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Maryland Address -6- owledgment (Notary Public) _________________________________ Name typed, printed, or stamped This Document Prepared by: _____________________________________Name _______________________________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking ackne of __________________________ ) ) ss County of ________________________ ) -5- The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by ___________________ State: ___________________________________ BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT. Notary's Acknowledgment Stat______________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: _______________________________e, the Principal appears to be of sound mind and does not appear to be under duress. Witness Signature: ___________________________________ Name: ___________________________________ City: ____________Signature of ("Principal") On this day ______________ (date) I declare that the Principal indicated that he understands the nature of this document and is signing it freely and voluntarily. Furthermor___________ (name of Principal) has executed this Durable Power of Attorney on ____________ (date) at ____________________ (city), __________________________ (state). ________________________________ ful 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. IN WITNESS WHEREOF, _______________d harmless. 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 good faith and/or willttorney. If this Durable -4- 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 termination, shall be hel 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 reliance on this power of a 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 not effective as to a 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 Agent; and/or (c) myr 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 limited to the extenthen 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 reasons for the use oe 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 under applicable law, t for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers arreasonable 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 shall provide an accountingly. 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 shall also be entitled to 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 resources and affairs properfect thereafter until my death. This Power of Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence (except as provided by any applicable statute). As used the rights, powers, and authority of my Agent shall become effective immediately upon execution of this instrument. The rights, powers, and authority of this document shall remain in full force and efent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and m any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agse whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. -3- 17. To disclair the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding thogent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, ocalendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Atax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whethere and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other incomfuture. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents.ks, bonds, debentures, commodities, options or any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the ny other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stoc draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with a, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, -2- negotiate, sell or transfer any note, security, oruding, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificatese accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, inclng Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokeragental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receivig, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmeive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program includince and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To recht to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insuranent or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the rigth all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrum or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal wind demands whatsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have,l sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title a amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hold, possess and/or invest any and aland obligations and such other instruments in writing of whatever kind and nature as may be. -1- 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect anyvings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts cuments, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, saions, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title donto binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applicatt's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter ieby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agenre in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hery-in-fact for me and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acqui______________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorneHIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO. KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _________________________________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 FOR YOU. YOU MAY REVOKE TRS 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 DOCUMENT, IS LEGALLY BINDING THIS DOCUMENT ARE BROAD AND SWEEPING. BEFORE SIGNING THIS DOCUMENT, CONSIDER ITS CONSEQUENCES. YOU ("GRANTOR") ARE PROVIDING ANOTHER PERSON ("AGENT") WITH THE POWER TO HANDLE BUSINESS AND LEGAL MATTEhe instructions included with the forms packages offered for sale, generally include state specific instructions. -2- DURABLE POWER OF ATTORNEY Effective Immediately (CAUTION): THE POWERS GRANTED BY Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the Durable Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so.ire it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow tment, will be legally binding upon the Grantor. The Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always be notarized, even if your state does not requhe 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 Agent, within the scope of the Power of Attorney docus not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. Tpacitated. This particular Form becomes effective immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes incapacitated. Note that the word "attorney" intally" competent person (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf, even if the Principal later becomes incahese forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attorney Effective Immediately A Durable Power of Attorney allows a natural "mearting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of t At the bottom of the document, indicate the name and address of the person who prepared it. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a sty careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. [_] access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be veresses should be adults. The Agent, the Agent's spouse or children, and the Notary should not be witnesses. [_] The Principal should keep the original document, as well as a copy. The Agent should havehe Durable Power of Attorney to be recorded 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. The witn Principal (i.e. the Grantor) becomes subsequently incapacitated. [_] The Principal (i.e. the person granting the power of Attorney) should sign the document before a Notary. Notarization will allow t Durable Power of Attorney Effective Immediately; (3) Durable Power of Attorney Effective Immediately [_] This Durable Power of Attorney becomes effective immediately and remains effective even if theInstructions & Checklist Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) Information for MarylandMaryland ________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- his _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. ________________________ State: ___________________________________ State of __________________________ ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me t_ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: _______________ (city), __________________________ (state). ________________________________ Signature of Principal Witness Signature: ___________________________________ Name: __________________________________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 ________________ (date), at ___________________l 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 good faith and/or willful misconduct, while le 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 termination, shall be held harmless. -4- Agent shal 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 reliance on this power of attorney. If this Durabto 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 not effective as to a third party until the(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 Agent; and/or (c) my assets to be subject er-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 limited to the extent necessary to prevent fected 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 reasons for the use or issuance of this powrict 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 under applicable law, then the remaining unaf and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restn 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 shall provide an accounting for all funds handledentitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensatioe and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly, as certified in writing by a licensed medical doctor. My Agent shall be on my subsequent disability, incapacity or lack of mental competence, except as provided by any applicable statute. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receivin writing by a licensed medical doctor. The rights, powers, and authority of this document shall remain in full force and effect thereafter until my death. This Power of Attorney shall not terminate rectly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and all rights and powers therein shall become effective upon my subsequent disability or incapacity as certified any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to -3- which I would be entitled, if the result is that the disclaimed assets pass diust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me from ions, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trof appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligatassign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers ar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendt tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers angible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gifncy, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, ther governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related documents; to obtain or provide information to and from any ageited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or otess that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limcontents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. 12. To maintain and/or operate any businosit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the orm any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities. -2- 10. To have access to any safe depuments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perfusiness with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instrhecking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any banyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, c any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, medical, military and social security benefits), and to appoint retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and performppropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension,y reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other a may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me b(now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own orest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible le, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvts, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payabst any other person or entity. -1- 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposik, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf againases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obligations and such other instruments in writing of whatever kind and nature as may be. 3. To request, asal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawry to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deall lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessaause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and l, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or c act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or persona___________________________________ as my alternate or successor Agent, as necessary, to serve with the same powers, rights and discretions. My Agent shall have full power and authority to perform any-fact for me and in my name, and in my behalf. If the above named Agent is unable to serve for any reason, I appoint _____________________________________ maintaining an address at: ____________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-inLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _____________________________________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 agent. -3- DURABbinding 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 for you. You may al 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 document, is legally 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 business and legic. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers granted by this power any real estate in Florida. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specifcord, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Two witnesses are necessary, if the Agent will deal with eal property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable Power of Attorney to be recorded as a public reis unable to serve or continue to serve as the Agent. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any r of Attorney takes effect only after the Principal becomes disabled or incompetent, an alternate Agent can be designated, at the time this Power of Attorney is signed, in the event the original Agent the Principal is incapacitated when the Power of Attorney goes into effect, or the Agent undertakes the acts. The Principal can revoke a Durable Power of Attorney at any time. Since this Durable Powernt and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Principal. This is especially important if n acting as the attorney-in-fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an attorney-in-fact by a power of attorney. A Power of Attorney is a "powerful" instrumecipal later becomes incapacitated. This particular Form becomes effective upon the disability or incapacity of the Principal. Note that the word "attorney" is not used here to mean "lawyer". The perso allows a natural "mentally competent " person (called the "Principal" or "Principal") to authorize someone else (called the "Agent" or "AttorneyIn-Fact") to act on his or her behalf, even if the Prinase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attorney Effective upon Disability A Durable Power of Attorneyhould only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating a document with another party. [_] The purchserve as the Agent. This section can be removed, deleted (and initialed) or the words "no one" can be entered. [_] These forms are not intended and are not a substitute for legal advice. These forms susiness and legal matters on the Principal's behalf. [_] This document offers the option of nominating an alternate Agent in the event that the first choice as Agent is unable to serve or continue to he Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle bginal document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks t real estate in Florida. The witnesses should be adults. Generally, anyone related by blood or marriage to the Principal, Agent or Notary should not be a witness. [_] The Principal should keep the oriecord, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. Two witnesses are necessary if the Agent will be dealing with anyincipal. [_] The Principal (i.e. the person granting the Power of Attorney) should sign the document before a Notary. Notarization will allow the Durable Power of Attorney to be recorded as a public rtion for Durable Power of Attorney Effective upon Disability; (3) Durable Power of Attorney Effective upon Disability [_] This Durable Power of Attorney becomes effective upon the Disability of the PrInstructions & Checklist Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2) Informa MarylandMaryland king acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- ___________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person ta________ State of __________________________ ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by _________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ________________________________________________ Signature of Principal Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: _________evoke this Power of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), __________________________ (state). ___________e in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may rerson relying in good faith on the authority of this document, without notice of such termination, shall be held harmless. -4- Agent shall not be liable for losses resulting from judgment errors madto indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. If this General Power of Attorney is terminated by operation of law, any py who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree any rights or ownership with respect to any life insurance policies I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third parto my Agent based on this document. The powers granted to my Agent by this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have and effect and not be affected by any partial invalidity. No person needs to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid tn in any manner. If any part of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full forcey shall be construed broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herei myself or any authorized personal representative or fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attornered as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested byd evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly. My Agent shall be entitled to reimbursement of all reasonable expenses incur document shall remain in full force and effect thereafter until my death or until my disability or incapacity. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive an This General Power of Attorney and the rights, powers, and authority of my Agent shall become effective immediately upon execution of this instrument. The rights, powers, and -3- authority of this, as may be appropriate. However, Agent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate.ime of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the tmy Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support whichor rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, lative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests o gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumu be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited tor organizations without regard to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors mayo tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons d to, federal, state, local or other income and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating tessionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limiteor may own or have an interest in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment profg proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. -2- 12. To maintain and/or operate any business that I currently own or have an interest in by me alone or in conjunction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, includinl or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased afts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, seln with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, dr of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institutioentative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificatesor its agencies in connection with governmental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Represe benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurancurchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and nts and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, pto execute any necessary document, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenat prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and y hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and ait, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due -1- in the future, owned by, due, owing payable, or belonging to, me or in which I have or mald, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposnecessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hoents, security agreements and other debts and obligations and such other instruments in writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps , or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgmes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit ofent, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, noton my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreemney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attortsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever _______________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whadress at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: ______________________________________ the fiduciary and other legal responsibilities of an agent. -3- GENERAL POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an adnyone to make medical and other health-care decisions for you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumesagent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize ading another person ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your structions. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are provirmore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific inalforms.com as well), stays in effect even if the Grantor later becomes disabled or incapacitated. Please note that this information is not intended as and is not a substitute for legal advice. Furthestates don't require that a General Power of Attorney be witnessed, it is always a very good idea to do so. Another type of Power of Attorney, called a Durable Power of Attorneys (available at findlege it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the General Power of Attorney to be recorded as a public record, if necessary. Although, some orney at any time. A General Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization will makld be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a General Power of Att does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and shoueath of the Grantor or until the Grantor becomes disabled or incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principalpal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf. This particular Form becomes effective immediately and remains effective until the dto the Disclaimers and Terms of Use found at findlegalforms.com -1- Information General Power of Attorney A General Power of Attorney allows a natural "mentally" competent person (called the "Princind should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject power to handle business and legal matters on the Principal's behalf. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you a as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has thehould keep the original document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact)g 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. [_] The Principal sa public record, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. Two witnesses are necessary if the Agent will be dealinncipal (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 recorded as er 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. [_] The PriInstructions & Checklist General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) General Pow MarylandMaryland __________________ witnesses, this _______ day of __________________, 20____. __________________________________________ Notary public Self-proved Will Affidavit [SEAL] ______________________ a notary public, and by _________________________________________, the testatrix, and by ___________________________________ , __________________________ , and ______________________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before me __________ ______________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ________se competent to be a witness. _____________________________________________ (Testatrix) _____________________________________________ (Witness) Print Name: ___________________________________ Address: of the witness's knowledge the testatrix 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 otherwit as the testatrix's free and voluntary act for