 Wherever requprevent 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 and each other 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 to initial the bottom of each page of the Will. This can Testator's Last Will and Testament. However, the witnesses don't need to read or know the contents of the Will. For example, the Testator can say: "The document I am about to sign is my Last Will andign the Will. The notary public is needed for 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 thee 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 Testator sd 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't b share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in the presence of three (3) qualified, competent, disinterested and adult witnesses anof "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 entitled to ad 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 states). Being though 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 Witnesses ancity; []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 Affidavit (alrs like taxes, taking care of the property, and making distributions to the beneficiaries Article VII: Contains miscellaneous provisions Signature Block: Testator needs to fill out: [] day month year ns ­ Page 2 named in the will. Testator must provide and fill out [] the name of executor; [] name of alternate executor. Article VI: Powers of Executor empowers the representative to deal with mattebts, administration 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 Checklist & Instructiooice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is also responsible for paying outstanding dewith the appointment of the Testator's Personal 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 ch [] name(s) of person(s)/entity(s) remaining tangible property is given to; [] name(s) of person(s)/entity(s) Residuary Estate is given to; [] state under whose laws the will is made Article V: Deals r must provide and fill out: [] description of property (or dollar amount); [] name(s) of person/entity property is given to (three blank paragraphs are provided, but you can add as many as you need).e III: Authorizes payments of debts and expenses. Article IV: Disposes of specific property. Allows Testator to give specific dollar amounts or other property to specific persons or charities. Testatoate of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and Burial expenses. Articlll out: []name, [] county and []state Article I: Gives the name of the ex-spouse and the name(s) of any child(ren). Testator must provide and fill out [] name of ex-spouse; [] name of child(ren) and deeds to be completed. Title: Enter name of Testator in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator must provide and fi00,000. This Will is divided into various sections. The content of each section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also nudes a selfproved affidavit. It distributes the assets of the Testator (i.e. person making the will) to specific beneficiaries named in the Will. This Will is suitable for estates worth less than $2,0; (2) Information about Wills; (3) Will ­ Divorced Person (not remarried) with Adult Children and self-proved affidavit. This Will is for a Divorced (not remarried) Person with Adult Children and inclChecklist and Instructions Will ­ Divorced (not remarried) Person with Adult Children This package contains (1) Checklist and Instruction for Will ­ Divorced Person (not remarried) with Adult Children IllinoisIllinois ess of the person preparing the instrument (Chap. 55 ILCS 5/3-5022). Quitclaim Deed - 2 _____ _____________________________ Buyer, Seller or Representative This document must contain the name and address of the Grantee for tax billing purposes: (Chap. 55 ILCS 5/3-5020) and name and addr_______________________ _________________________________________ _________________________________________ EXEMPT under provisions of Paragraph _______ Section 31-45, Property Tax Code. Date:______________________, 20____. MUNICIPAL TRANSFER STAMP (If Required) COUNTY/ILLINOIS TRANSFER STAMP (If Required) NAME & ADDRESS OF PREPARER: _________________________________________ _____________________ day of _________________, 20____. _______________________________ Signature of Notary Public (Seal) _______________________________ Printed Name of Notary My commission expires on _______________her or their) free and voluntary act, for the uses and purposes therein set forth, including the release and waiver of the right of homestead. Given under my hand and notarial seal, this _____________pouse) ______________________________ subscribed to the foregoing instrument, appeared before me this day in person, and acknowledged that he (she or they) signed and delivered the instrument as his (___ ) ) ) ss I, the undersigned, a Notary Public in and for said County, in the State aforesaid, DO HEREBY CERTIFY THAT ____(Name of Grantor, and if acknowledged by a spouse, the name of Grantor's s____, 20 _______ . ____________________________________________ ____________________________________________ Type or print name Quitclaim Deed - 1 State of ILLINOIS County of _______________________f. Permanent Index Number(s) (if necessary) ________________________________________________ Property Address: _____________________________________________________________ EXECUTED this day of ____Grantor nor Grantor's heirs, administrators, executors, successors and/or assigns shall have, claim or demand any right or title to the aforesaid property, premises or appurtenances or any part thereoall of Grantor's right, title and interest in and to the above described property unto the said Grantee, Grantee's heirs, administrators, executors, successors and/or assigns forever; so that neither t in the following described real estate: (Insert legal description) in the City of __________________________, County of ___________________________________, State