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Indiana _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. City: __________________________________ State: ___________________________________ State of INDIANA ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me__________________ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ______________________________________________ (date), at _______________________ (city), Indiana. ________________________________ Signature of Principal Witness Signature: ___________________________________ Name: _________________od 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 _____, 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 in goe 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 terminationot 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 reliancAgent; 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 is nimited 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 my easons 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 are ler 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 the rs, 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 undl 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, rightll 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 shalrces 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 shaor 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 resoucome 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 disability ed, 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 shall be, 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 entitlfer 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 document) 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 transreditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any ofically 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 the ceral 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 specife 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 fedse, 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 to thts 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 otherwis; 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 giffile 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 documentassistance 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/or r 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 business d 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 othery 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, an 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. Treasuals, 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 any 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 withdrawr close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similarmilitary 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 and/o 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, medical, cover 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; to 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, includingght 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 and rel 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 riell, 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 personaow 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, rent, sers, 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 disputed, nle 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 papf 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 sett 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 writing oficates, 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 otherracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certi 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, contted 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, endorseent'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 limitransaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Aggent 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, item, ___________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My A ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint _____________agent. -3- Document Prepared by: Name: _________________________________________ Address: _______________________________________ Phone:______________________ INDIANA GENERAL POWER OF ATTORNEY KNOWfor 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 an ment, 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 decisions 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 docued 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 handle 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 granttor 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 isbe 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 Granhe 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 Attorney 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 challenge tAgent, 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 should pointed 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 the led 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 aphe "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 disabforms.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 (called tney 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 findlegalncipal'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 attorr 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 Prihe 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 Grantoana, 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. Te 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 Indirded 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 b The Principal (i.e. the person granting the Power of Attorney; sometimes called the Grantor) should sign the document before a Notary. Notarization will allow the General Power of Attorney to be recoeral Power of Attorney [_] This General Power of Attorney becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitated. [_]Instructions & Checklist Indiana General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) Gen IndianaIndiana _____________ witnesses, this _______ day of __________________, 20____. __________________________________________ Notary public [SEAL] Self-proved Will Affidavit __________________ a notary public, and by _________________________________________, the testator, and by ___________________________________ , __________________________ , and ______________________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before me ________________________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________mpetent to be a witness. