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Illinois 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 Self-proved Will Affidavit [SEAL] ___________________, the testator, and by ___________________________________ , __________________________ , and ___________________________________ witnesses, this _______ day of __________________, _________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before me ________________________________ a notary public, and by _____________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ______________________________ 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. _______________________________________ed 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 that time 18 years oftor'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 the purposes expressy 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 instrument as the testa______________________ and ________________________________, the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument in those capacities, personall of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ________________________________, and _______________________________, and _______________________________________ ___________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 7_____________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ __________________________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ __ 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 name. Dated: ______________ Witness __________ Witness Page 6 of ______ We understand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress,nce and at Testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Initials: __________ Testator __________ Witness ____d 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 Testator's sight and preseury 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 signed in our sight ans 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 under penalty of perjlow to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign a____________ (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 the Witnesses named bed 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 ____________________, ______. at ________ matrimonial rights or controls by his or her spouse. 8. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability shoulf 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 hereunder, free from allr. 7. 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 sharing or division obuted 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 not, by my Executouse. I am not currently married to anyone. No Children. I do not have any children at the time of the signing of this Will. 6. Beneficiary Disputes. If any bequest requires that the bequest be distriTestator __________ Witness __________ Witness __________ Witness Page 5 of ______ fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. 5. No Spod my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or non-actions as the Initials: __________ e date of my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, an. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after thnd such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. 2. Thirty Day Survival Requiremente plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shall include an adopted person are not to be considered as forming a part of this Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include all genders, and the use of the singular thfor the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and aes and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VI MISCELLANEOUS PROVISIONS The provisions in this Will their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiarich exercise may have the effect of conferring an advantage on any one or more of the beneficiaries or would otherwise, but for the foregoing, be considered as being other than an impartial exercise of. The Executor shall exercise the powers, authority and discretion granted herein in what Executor deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not suy protected in exercising any discretion granted 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 discretiononable expenses and costs incurred in connection with administering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor shall be fullr no consideration and upon such terms and conditions as the Executor may deem advisable and to refer to arbitration all such claims if the Executor deem same advisable. 11. Pay all necessary and reastness __________ Witness Page 4 of ______ 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration ood faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. Initials: __________ Testator __________ Witness __________ Wi any loss, claim, tax or other cost experienced by any such person or by my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor in goexercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereof. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of federal government of the United States of America, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, and such s of any such property so used. 8. Make or refrain from making, in Executor's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by therty, without paying any rent, without giving any bond or security and without liability for any loss or damage. The Executor shall not be liable or responsible for any injury to, consumption of or losng into possession and no such interest not actually producing income shall be treated as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property or real prope for loss to the intent that investments or assets so retained shall be deemed to be authorized investments for all purposes of my Will. No reversionary or future interest shall be sold prior to falliney, property or undivided fractional share in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's absolute discretion without responsibilityey may think best. Make any division or distribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and cause any share to be composed of mo or credit or for part cash and part credit as they may in their absolute discretion decide upon, or to postpone such conversion of my estate or any part or parts thereof for such length of time as therty or any part thereof so valued. 5. Sell, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cashr shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor may be beneficially interested in the prophat the Executor shall in their absolute discretion 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 Executoshare or interest therein either wholly or in part in the assets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and declare ttgage or mortgages and to pay off any mortgage 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 e or any part thereof, to borrow money on any such Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 3 of ______ real estate upon the security of any moring and improvements and generally to manage any such property. The Executor shall also have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my estatadequate condition and repair, in the manner and to the extent that the Executor shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuildobate administration of my estate for such period as the Executor shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in ents as may be necessary to effect such a sale, 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 prs as may be deemed advisable, without order of court and without notice to anyone. I also give to the Executor power to execute and deliver such deeds, mortgages, leases or other instruments and docum encumber or dispose of all or part of any real or personal property that may be included in my estate in such manner and for such purposes, for such prices, and upon such terms, credits and conditioned by law or necessary or appropriate for proper administration of my estate, the Executor shall have the right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwisey or surety shall be