of Illinois. TO HAVE AND TO HOLD to ______________________________________ ("Grantee"), whose address is __________________________________________ County of _________, State of _______________________ (Grantees Address) all interesgrantor's name or names and place of residence) FOR A VALUABLE CONSIDERATION, in the amount of TEN AND NO/100 DOLLARS ($10.00) in hand and other good and valuable consideration, conveys and quitclaimsRANTOR: ____________________________________________________________ a married unmarried individual whose address is ______________________________ County of _________, State of _____________ (insert ers and Terms of Use found at findlegalforms.com Recording requested by: and when recorded, please return this deed and tax statements to: Above reserved for official use only QUITCLAIM DEED THE Got be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. The purchase and use of these forms is subject to the Disclaimattorney and title insurance company to protect your interests. 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 nd in family situations or to correct possible technical defects in the title to the property. If you are a buyer taking a Quitclaim Deed, make sure that it satisfies your needs. Consult a real estate able to transfer a fee simple estate or make promises about the title. A buyer will rarely accept a Quitclaim Deed as the only form of conveyance when buying a property. Quitclaim deeds are mainly user guarantee by the person making it (i.e. the Grantor) about the nature or quality of that interest, or even if any interest exists at all. This type of deed may be useful in cases where a party is unmers and Terms of Use found at findlegalforms.com Information for Quitclaim Deed This Quitclaim Deed form is used to convey an interest in real estate. A Quitclaim Deed does not include any promise obe used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject to the Disclaibe sure to type or print all names below all signatures. [_] 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 ansferred in the deed is residential property, then the grantor must provide to the grantee an individual permanent index number the specifically represents that land conveyed in the deed. [_] Please ILCS 5/3-5020) and name and address of the person preparing the instrument (Chap. 55 ILCS 5/3-5022). [_] If the deed is executed in a county that has 3,000,000 or more inhabitants, and the property trs may apply. Nonconforming documents may be returned unrecorded or may be charged additional fees [_] This document must contain the name and address of the Grantee for tax billing purposes (Chap. 55 Deed may require other documents to be filed with it. Please check your local requirements with your local Recorder's (or similar) office. [_] Depending on the type of document, additional requirementQuitclaim Deed may not be effective against third parties. [_] Documents referencing land should include a legal description of the land. Verify that the legal description is correct. [_] A Quitclaim aim Deed [_] The Grantor should date and sign the Quitclaim Deed before a Notary. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the Instructions & Checklist for Illinois Quitclaim Deed [_] This packet includes: (1) Instructions and Checklist for Quitclaim Deed; (2) General Information about Quitclaim Deeds; and (3) Illinois Quitcl IllinoisIllinois ______________ _____________________________________________________ (Witness Signature) Print Name: ___________________________________________ declarant's death, or directly financially responsible for declarant's medical care. _____________________________________________________ (Witness Signature) Print Name: _____________________________o any portion of the estate of the declarant according to the laws of intestate succession or, to the best of my knowledge and belief, under any will of declarant or other instrument taking effect at declaration as a witness in the presence of the declarant. I did not sign the declarant's signature above for or at the direction of the declarant. At the date of this instrument, I am not entitled telieve him or her to be of sound mind. I saw the declarant sign the declaration in my presence (or the declarant acknowledged in my presence that he or she had signed the declaration) and I signed the______________________________________________________________ City, County and State of Residence ___________________________________________________ The declarant is personally known to me and I bation shall be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences from such refusal. Signed: ____________sary by my attending physician to provide me with comfort care. In the absence of my ability to give directions regarding the use of such death delaying procedures, it is my intention that this declarng the dying process be withheld or withdrawn, and that I be permitted to die naturally with only the administration of medication, sustenance, or the performance of any medical procedure deemed necesndition by my attending physician who has personally examined me and has determined that my death is imminent except for death delaying procedures, I direct that such procedures which would only proloily make known my desires that my moment of death shall not be artificially postponed. If at any time I should have an incurable and irreversible injury, disease, or illness judged to be a terminal co This declaration is made this __________ day of _________________ , _________________(month, year). I, ___________________________________________________, being of sound mind, willfully and voluntarf 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.com Living Will DECLARATIONattorney 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 consequences arising out osubstitute 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 signed without consulting an mplied 