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ____the witness's knowledge the testator was at that 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 coas the testator's free and voluntary act for the 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 that the testator signed and executed the instrument as the testator's will, that the testator signed willingly (or willingly directed another to sign for the testator), that the testator executed it e attached or foregoing instrument in those capacities, personally appearing before the undersigned authority and being first duly sworn, declare to the undersigned authority under penalty of perjury ____________, and _______________________________, and ________________________________ and ________________________________, the testator and the witnesses, respectively, whose names are signed to th__________ Witness __________ __________ Witness Witness Page 7 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ___________________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testator _______ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ____________Name: Address: City: State: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ____________________________s at the address set forth after his or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: and memory. We believe that this Will was not procured by duress, menace, fraud or undue influence. The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and residequest, and in the sight and presence of each other, 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___________________ (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 presence and at testator's ree State of ____________________ that the above instrument, which consists of _____ pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by __________s 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 perjury under the laws of th________________ Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 6 of ______ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witnesnder no constraint or undue influence and ask the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________is Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare this to be my Last Will and Testament, that I am of legal age and sound mind, that I make this u. In that case, the terms of this Will shall then take precedence over any Will or Codicils of my Spouse, except where otherwise directed by law. IN WITNESS WHEREOF, I have signed my name below to thy it is difficult or impractical to determine the order of deaths or to determine who survived the death of the other Spouse or who died first, I direct that it be determined that I survived my Spouseceable, any invalidity, illegality or unenforceability should affect only that provision and all other provision should remain effective. 7. Survival. If my Spouse and I die under circumstances whereb separate property of a beneficiary hereunder, 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 unenforproperty, partnership or other form of sharing or division of property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain theh beneficiaries if they can agree, and if not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned or anticipated, or fall into any community of Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by sucion with or arising out of that fiduciary'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 the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connectary shall be deemed not to have survived me 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 _____ Witness __________ __________ Witness Witness Page 5 of ______ 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficisuch 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. Initials: __________ Testator _____ural, 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 and ot 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 the plthe 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 are nd shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VII MISCELLANEOUS PROVISIONS The provisions in this Will for r 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 beneficiaries anercise 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 thei 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 such extected 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 discretion. Thee 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 fully proconsideration 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 reasonablve an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration or no om any election, determination, designation 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 haes hereof. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or by my estate resulting frstator __________ Witness __________ __________ Witness Witness Page 4 of ______ territory, and such exercise of discretion by the Executor shall be conclusive and binding upon all the beneficiarieral 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 Initials: __________ Te 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 the fed 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 loss ofnto 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 property, 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 falling i 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 responsibility foray 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 money,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 they m 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 cash or all 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 propertythe 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 Executor she 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 that e 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 share right to renew and keep renewed any mortgage 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 mortgagisable. 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor shall also have thincome therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the manner and to the extent that the Executor shall deem adv_____ __________ Witness Witness Page 3 of ______ 2. Take charge of any real property as part of the probate administration of my estate for such period as the Executor shall determine; collect any as may be necessary to affect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. Initials: __________ Testator __________ Witness _____ 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 documentsumber 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 conditions asy 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 otherwise encsurety shall be required of any Executor serving hereunder. ARTICLE VI POWERS OF EXECUTOR In addition to the existing authority of the Executor and in addition to other powers and authority granted bon over my estate, using "informal," "unsupervised," or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, security or r 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 jurisdictiecutor" 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 original oble to serve or continue to serve as Executor for any reason, I appoint ___________________________________, to be the Executor of this my Will in the place and instead of my Spouse. References to "Exufficient discharge to the Executor. ARTICLE V NOMINATION OF EXECUTOR I appoint my Spouse ___________________________________, as the Executor of this my Will. If my Spouse cannot, does not or is unaerson with whom the beneficiary resides at the time of the distribution or to any other person the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a s authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of such person, pcally 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 disability, Iintestate at the time fixed for distribution under this provision. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 2 of ______ Except as may be specifiduary estate shall be distributed to 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 ______________________________________________________________________ ____________________________________________________________________________ If any such beneficiary does not survive me, my resis. If none of the named child(ren) or their descendants, survive me, I direct that my residuary estate be distributed in equal shares per stirpes to: ___________________________________________ ___________________________________ _____________________________________________________________________(name(s)). If more than one child is named, then the distribution shall be in equal shares per stirpe_________. If my Spouse does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed in equal shares to my child(ren) _____________esiduary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed, bequeathed and given to my Spouse. _____________________________erest in my primary residence or homestead, if any, shall be distributed to my Spouse ___________________________________. If my Spouse does not survive me, this bequest shall be distributed with my r_____________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. Primary Residence My int_____ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. ________________________________all be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. ________________________________________h respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. _____________________________________________ shh taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchaser or transferee upon or after my death pursuant to any agreement withe taxes are owed by my estate or by any beneficiary. The Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. This direction shall not extend to or include any suclifetime or by survivorship. The payment of the taxes Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 1 of ______ shall be made regardless of whether t 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 during my e 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 taxestaxes (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 of tht. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. All 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 any cour__ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposition ______________________ Born on _________________ Name: ____________________________________________ Born on _________________ Name: ____________________________________________ Born on _______________________________________ (name of spouse). All references to "my Spouse" refer to ________________________________ (name of spouse). I have the following adult child(ren): Name: ______________________ty), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I SPOUSE & CHILDREN I am married to __________________ out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, _________________________________________ (name), of ____________________ (counng an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arisingnot a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consultian unlimited amount to his or her spouse upon death without any federal estate tax liability. This is referred to as the "Marital Deduction." This information and these forms are not intended and are rement accounts and qualified employee benefit plans; the face value of any life insurance policy; property you are holding in trust; any joint property you own In addition, each individual may leave l estate; stocks and bonds; bank accounts; tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); partnership (business) interests; individual retissionals and an attorney. Information about Wills ­ Page 2 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: rea000,000 in value, the greater your need for professional estate tax planning advice. If your assets come near the $2,000,000 level, you really shouldn't use this Will and should consult with tax profes $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 and/or exceeds $2,es 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 from 2006 to 2008, that credit i 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 law providelf-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 principalia 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 permits svit 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, Californ 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 the affida 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 revocation. 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 witnesses are 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 formalities for 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 modern laws,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 signed. Thedesignations (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 enclosed e for the Testator's estate. It merely directs how the assets that are individually owned by the Testator will be distributed. Assets held jointly with rights of survivorship, assets with beneficiary f 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 avoid probat 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 and Terms oor 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 estatet 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 point fets 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 effec to place. All wills should be reviewed by a lawyer before they are signed. If the Testator moves to another state, the current will should be checked by a lawyer in their new state to make sure it mesure that the total of all of the beneficiaries' percentage's equal 100%. Check the totals before signing the Will. State and federal laws that affect estate planning can vary over time and from placeuse 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 ator has a child or if a named beneficiary or one of the Executors dies. Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Will may be invalid if a sposired, the original and all copies should be destroyed and an entirely new Will should be signed. New wills are commonly necessary when, for example, the Testator's marital status changes, if the Testdvisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or modifying words on the face of the Will. Such changes are usually disregarded. Instead, when changes are de to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and other matters. The tax results of the choices made in this Will should be discussed with a competent tax addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benefits arising in other contracts and plans are not normally governed by a will. This Will is not designedally pass to another person by operation of law or by any contract. For example, the Will does not dispose of property held in joint tenancy with rights of survivorship or property held in trust. In as) be provided to the person named as Executor / Personal Representative. Checklist & Instructions ­ Page 4 This Will does not dispose of property that, on the death of the Testator, would automaticopies 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 wisheation 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 photocve, to make sure that they are willing and can serve. If you select a bank or trust company, be sure to check into their fees for such services. The original of the Will should be kept in a secure locthat 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 Representatidavit) 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) wledgments 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 affiome states) 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 acknoaffidavit, 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 sevokes 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 requested, the date should be filled in (preferably by hand), with the date of the actual signing. This step could be crucial to determine the validity of the Will at a later date (i.e. if this Will rence of the Testator and each other and of the notary public. The witnesses must be satisfied that the Testator is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever ttom of each page of the Will. This can prevent subsequent substitution of pages. The witnesses should also initial the bottom of each page of the Will. All witnesses must sign their names in the pres I am about to sign is my Last Will and Testament. I am signing it freely and voluntarily," or similar words. Although not required in most states, it is a good idea for the Testator to initial the bobout to be signed is intended to be the Testator's Last Will and Testament. However, the witnesses don't need to read or know the contents of the Will. For example, the Testator can say: "The documentr sign the Will. The notary public is needed for the self- proved affidavit. Checklist & Instructions ­ Page 3 Before signing the Will, the Testator should orally declare that the document that is at be located. The witnesses should not be beneficiaries under the Will. For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testato and a notary public. The signature of a third witness can provide additional protection if the signature of one of the witnesses is deemed to be invalid for any reason or if one of the witnesses can'ed to a share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in the presence of three (3) qualified, competent, disinterested adult witnesses Being of "sound mind" usually means that the Testator knows that he/she is signing a Will, is familiar with the property and the value thereof and knows about relatives and others who might be entitl a Notary in the presence of one another. 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).lthough 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 andgnature; and · · · · · Witnesses: Witnesses must provide and fill out: name of state; number of pages; name of testator; and witness signatures and information. Affidavit: The enclosed Affidavit (ar husband or wife has a will which contains a similar paragraph or wording, then delete Paragraph 7 (Survival) from this Will. Signature Block: Testator needs to fill out: name day month year city; Sis should have this (or this type) of paragraph. Basically: (a) if your husband or wife has a will and there is no similar paragraph in it, then keep Paragraph 7 (Survival) in this Will; but (b) if youscellaneous provisions. IMPORTANT NOTE: Paragraph 7 (Survival) in this section is important. If both spouses (i.e. husband and wife) have a Will (which is always recommended) then only one of the Willxecutor. Article VI: Powers of Executor empowers the representative to deal with matters like taxes, taking care of the property, and making distributions to the beneficiaries Article VII: Contains mibts and expenses, the Personal Representative will pay whatever is left to the beneficiaries named in the will. Testator must provide and fill out the name of executor (spouse) and name of alternate eeath) of managing the testator's property. The Personal Representative is also responsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying deternate, and allows the Testator to name an Executor to administer the estate, and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's dTestator; and state under whose laws the will is made · · Checklist & Instructions ­ Page 2 · Article V: Deals with the appointment of the Testator's Personal Representative (i.e. Executor) and alren) to whom the residuary estate will be given in the event the Spouse predeceases the Testator; name of "alternate" beneficiaries to whom the residuary estate will be given if child(ren) predecease re provided, but you can add as many as you need). name of Spouse to whom Testator's interest in any primary residence is given; name of Spouse to whom the Residuary Estate is given to; name of child(children if the spouse predeceases the Testator. Testator must provide and fill out: description of property (or dollar amount); name(s) of person/entity property is given to (three blank paragraphs aresiduary property. Allows Testator to give specific dollar amounts or other property to specific persons or charities and gives any primary residence and the residuary estate to the spouse or to the s as necessary. Article II: Authorizes payment of funeral and Burial expenses. Article III: Authorizes payments of debts and expenses. Article IV: Disposes of specific property, primary residence and or must provide and fill out name of spouse (in two places); name of child(ren) and date of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for nametament of." Introduction: Contains preliminary information about the will. Testator must provide and fill out: name, county and