the purposes expressed in it, that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness, and that to the bestt the testatrix signed and executed the instrument as the testatrix's will, that the testatrix signed willingly (or willingly directed another to sign for the testatrix), that the testatrix executed ittached 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 tha________, and _______________________________, and ________________________________ and ________________________________, the testatrix and the witnesses, respectively, whose names are signed to the a_______ Witness __________ __________ Witness Witness Page 9 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testatrix/Wife _____________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _____________________ress: City: State: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _ address set forth after his or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Addory; 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 resides at thend 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 and mem___________ (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 request, aof ____________________ 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 _______________________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 8 of ______ We, the undersigned, hereby certify and declare under penalty of perjury under the laws of the State __ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) Initials: _____traint or undue influence and ask the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _______________________________________s _____ 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 under no consthe terms of his Will shall then take precedence over the terms of this Will or it's Codicils, except where otherwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, thior 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 my Husband survived me. In that case, dity, illegality or unenforceability should affect only that provision and all other provision should remain effective. 7. Survival If my Husband and I die under circumstances whereby it is difficult 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 unenforceable, any invalihip 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 the separate property 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 property, partnersequest 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 such beneficiaries ifng out of that fiduciary's good faith actions or nonactions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any baudulent 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 connection with or arisied 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 the absence of fr________ __________ Witness Witness Page 7 of ______ 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemescendants, 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: __________ Testatrix/Wife __________ Witness __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 such adopted person's d 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 plural, and vice versa. 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 not to be considered asect to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE X MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of myor 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 and shall not be subj 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 their duties hereunder owers, authority and discretion granted herein in what Executor or Trustee deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have theed to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor or Trustee shall exercise the pministering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor or Trustee shall be fully protected in exercising any discretion grantee may deem advisable and to refer to arbitration all such claims if the Executor or Trustee deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with adpay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and conditions as the Executor or Trustby the Executor or Trustee in good faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or herwise, by reason of 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 __________ __________ Witness Witness Page 6 of ______ conclusive and binding upon all the beneficiaries hereof. The Executor or Trustee shall not be liable to any person, whether beneficiary or ot any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall be Initials: __________ Testatrix/Wife __________ Witness ections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States of America, by the legislature or government of any state, or byrustee shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or refrain from making, in Executor's or Trustee's absolute discretion, any eliaries of my estate to use any tangible personal property or real property, without paying any rent, without giving any bond or security and without liability for any loss or damage. The Executor or Ty Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest not actually producing income shall be treated as producing income. 7. Permit any benefich at Executor's or Trustee's absolute discretion without responsibility for loss to the intent that investments or assets so retained shall be deemed to be authorized investments for all purposes of mfair market value and cause any share to be composed of money, property or undivided fractional share in property. 6. Retain any of my investments or assets in the form existing at the date of my deator any part or parts thereof for such length of time as they 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 s, in such manner and upon such terms, and either for cash 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 utor or Trustee may be beneficially interested in the property 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 timement and the decision of the Executor or Trustee shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Execressly will and declare that the Executor or Trustee 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 pay or set aside or pay any share 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 expn the security of any mortgage 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 estateor Trustee shall also have the 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 upotee shall deem advisable. 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 5 of ______ 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 or Trusration of my estate for such period as the Executor or Trustee shall determine; collect any income Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 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 probate administble, without order of court and without notice to anyone. I also give to the Executor or Trustee power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may bell 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 as may be deemed advisastration of my estate and the Trust, the Executor and the Trustee shall have the right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of aWill and of any Trustee with regards to the administration of any Trust created by this Will, and in addition to other powers and authority granted by law or necessary or appropriate for proper adminiurt. No bond, security or surety shall be required of any Executor serving hereunder. ARTICLE IX POWERS OF EXECUTOR & TRUSTEE In addition to the existing authority of the Executor with regards to the he court having jurisdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate coto time whether original 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 tHusband. References to "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 cannot, does not or is unable 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 stead of my of such child pursuant to the provisions of applicable law. ARTICLE VIII NOMINATION OF EXECUTOR I appoint my Husband ___________________________________, as the Executor of this my Will. If my Husbandtioned Guardian. It is my wish that before the expiration of ___ days from the date of my death the appointed Guardian apply to have custody of such child(ren) and act as the guardian of the property r is unable to serve or continue to serve as Guardian for any reason, I appoint ___________________________________, as the Guardian of my minor child(ren) in the place and stead of the first aforemen__________, as the Guardian of my minor child(ren). If such Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 