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 not intended and are not a erson for failure to act upon a revocation made pursuant to this Section unless that person has actual knowledge of the revocation. (Source: P.A. 85-860.) [_] These forms are provided "as is" and no istructions ­ Page 3 medical record the time and date when and the place where he or she received notification of the revocation. (c) There shall be no criminal or civil liability on the part of any peffective upon communication to the attending physician by the declarant or by another who witnessed the revocation. The attending physician shall record in the patient's Living Will Information & Inon of the intent to revoke the declaration, in the presence of a witness 18 years of age or older who signs and dates a writing confirming that such expression of intent was made. (b) A revocation is icating intention to cancel; (2) By a written revocation of the declaration signed and dated by the declarant or person acting at the direction of the declarant; or (3) By a oral or any other expressie by the declarant, without regard to declarant's mental or physical condition, by any of the following methods: (1) By being obliterated, burnt, torn or otherwise destroyed or defaced in a manner indthe circumstances, he is immune from civil or criminal liability that otherwise might be incurred. (Source: P.A. 85-860.) 755 ILCS 35/5) Sec. 5. Revocation. (a) A declaration may be revoked at any tim terminal condition under this Section is presumed to be acting in good faith. Unless it is alleged and proved that his action violated the standard of reasonable professional care and judgment under al condition, the attending physician who knows of a declaration shall record the determination and the terms of the declaration in the declarant's medical record. A physician who records in writing ahe necessity of obtaining a court order to do so, and (3) any member of the patient's family. 755 ILCS 35/4) Sec. 4. Recording of a Terminal Condition. Upon determining that the declarant has a terminfectuation of the patient's declaration. The order of priority is as follows: (1) any person authorized by the patient to make such arrangements, (2) a guardian of the person of the patient, without t priority, as set forth in this subsection, who is available, able, and willing to make arrangements for the transfer of the patient and the appropriate medical records to another physician for the efysician is unwilling to comply with its provisions and the patient is at any time not able to initiate the transfer, then the attending physician shall without delay notify the person with the highest the physician is unwilling to comply with its provisions and the patient is able, it is the patient's responsibility to initiate the transfer to another physician of the patient's choosing. If the ph, or copy of the declaration, a part of the patient's medical records. If the physician is at any time unwilling to comply with its provisions, the physician shall promptly so advise the declarant. Ifide the declaration to the physician and to ask the attending physician whether he or she is willing to comply with its provisions. An attending physician who is so notified shall make the declaration delaying procedures. (d) If the patient is able, it shall be the responsibility of the patient to provide for notification to his or her attending physician of the existence of a declaration, to provn shall be given no force and effect as long as in the opinion of the attending physician it is possible that the fetus could develop to the point of live birth with the continued application of death declarant, or another at the declarant's direction, and witnessed by 2 individuals 18 years of age or older. (c) The declaration of a qualified patient diagnosed as pregnant by the attending physiciaa document directing that if he is suffering from a terminal condition, then death delaying procedures shall not be utilized for the prolongation of his life. (b) The declaration must be signed by the sound mind and having reached the age of majority or having obtained the status of an emancipated person pursuant to the "Emancipation of Mature Minors Act", as now or hereafter amended, may execute eath is imminent and the application of death delaying procedures serves only to prolong the dying process. (Source: P.A. 85-860.) (755 ILCS 35/3) Sec. 3. Execution of a Document. (a) An individual ofdelaying procedures as long as he or she is able to do so. (h) "Terminal condition" means an incurable and irreversible condition which is such that Living Will Information & Instructions ­ Page 2 died in writing to be afflicted with a terminal condition by his or her attending physician who has personally examined the patient. A qualified patient has the right to make decisions regarding death eans a person licensed to practice medicine in all its branches. (g) "Qualified patient" means a patient who has executed a declaration in accordance with this Act and who has been diagnosed and verif. (e) "Person" means an individual, corporation, business trust, estate, trust, partnership, association, government, governmental subdivision or agency, or any other legal entity. (f) ) "Physician" mhall not be withdrawn or withheld from a qualified patient if the withdrawal or withholding would result in death solely from dehydration or starvation rather than from the existing terminal conditionthis Act does not affect the responsibility of the attending physician or other health care provider to provide treatment for a patient's comfort care or alleviation of pain. Nutrition and hydration silation, artificial kidney treatments, intravenous feeding or medication, blood transfusions, tube feeding and other procedures of greater or lesser magnitude that serve only to delay death. However, fied patient, in the judgement of the attending physician would serve only to postpone