state Article I: Gives the name of the spouse and any child(ren). Testatre information to be provided and filled out in the space provided. The enclosed Affidavit also needs to be completed. · · · Title: Enter name of Testator in blank space under title "Last Will and Tesc gifts to others as well. This Will is suitable for estates worth less than $2,000,000. This Will is divided into various sections. The content of each section is explained below. Some sections requiibutes the assets of the Testator (i.e. person making the will) to the spouse if he/she survives the Testator, otherwise the assets will go to the children. It also allows the Testator to make specifi (3) Will ­ Married Person with Adult Children with self-proved affidavit. This Will is for use by a married person (husband or wife) with adult children and includes a self-proved affidavit. It distrChecklist and Instructions Will - Married Person with Adult Children This packet includes: (1) Checklist and Instruction for Will ­ Married Person with Adult Children; (2) Information about Wills; and IndianaIndiana ___ nd at least eighteen (18) years of age. Witness ________________________________________________ Date __________________ Witness ________________________________________________ Date ___________________ City, County and State of Residence ________________________________________________ The declarant has been personally known to me, and I believe (him/her) to be of sound mind. I am competent amedical or surgical treatment and accept the consequences of the request. I understand the full import of this declaration. Signed: ___________________________________________________________________to give directions regarding the use of life prolonging procedures, it is my intention that this declaration be honored by my family and physician as the final expression of my legal right to request dration, the administration of medication, and the performance of all other medical procedures necessary to extend my life, to provide comfort care, or to alleviate pain. In the absence of my ability ave an incurable injury, disease, or illness determined to be a terminal condition I request the use of life prolonging procedures that would extend my life. This includes appropriate nutrition and hyI, ________________________________________________________________, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known my desire that if at any time I h____________________________________________ Date __________________ 2 Life Prolonging Procedures DECLARATION Declaration made this _____________________ day of _____________________ (month, year). ly responsible for the declarant's medical care. I am competent and at least eighteen (18) years of age. Witness ________________________________________________ Date __________________ Witness ____eclarant's signature above for or at the direction of the declarant. I am not a parent, spouse, or child of the declarant. I am not entitled to any part of the declarant's estate or directly financial_________________________________________________ City, County, and State of Residence The declarant has been personally known to me, and I believe (him/her) to be of sound mind. I did not sign the d_____________________________________ I understand the full import of this declaration. Signed: _______________________________________________________________________ _______________________________ ____________________________________________________________________________ 1 ____________________________________________________________________________ _______________________________________he refusal. Additional Instructions (optional): ____________________________________________________________________________ __________________________________________________________________________dures, it is my intention that this declaration 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 of te representative appointed under IC 16-361-7 or my attorney in fact with health care powers under IC 30-5-5. In the absence of my ability to give directions regarding the use of life prolonging proce to sustain life is futile or excessively burdensome to me. __________ I intentionally make no decision concerning artificially supplied nutrition and hydration, leaving the decision to my health carnutrition and hydration, even if the effort to sustain life is futile or excessively burdensome to me. __________ I do not wish to receive artificially supplied nutrition and hydration, if the effortovision of artificially supplied nutrition and hydration. (Indicate your choice by initialing or making your mark before signing this declaration): __________ I wish to receive artificially supplied to die naturally with only the performance or provision of any medical procedure or medication necessary to provide me with comfort care or to alleviate pain, and, if I have so indicated below, the pra short time; and (3) the use of life prolonging procedures would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted the circumstances set forth below, and I declare: If at any time my attending physician certifies in writing that: (1) I have an incurable injury, disease, or illness; (2) my death will occur within __________________________________, being at least eighteen (18) years of age and of sound mind, willfully and voluntarily make known my desires that my dying shall not be artificially prolonged underclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION Declaration made this _____________________ day of _____________________ (month, year). I, ______________________________ling with estate 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 Disstarting 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 dear legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a rocedures withheld or withdrawn. [_] 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 theiation unless the person had actual knowledge of the revocation. (d) The revocation of a life prolonging procedures will declaration is not evidence that the declarant desires to have life prolonging p expression of intent to revoke. (b) A revocation is effective when communicated to the attending physician. (c) No civil or criminal liability is imposed upon a person for failure to act upon a revocollowing: (1) A signed, dated writing. (2) Physical cancellation or destruction of the declaration by the declarant or another in the declarant's presence and at the declarant's direction. (3) An oralation or life prolonging procedures will declaration Sec. 12. (a) A living will declaration or a life prolonging procedures will declaration may be revoked at any time by the declarant by any of the fific directions. The invalidity of any additional, specific directions does not affect the validity of the declaration. As added by P.L.2-1993, SEC.19. IC 