required of any Executor serving hereunder. ARTICLE V POWERS OF EXECUTOR In addition to the existing authority of the Executor and in addition to other powers and authority grantdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, securitnal or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to administer my estate without adjudication, order or direction of the court having juriso "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my Will, my estate or any portion thereof who may be acting as such from time to time whether origitinue to serve as Executor for any reason, I appoint ___________________________________, , to be the Executor of this my Will in the place and stead of the first aforementioned Executor. References t_ ARTICLE IV NOMINATION OF EXECUTOR I appoint ___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or is unable to serve or cont thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 2 of _____tor, committee of such person, trustee of such person, person with whom the beneficiary resides at the time of the distribution or to any other person the Executor may consider to be a proper recipiene age of majority or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservatribution under this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, if any person should become entitled to any share in my estate before attaining tho my heirs-at-law, their identities and respective 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 dis_________________________________________________, ____________________________________________________________, If any such beneficiary does not survive me, my residuary estate shall be distributed trt of the rest of my estate. Residuary Estate I direct that my residuary estate be distributed in equal shares per stirpes to: ____________________________________________________________, ___________l distribute the rest of my tangible personal property not disposed of in this Article, or all of my tangible personal property if there are no specific bequests of tangible personal property, as a pale personal property shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. The Executor shal__________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. My remaining tangib__________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. ________________________________________ Witness Page 1 of ______ ARTICLE III DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. ___________________________________________r acquired by such purchaser or transferee upon or after my death pursuant to any agreement with respect to such property. Initials: __________ Testator __________ Witness __________ Witness _____beneficiary for the payment of the taxes. This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to o my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not seek reimbursement from any axes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me either duringf the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the tAll taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall create, out o court. ARTICLE II PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. tion of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of anystament. ARTICLE I FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposi_______________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Tealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, ______ starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when de,000 in 2006). This information and these forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a or her spouse upon death without any federal estate tax liability. This is referred to as the "Marital Deduction". If the recipient spouse is not a U.S. citizen, the deduction is limited (it was $100ployee benefit plans; [] the face value of any life insurance policy; [] property you are holding in trust; any joint property you own In addition, each individual may leave an unlimited amount to his; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified em attorney. Before using this Will, it may be helpful to determine the value of all of the assets in your estate. Assets may include the following: [] real estate; [] stocks and bonds; [] bank accountssional estate tax planning advice. If your assets come near the $2,000,000 level, Information about Wills ­ Page 2 you really shouldn't use this will and should consult with tax professionals and and his or her spouse. Estates totaling $2,000,000 or more could be subject to federal estate tax. As your estate approaches $2,000,000 in value and exceeds that amount, the greater your need for profesagainst the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying from 2006 to 2008, that credit is $2,000,000. The credit is available to each individual anmay need more complicated planning to reduce or limit death taxes. Testators should have an understanding of tax laws. Federal tax law provides that upon the death of an individual, there is a credit format similar to the one included in our wills. The Will is for anyone in any life situation where this Will is to be used as the principal estate planning document. If you have a large estate, you ude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. New Hampshire permits self proving, but requires the affidavit to be in a specificis a separate document from the Will). In those states it will have to be "proven" in court, like any other will. In Ohio, Maryland, California and the District of Columbia, the courts have some latits of 2003) do not have statutes permitting self proving wills. The affidavit will be of no use in those states. However, including the affidavit in those states will not invalidate the Will (since it e Affidavit, the Will may still be subject to contest on such grounds as undue influence, lack of testamentary capacity, or prior revocation. A few states like Louisiana, Maryland, Ohio and Vermont (athe need to have witnesses testify, that the formalities in signing the Will were followed. The Affidavit can also be useful if witnesses are not available when they are needed.. However, even with thes come into court and testify under oath, or through sworn affidavits, that each saw the Testator sign the will and that the formalities for signing a Will were followed. The Affidavit may eliminate Will. However, it can speed up the admission of the Will to probate after the death of the Testator. Before the adoption of more modern laws, all wills were proved by having one or more of the witnesswledgment and the affidavit of the witnesses, made before a Notary, that all required formalities were observed when the Will was signed. The Affidavit does not affect the validity or legality of the ans), and assets held in trust generally will not be required to be probated and will not be governed by this Will. The Will has an enclosed self-proving affidavit, which contains the Testator's acknos which are individually owned by the Testator will be distributed. Assets held jointly with rights of survivorship, assets with beneficiary designations (such as life insurance or employee benefit plhis Will distributes the assets of the person making the Will (the "Testator") as specified by the Testator. This Will does not avoid probate for the Testator's estate. It merely directs how the assetthis 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 Information about Wills Ttorney 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 of bstitute 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 atlied 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 suned. If the Testator moves to another state, the current will should be checked by a lawyer in their new state to make sure it meets local requirements. [_] These forms are provided "as is" and no imp. Check the totals before signing the Will. State and federal laws which affect estate planning can vary over time and from place to place. All wills should be reviewed by a lawyer before they are sigttorney if you wish to disinherit a spouse or any children. If any part of the Will calls for distribution in percentages, make