the moment of death. In appropriate circumstances, such procedures include, but are not limited to, assisted venttate to administer health care in the ordinary course of business or practice of a profession. (d) "Death delaying procedure" means any medical procedure or intervention which, when applied to a qualioluntarily executed by the declarant in accordance with the requirements of Section 3. (c) "Health-care provider" means a person who is licensed, certified or otherwise authorized by the law of this Sician" means the physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient. (b) "Declaration" means a witnessed document in writing, vinstructing his or her physician to withhold or withdraw death delaying procedures in the event of a terminal condition. (Source: P.A. 85-860.) (755 ILCS 35/2) Sec. 2. Definitions: (a) "Attending physe no longer able to participate actively in decisions about themselves, the legislature hereby declares that the laws of this State shall recognize the right of a person to make a written declaration ical care, including the decision to have death delaying procedures withheld or withdrawn in instances of a terminal condition. In order that the rights of patients may be respected even after they aris Statutes relating to Living Wills. (755 ILCS 35/1) Sec. 1. Purpose. The legislature finds that persons have the fundamental right to control the decisions relating to the rendering of their own med) is based on Chapter 755 Section 35 of the Illinois Compiled Statutes also known as the Illinois Living Will Act (755 ILCS 35/). For your convenience, we have included useful excerpts from the Illino Instruction for Illinois Declaration to Physicians (Illinois Living Will); (2) Illinois Declaration to Physicians (Illinois Living Will). This Illinois Declaration to Physicians (Illinois Living Will______________________________ (Successor agent) _________________________________ (Principal) Information and Instructions Illinois Living Will Declaration This package contains (1) Information andgnature of my agent (and successors) are correct. _________________________________ (Principal) _________________________________ (Successor agent) _________________________________ (Principal) ___of attorney, you must complete the certification opposite the signatures of the agents.) Specimen signatures of agent (and successors) _________________________________ (Agent) I certify that the si__________________________ (witness) (You may, but are not required to, request your agent and successor agents to provide specimen signatures below. If you include specimen signatures in this power principal has had an opportunity to read the above form and has signed the form or acknowledged his or her signature or mark on the form in my presence. _______________________________ Residing at __ of this grant of powers to my agent. Illinois Statutory Short Form Power of Attorney for Health Care Page 4 Signed: _______________________________________________________________ (principal) The I nominate the agent acting under this power of attorney as such guardian, to serve without bond or security. 7. I am fully informed as to all the contents of this form and understand the full importourt finds that such appointment will serve your best interests and welfare. Strike out paragraph 6 if you do not want your agent to act as guardian.) 6. If a guardian of my person is to be appointed,dian of your person, in the event a court decides that one should be appointed, you may, but are not required to, do so by retaining the following paragraph. The court will appoint your agent if the cncompetent or disabled person or the person is unable to give prompt and intelligent consideration to health care matters, as certified by a licensed physician. (If you wish to name your agent as guar________________________________________________________________ For purposes of this paragraph 5, a person shall be considered to be incompetent if and while the person is a minor or an adjudicated ithe order named) as successors to such agent: ________________________________________________________________________ ________________________________________________________________________ ________ing paragraph.) 5. If any agent named by me shall die, become incompetent, resign, refuse to accept the office of agent or be unavailable, I name the following (each to act alone and successively, in rt determination of your disability, when you want this power to terminate prior to your death.) (If you wish to name successor agents, insert the names and addresses of such successors in the followfect) 4. ( ) This power of attorney shall terminate on ______________________________ _____________________________________________________________________ (Insert a future date or event, such as cou_________________________________________________________ (insert a future date or event during your lifetime, such as court determination of your disability, when you want this power to first take ef on the beginning date or duration is made by initialing and completing either or both of the following:) 3. ( ) This power of attorney shall become effective ___________________________ _____________ attorney will become effective at the time this power is signed and will continue until your death, and beyond if anatomical gift, autopsy or disposition of remains is authorized, unless a limitationy you in the manner provided in section 4-6 of the Illinois "powers of attorney for health care law" (see the back of this form). Absent amendment or revocation, the authority granted in this power ofI have for recovery or the cost of the procedures. Initialed _____________ Illinois Statutory Short Form Power of Attorney for Health Care Page 3 (This power of attorney may be amended or revoked bma, I want life-sustaining treatment to be withheld or discontinued. Initialed _____________ I want my life to be prolonged to