16-36-4-12 - Revocation of living will declar36-4-9 - Forms of declaration; requisites Sec. 9. A declaration must be substantially in the form set forth in either section 10 or 11 of this chapter, but the declaration may include additional, specnt. (g) A life prolonging procedures will declaration under section 11 of this chapter does require the physician to use life prolonging procedures as requested. As added by P.L.2-1993, SEC.19. IC 16-se, withholding, or withdrawal of life prolonging procedures under this chapter; and (2) shall be given great weight by the physician in determining the intent of the patient who is mentally incompetetion under section 10 of this chapter: (1) does not require the physician to use, withhold, or withdraw life prolonging procedures but is presumptive evidence of the patient's desires concerning the uphysician Living Will Information & Instructions ­ Page 3 who is notified shall make the declaration or a copy of the declaration a part of the declarant's medical records. (f) A living will declarae person's pregnancy. (e) The life prolonging procedures will declarant or the living will declarant shall notify the declarant's attending physician of the existence of the declaration. An attending personal representative or as the attorney for the estate in the declarant's will. (d) The living will declaration of a person diagnosed as pregnant by the attending physician has no effect during thponsible for the declarant's medical care. For the purposes of subdivision (3), a person is not considered to be entitled to any part of the declarant's estate solely by virtue of being nominated as astate whether the declarant dies testate or intestate, including whether the witness could take from the declarant's estate if the declarant's will is declared invalid. (4) Be directly financially ress: (1) Be the person who signed the declaration on behalf of and at the direction of the declarant. (2) Be a parent, spouse, or child of the declarant. (3) Be entitled to any part of the declarant's eence of at least two (2) competent witnesses who are at least eighteen (18) years of age. (c) A witness to a living will declaration under subsection (b)(5) may not meet any of the following condition(2) Be in writing. (3) Be signed by the person making the declaration or by another person in the declarant's presence and at the declarant's express direction. (4) Be dated. (5) Be signed in the presection 11 of this chapter or a living will declaration under section 10 of this chapter. (b) A declaration under section 10 or 11 of this chapter must meet the following conditions: (1) Be voluntary. dures will declarations; living will declarations Sec. 8. (a) A person who is of sound mind and is at least eighteen (18) years of age may execute a life prolonging procedures will declaration under se provider for the failure to provide medical treatment to a patient who has refused the treatment in accordance with this section. As added by P.L.2-1993, SEC.19. IC 16-36-4-8 - Life prolonging proce. (b) No health care provider is required to provide medical treatme nt to a patient who has refused medical treatment under this section. (c) No civil or criminal liability is imposed on a health carunity from liability for failure to treat patient after refusal of treatment Sec. 7. (a) A competent person may consent to or refuse consent for medical treatment, including life prolonging proceduresical or surgical means or procedures calculated to prolong the competent adult's life provided, withheld, or withdrawn. As added by P.L.2-1993, SEC.19. IC 16-36-4-7 - Consent to medical treatment; imms added by P.L.2-1993, SEC.19. IC 16-36-4-6 - Policy Sec. 6. A competent adult has the right to control the decisions relating to the competent adult's medical care, including the decision to have medno recovery; and (2) death will occur from the terminal condition within a short period of time without the provision of life prolonging procedures. Living Will Information & Instructions ­ Page 2 Andition defined Sec. 5. As used in this chapter, "terminal condition" means a condition caused by injury, disease, or illness from which, to a reasonable degree of medical certainty: (1) there can be As used in this chapter, "qualified patient" means a patient who has been certified as a qualified patient under section 13 of this chapter. As added by P.L.2-1993, SEC.19. IC 16-36-4-5 - Terminal coer, "living will declarant" means a person who has executed a living will declaration under section 10 of this chapter. As added by P.L.2-1993, SEC.19. IC 16-36-4-4 - Qualified patient defined Sec. 4. has executed a life prolonging procedures will declaration under section 11 of this chapter. As added by P.L.2-1993, SEC.19. IC 16-36-4-3 - Living will declarant defined Sec. 3. As used in this chapt SEC.19. Amended by P.L.99-1994, SEC.1. IC 16-36-4-2 - Life prolonging procedures will declarant defined Sec. 2. As used in this chapter, "life prolonging procedures will declarant" means a person whoong the dying process. (b) The term does not include the performance or provision of any medical procedure or medication necessary to provide comfort care or to alleviate pain. As added by P.L.2-1993,re" means any medical procedure, treatment, or intervention that does the following: (1) Uses mechanical or other artificial means to sustain, restore, or supplant a vital function. (2) Serves to prollating to Living Wills. IC 16-36-4 Chapter 4. Living Wills and Life Prolonging Procedures IC 16-36-4-1 - Life prolonging procedure defined Sec. 1. (a) As used in this chapter, "life prolonging proceduLife Prolonging Declaration. This Indiana Living Will is based on Indiana Code Title 16-36 Chapter 4 Section 1 et. Seq. For your convenience, we have included useful excerpts from the Indiana Codes retructions Indiana Living Will & Life Prolonging Declaration This package contains (1) Information and Instruction for Indiana Living Will and Life Prolonging Declaration; (2) Indiana Living Will; (3) ______________, the principal, this _____ day of __________________, 20____. ______________________________________ (Notary Public) My Commission expires __________________ -2- Information and Insen years of age or older, of sound mind, and under no constraint or undue influence. ___________________________________ (Principal) Subscribed and acknowledged before me by _____________________________________ 20 _____, and do hereby declare to the undersigned witness that I sign it willingly, and I execute it as my free and voluntary act for the purposes herein expressed, and that I am eighteng of nutrition and hydration through intravenous, gastrostomy or nasogastric tubes.. I, ___________________________________, the principal, sign my name to this instrument this _______ day of ______-1- I understand health care to include