sure that the total of all of the beneficiaries' percentage's equal 100% Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Will may be invalid if a spouse receives nothing or only a small portion of the estate. Consult an ald be written and signed. New wills are commonly necessary when, for example, the Testator's marital status changes, if the Testator has a child or if a named beneficiary or one of the Executors dies.on the face of the Will. Such changes are usually disregarded. If changes are desired, the Checklist & Instructions ­ Page 4 original and all copies should be destroyed and an entirely new Will shou The tax results of the choices made in this Will should be discussed with a competent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or changing words in other contracts and plans are not normally governed by a will. This Will is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and other matters.f property held in joint tenancy with rights of survivorship or property held in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benefits arising. This Will does not dispose of property that, on the death of the Testator, would automatically pass to another person by operation of law or by any contract. For example, the Will does not dispose oted to probate. Copies are rarely accepted. A copy of the Will should be kept by the Testator and may also (if Testator so wishes) be provided to the person named as Executor / Personal Representativeher legal instruments where multiple originals are prepared, only one original "copy" of a will should be prepared. While photocopies may be used for reference purposes, only the original can be admitnk or trust company, be sure to check into their fees for such services. The original of the Will should be kept in a secure location such as a safe deposit box at a bank or lawyer's office. Unlike oty with family members. It is best to talk to people (and banks or trust companies) before naming them as a Personal Representative, to make sure that they are willing and can serve. If you select a baPersonal Representative / Executor should be picked carefully. It is very important to pick a person (or bank or trust company) that can be trusted to handle financial matters and to deal appropriatel formalities were observed when the Will was signed. The total number of pages (excluding i.e. not counting the self-proving affidavit) should be entered by hand in the bottom right of each page. The s the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary or other person authorized to take acknowledgments and administer oaths. The affidavit states that all requirednot a part of the Will itself. The Testator and the witnesses should sign the self-proving affidavit (called "Proof of Will" in some states) and attach it to the end of the Will. The Affidavit containng the page(s) on which the witness signature lines appear, should be indicated by the Witnesses. The page with the self-proving affidavit, if included, should not be counted because the affidavit is date of the actual signing. This step could be crucial to determine the validity of the Will at a later date (i.e. if this Will revokes an earlier Will). The total number of pages in the Will, includisses must be satisfied that the Testator is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever requested, the date should be filled in (preferably by hand), with the initial the bottom of each page of the Will. Checklist & Instructions ­ Page 3 All witnesses must sign their names in the presence of the Testator and each other and of the notary public. The witnes. Although not required in most states, it is a good idea for the Testator to initial the bottom of each page of the Will. This can prevent subsequent substitution of pages. The witnesses should alsoed to read or know the contents of the Will. For example, the Testator can say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and voluntarily," or similar wordvit. Before signing the Will, the Testator should orally declare that the document that is about to be signed, is intended to be the Testator's Last Will and Testament. However, the witnesses don't ne For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testator sign the Will. The notary public is needed for the self proved affidational protection if the signature of one of the witnesses is deemed to be invalid for any reason or if one of the witnesses can't be located. The witnesses should not be beneficiaries under the Will.e presence of three (3) qualified, competent, disinterested and adult witnesses and a notary public. Important Note: Vermont requires three witnesses. The signature of a third witness can provide addi the value thereof and knows about relatives and others who might be entitled to a share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in thn signing the Will and must be of legal age (i.e. eighteen in most states). Being of "sound mind" usually means that the Testator knows that he/she is signing a Will, is familiar with the property andude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. The Testator (i.e. the person who is writing the Will) must be of "sound mind" wheis a separate document from the Will). In those states it will have to be "proven" in court, like any other Will. In Ohio, Maryland, California and the District of Columbia, the courts have some latitf proving wills. The affidavit will be of no use in those states and does not need to be completed. However, signing and including the affidavit in those states will not invalidate the Will (since it d, by the Testator, all Witnesses and a Notary in front of each other. Important Note: A few states like Louisiana, Maryland, Ohio and Vermont (as of 2003).do not have specific statutes permitting selAffidavit: The enclosed Affidavit (although technically not part of the Will) states that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signeeds to fill out: [] day month year city; [] Signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; [] witness signatures and info rs like taxes, taking care of the property, and making distributions to the beneficiaries Checklist & Instructions ­ Page 2 Article VI: Contains miscellaneous provisions Signature Block: Testator nebeneficiaries named in the will. Testator must provide and fill out [] the name of executor; [] name of alternate executor. Article V: Powers of Executor empowers the representative to deal with matteresponsible for paying outstanding debts, 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 and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is also s the will is made Article IV: Deals with the appointment of the Testator's Personal Representative (i.e. Executor) and alternate; It allows the Testator to name an Executor to administer the estate, ut you can add as many as you need). [] 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 lawecific persons or charities. Testator 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, b funeral and burial expenses. Article II: Authorizes payments of debts and expenses. Article III: Disposes of specific property. Allows Testator to give specific dollar amounts or other property to sper title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator must provide and fill out: []name, [] county and []state Article I: Authorizes payment ofh section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also needs to be completed. Title: Enter name of Testator in blank space undciaries named in the Will. This Will is suitable for estates worth less than $2,000,000. This Will also includes a self-proved affidavit. This Will is divided into various sections. The content of eacSingle Person with no Children with self-proved affidavit. This Will is for a Single Person with no Children. It distributes the assets of the Testator (i.e. person making the will) to specific benefiChecklist and Instructions Will - Single Person with No Children This package contains (1) Checklist and Instruction for Will ­ Single Person with no Children; (2) Information about Wills; (3) Will ­ 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