the greatest extent possible without regard to my condition, the chances ed unless I am in a coma which my attending physician believes to be irreversible, in accordance with reasonable medical standards at the time of reference. If and when I have suffered irreversible coble extension of my life in making decisions concerning life-sustaining treatment. Initialed _____________ I want my life to be prolonged and I want life-sustaining treatment to be provided or continuntinued if my agent believes the burdens of the treatment outweigh the expected benefits. I want my agent to consider the relief of suffering, the expense involved and the quality as well as the possigree with one of these statements, you may initial that statement; but do not initial more than one): I do not want my life to be prolonged nor do I want life-sustaining treatment to be provided or cois of particular importance. For your convenience in dealing with that subject, some general statements concerning the withholding or removal of life-sustaining treatment are set forth below. If you astitution, etc.): _____________________________________________________________________ _____________________________________________________________________ (The subject of life-sustaining treatment consistent with your religious beliefs or unacceptable to you for any other reason, such as blood transfusion, electro-convulsive therapy, amputation, psychosurgery, voluntary admission to a mental inn life-sustaining measures should be withheld; a direction to continue food and fluids or life-sustaining treatment in all events; or instructions to refuse any specific types of treatment that are inhall not include the following powers or shall be subject to the following rules or limitations (here you may include any specific limitations you deem appropriate, such as: your own definition of whet's powers or prescribe special rules or limit the power to make an anatomical gift, authorize autopsy or dispose of remains, you may do so in the following paragraphs.) 2. The powers granted above sluding withdrawal of food and water and other life-sustaining measures, if your agent believes such action would be consistent with your intent and desires. If you wish to limit the scope of your agen Page 2 (The above grant of power is intended to be as broad as possible so that your agent will have authority to make any decision you could make to obtain or terminate any type of health care, incific organs: __________________________________________________ ______________________________________________________________________ Illinois Statutory Short Form Power of Attorney for Health Care orize an autopsy and direct the disposition of my remains. Effective upon my death, my agent has the full power to make an anatomical gift of the following (initial one): ______ Any organ: ______ Specen though my death may ensue. My agent shall have the same access to my medical records that I have, including the right to disclose the contents to others. My agent shall also have full power to authto make any and all decisions for me concerning my personal care, medical treatment, hospitalization and health care and to require, withhold or withdraw any type of medical treatment or procedure, ev_____________________________________________________________ (insert name and address of agent) as my attorney- in- fact (my "agent") to act for me and in my name (in any way I could act in person) made this __________ day of___________________(month, year). 1. I, __________________________________________________________________ (insert name and address of principal) hereby appoint: __________ts the use of any different form of power of attorney you may desire. If there is anything about this form that you do not understand, you should ask a lawyer to explain it to you.) POWER OF ATTORNEY ies for violating the law are explained more fully in sections 4-5, 4-6, 4-9 and 4-10(b) of the Illinois "Powers of Attorney for Health Care Law" of which this form is a part. That law expressly permi terminates it, your agent may exercise the powers given here throughout your lifetime, even after you become disabled. The powers you give your agent, your right to revoke those powers and the penaltot co-agents, and no health care provider may be named. Unless you expressly limit the duration of this power in the manner provided below, until you revoke this power or a court acting on your behalfipts, disbursements and significant actions taken as agent. A court can take away powers of your agent if it finds the agent is not acting properly. You may name successor agents under this form but n a duty on your agent to exercise granted powers; but when powers are exercised, your agent will have to use due care to act for your benefit and in accordance with this form and keep a record of receithdraw any type of personal care or medical treatment for any physical or mental condition and to admit you to or discharge you from any hospital, home or other institution. This form does not imposeh Care (NOTICE: the purpose of this power of attorney is to give the person you designate (your "agent") broad powers to make health care decisions for you, including power to require, consent to or wd with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Illinois Statutory Short Form Power of Attorney for Healts your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussevice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fitbeen made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax ade Health Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implied or express warranties have Illinois Advance Health Care Directive This package contains both an Illinois Power of Attorney for Health Care and an Illinois Living Will. Together these forms are also sometimes known as an Advanc IllinoisIllinois _____________ 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 Illinois