any medical care, treatment, service, or procedure to maintain, diagnose, treat, or provide for my physical or mental well-being, and also includes the providi physicians and other relevant health care givers. To the extent appropriate, my health care representative may also discuss this decision with my family and others to the extent they are available. representative must try to discuss this decision with me. However, if I am unable to communicate, my health care representative may make such a decision for me, after consultation with my physician ormay express my will that such health care be withheld or withdrawn and may consent on my behalf that any or all health care be discontinued or not instituted, even if death may result. My health care y health care representative is satisfied that certain health care is not or would not be beneficial or that such health care is or would be excessively burdensome, then my health care representative representative to make decisions in my best interest concerning withdrawal or withholding of health care. If at any time based on my previously expressed preferences and the diagnosis and prognosis mome telephone number) _________________ (work telephone number) Appointment of my Attorney- in-Fact as my Health Care Representative In addition to the powers granted above, I authorize my health careneyin- fact, I hereby appoint: __________________________________________________ (name of successor attorney- in- fact) of _____________________________________________ (address) _________________ (hmical gifts on my behalf; (5) to request an autopsy; and (6) to make plans for the disposition of my body In the event the person I appoint above is unable, unwilling or unavailable to act as my attorre providers to care for me; (2) to admit or release me from a hospital or health care facility; (3) to have access to my records, including medical records, concerning my condition; (4) to make anatoapable of making my own health care decisions. I grant my attorney- in- fact the following powers in matters affecting my health care: (1) to employ or contract with servants, companions, or health ca____________________ (address) _________________ (home telephone number) _________________ (work telephone number) as my attorney- in- fact to make health care decisions on my behalf whenever I am inc (address) being of sound mind, willfully and voluntarily appoint hereby appoint _________________________________________________ (name of attorney- in-fact) _________________________________________e found at findlegalforms.com -4- Power of Attorney for Health Care I, _________________________________________________________ (name) of ___________________________________________________________rty. Any -3- 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 and Terms of Using or signing this document you should have an attorney review it to make sure it fits your particular situation. You should also consult an attorney whenever a document is negotiated with another pa 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 without consulting with an attorney first. Before usrranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legale recorded; and (2) reference the book and page or instrument number where the instrument creating the power of attorney is recorded. [_] These forms are provided "as is" and no implied or express wass the attorney in fact or other person has actual knowledge of the revocation. (c) If an executed power of attorney was recorded under IC 30-5-3-3, the revocation of the power of attorney must: (1) be revoked only by a written instrument of revocation that: (1) identifies the power of attorney revoked; and (2) is signed by the principal. (b) A revocation under subsection (a) is not effective unleof the principal, a term of the contract notwithstanding. IC 30-5-10-1 Revocation of power; record Sec. 1. (a) Except as otherwise stated in the power of attorney, an executed power of attorney may bis not a suicide or homicide for any purpose under a statute or rule of law and does not impair or invalidate an insurance, annuity, or other type of contract that is conditioned on the life or death ipline for failure to comply with the attorney in fact. (3) If the principal's death results from withholding or withdrawing health care in accordance with the terms of a power of attorney, the death sonable medical standards at the time of reference and the provider promptly transfers the principal to another health care provider, the provider is not subject to civil or criminal liability or disc if death or injury to the principal results. (2) If the actions of a health care provider who fails to comply with a direction or decision of the attorney in fact are substantially in accord with rea) A health care provider or other person is not subject to civil or criminal liability or discipline for unprofessional conduct for complying with a direction or decision by the attorney in fact, evenrectly with the principal as a fully competent person. In addition, the following rules shall be applied to protect and validate the acts of the attorney in fact and provider or other person: -2- (1e terms of the power of attorney is protected and released from liability to the same extent as the provider or other person would be protected or released if the provider or other person had dealt diion or decision of attorney in fact Sec. 10. A health care provider or other person who acts in good faith reliance on a direction or decision of an attorney in fact that is not clearly contrary to thssary decisions. Each person to whom the attorney in fact communicates a direction shall comply with the direction. IC 30-5-9-10 Health care providers; persons acting in good faith reliance on directe disposition of the principal's remains; the anatomical gift, autopsy, or remains disposition shall be considered the act of the principal or of the person who has priority under law to make the neceosition Sec. 6. If a power of attorney authorizes the attorney in fact to: (1) make an anatomical gift on behalf of the principal; (2) authorize an autopsy of the principal's remains; or (3) direct thhis decision with my family and others to the extent they are available. (b) Nothing in this section may be construed to authorize euthanasia. IC 30-5-7-6 Anatomical gifts, autopsies, or remains dispe may make such a decision for me, after consultation with my physician or physicians and other relevant health care givers. To the extent appropriate, my health care representative may also discuss t discontinued or not instituted, even if death may result. My health care representative must try to discuss this decision with me. However, if I am unable to communicate, my health care representativis or would be excessively burdensome, then my health care representative may express my will that such health care be withheld or withdrawn and may consent on my behalf that any or all health care bed on my previously expressed preferences and the diagnosis and prognosis my health care representative is satisfied that certain health care is not or would not be beneficial or that such health care in substantially the same form set forth below: I authorize my health care representative to make decisions in my best interest concerning withdrawal or withholding of health care. If at any time base outweighed by the demands of the treatment and death may result. To empower the attorney in fact to act under this section, the following language must be included in an appointment under IC 16-36-1 ction 16(2) of this chapter, the attorney in fact may be empowered to ask in the name of the principal for health care to be withdrawn or withheld when it is not beneficial or -1- when any benefit isans fo r the disposition of the principal's body. IC 30-5-5-17 Consent to or refusal of health care Sec. 17. (a) If the attorney in fact has the authority to consent to or refuse health care under selth care facility. (4) Have access to records, including medical records, concerning the principal's condition. (5) Make anatomical gifts on the principal's behalf. (6) Request an autopsy. (7) Make pl accordance with IC 16-36-4 and IC 16-36-1 by properly executing and attaching to the power of attorney a declaration or appointment, or both. (3) Admit or release the principal from a hospital or hea with servants, companions, or health care providers to care for the principal. (2) If the attorney in fact is an individual, consent to or refuse health care for the principal who is an individual indual requiring health care. (b) Language conferring general authority with respect to health care powers means the principal authorizes the attorney in fact to do the following: (1) Employ or contractable of consenting to the individual's own health care or to the health care of another from consenting to health care administered in good faith under the religious tenets and practices of the indiviom the Indiana Statutes relating to the Indiana Power of Attorney for Health Care Form. IC 30-5-5-16 Health care powers; religious tenets Sec. 16. (a) This section does not prohibit an individual capna Power of Attorney for Health Care Form. This Indiana Power of Attorney for Health Care is based on Title 30 Chapter 5 Section 30-5-5-16 of the Indiana Statutes. The following are useful excerpts frindlegalforms.com Information and Instructions Indiana Power of Attorney for Health Care This package contains (1) Information and Instruction for Indiana Power of Attorney for Health Care; (2) Indiay possible tax conseque nces arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at f be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Anese forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should notThese 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 effect or completeness. [_]Thlth Care Directive. This package also includes the Indiana Life Prolonging Procedures Declaration. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] Indiana Advance Health Care Directive This package contains both a Indiana Power of Attorney for Health Care and a Indiana Living Will. Together these forms are also sometimes known as an Advance Hea IndianaIndiana unless required by law. _____________________ (print name of preparer). Quitclaim Deed - 2 t was prepared by _________________________________ (print name). I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, uted the instrument. WITNESS my hand and official seal. _______________________________ Signature of Notary Public NOTARY SEAL _______________________________ Printed Name of Notary This instrumene/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, exec__________ personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/shme of Grantor Quitclaim Deed - 1 State of Indiana County of ______________ } ss. On ______________________, 20,___ before me, _________________________________, personally appeared ________________n. IN WITNESS WHEREOF, Grantor has executed this Quitclaim Deed on __________________, 20 __. ____________________________________________ ____________________________________________ Type or Print Naher Grantor nor Grantor's heirs, successors and/or assigns shall have claim or demand any right or title to the property described above, or any of the buildings, appurtenances and improvements thereorictions of record. TO HAVE AND TO HOLD all of Grantor's right, title and interest in and to the above described property unto Grantee, Grantee's heirs, successors and/or assigns forever; so that neit_______________________________, State of Indiana described as follows: [Insert legal description] SUBJECT TO all, if any, valid easements, rights of way, covenants, conditions, reservations and restll right, title, interest and claim to the plot, piece or parcel of land, with all the buildings, appurtenances and improvements thereon, if any, in the City of __________________________, County of ________ DOLLARS ($______) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Grantor hereby REMISES, RELEASES, AND FOREVER QUITCLAIMS to Grantee, a________________ and ________________________________ ("Grantee") whose address is _____________________________________________________. FOR A VALUABLE CONSIDERATION, in the amount of _______________RESENTS THAT: THIS QUITCLAIM DEED, made and entered into on ___________________, 20_____, between ____________________________ ("Grantor") whose address is _________________ __________________________egalforms.com Recording requested by: and when recorded, please return this deed and tax statements to: Escrow No.: For recorder's use only Title Order No.: QUITCLAIM DEED KNOW ALL MEN BY THESE Pan 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 Disclaimers and Terms of Use found at findly be charged additional fees 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 k your local requirements with your local Recorder's (or similar) office. Depending on the type of document, additional requirements may apply. Nonconforming documents may be returned unrecorded or ma. Documents referencing land should include a legal description of the land. Verify that the legal description is correct. A Quitclaim Deed may require other documents to be filed with it. Please checim Deed before a Notary. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the Quitclaim Deed may not be effective against third partiesInstructions & Checklist for Quitclaim Deed Indiana (Individual) This package contains (1) Instructions and Checklist for Quitclaim Deed (2) Quitclaim Deed The Grantor should date and sign the Quitcla IndianaIndiana _____________ 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 Indiana