4 of ______ person cannot, does not oVII GUARDIAN If my Husband predeceases me or if it becomes otherwise necessary to appoint a Guardian for any of my minor child(ren) under the age of eighteen years, I appoint _________________________the beneficiaries under the Trust once a year. If a beneficiary is a minor or has a disability, the Trustee may provide such accounting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE under this Will in the place and stead of the first aforementioned Executor. No bond, security or surety shall be required of any Trustee serving hereunder. The Trustee shall provide an accounting to tee under this Will. If such person or entity cannot, does not or is unable to serve or continue to serve as Trustee for any reason, I appoint ___________________________________, , to be the Trustee tee's own opinion and judgment, feels that the `proceeds' may be subject to any type of seizure or other legal proceeding. ARTICLE VI TRUSTEE I appoint ___________________________________, as the Trusath and the beneficiary has not accepted any of the benefits so renounced. The Trustee may withhold the distribution of any income or principal to any beneficiaries under the Trust if Trustee, in Trusn the trust renounced by a beneficiary, the trust shall be construed as though such beneficiary predeceased me if the beneficiary's renunciation occurred within nine months following the date of my deon the right of any beneficiary to renounce, in whole or in part, any provisions of the trust for the benefit of such beneficiary, or upon any power of appointment herein granted. As to any interest iiary in the Trust shall not be subject to any assignment, anticipation, creditor's claim, seizure, attachment or other manner of legal process. this provision shall not be deemed to be a limitation uputor would have been required to distribute it had I died intestate, unmarried, and a resident of the state of ___________________ at such time and owning such property. 5. The interest of any beneficted under this Will or when the trust is ended, none of the intended beneficiaries of the trust is living, the Trustee shall distribute the property to whomever and in the same proportions as, my Execg shall be divided among any of my other children, who shall be living at the time of the death of such child, in equal shares per stirpes. 4. If at any time prior to the termination of the Trust creae before receiving the whole of his or her share under the Trust created by this Will, and if such child leaves no descendants surviving him or her, then such share or the amount thereof then remainin per stirpes. The Trustee shall administer such shares for any descendants under the age of _____________ years as directed by this Will for any of my minor children. If any of my child(ren) should di receiving the whole of his or her share under the Trust created by this Will, then such share or the amount thereof then remaining shall be divided among the descendants of such child in equal sharesemaining income and principal of the Trust. If any of my child(ren) should die before Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 3 of ______ s or her share of the Trust, including any share of undistributed income. When my youngest child reaches the age of _______ years, this Trust will terminate and the Trustee shall give that child any rild(ren) such portion shall be added to the principal. 3. As each minor child reaches the age of _______ years, the Trust will terminate as to that child alone and the Trustee shall give that child hie of the final distribution at the termination of the trust. If during any year that the Trust is in effect any portion of the income from the trust is not paid to or applied for the benefit of the chhildren, but should be based on the individual need(s) of my child(ren) and on the availability of assets in the trust. Any such payments shall not be deducted from or charged to the child(ren)'s sharge and professional education) until such time as each child is no longer a minor as defined herein. If deemed necessary by the Trustee, such amounts paid to my child(ren) need not be equal among my cpay any minor child(ren) or their descendants such sums from the income or principal of the Trust as the Trustee deems appropriate for their maintenance, support, health and education (including colleed as part of the Trust assets. In Trustee's discretion, the Trust assets may be converted into cash or other instruments in order to make the administration of the Trust easier. 2. The Trustee shall child(ren). The share of the proceeds of any life insurance policy on my life, any pension plan, contract or other policy passing to any minor children shall be held in trust by the Trustee and treatined, held, managed, invested, administered and distributed by the Trustee, under the provisions of this Will, in order to provide for the care, health, support, maintenance and education of any minorhe Trustee named in this Will, to invest and to hold in trust, as a private trust, (herein referred to as "Trust" or "Trust assets") for the benefit of my child(ren). 1. The Trust assets shall be retand referred to as "minor child(ren)" for purposes of this Will and the Trust created thereby. I direct the Executor to transfer all assets that have passed under this Will to any minor child(ren) to te Executor. ARTICLE V TRUST FOR MINOR CHILDREN If my Husband predeceases me and, at the time of my death, any of my child(ren) are under the age of ____________ years, those children shall be deemed aiciary 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 sufficient discharge to tho 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, person with whom the benefherein 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, I authorize the Executor t__ the laws of the State of ____________________, then in effect, as if I had died intestate at the time fixed for distribution under this provision. Except as may be specifically otherwise provided ibuted to my heirs-at-law, their identities and respective shares to be determined under Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 2 of ____es)). If more than one beneficiary is named, then the distribution shall be in equal shares per stirpes. If any such above mentioned beneficiary does not survive me, my residuary estate shall be distrof by this Will, shall be distributed to: ______________________________________________________________ _____________________________________________________________________ (name(s) of beneficiary(iequally among any surviving child(ren) or their descendants per stirpes. If none of my children or their descendants survive me, then my residuary estate and any other property not otherwise disposed then living shall be distributed to the then living descendants of the deceased child, per stirpes. If any child predeceases me and leaves no descendants, then that child's share shall be distributed ________________________________________________(name(s)), while trying to maintain regard for each child's preference. Each share created for a deceased child of mine who has one or more descendants erty not otherwise disposed of by this Will, shall be distributed in equal shares per stirpes to my child(ren) ___________________________________________________________________ _____________________including any real property and personal property, be distributed, and given to my Husband. ____________________________. If my Husband does not survive me, then my residuary estate and any other propd to my Husband ___________________________________. If my Husband does not survive me, this bequest shall be distributed with my residuary estate. Residuary Estate I direct that my residuary estate, __. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. Primary Residence My interest in my primary residence or homestead, if any, shall be distributehis beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to _________________________________ficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If tc Bequests I direct that the following specific bequests be made from my estate. _____________________________________________ shall be distributed to ___________________________________. If this bene with any property transferred to or acquired by such purchaser or transferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specifi__________ Witness __________ __________ Witness Witness Page 1 of ______ This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not be seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testatrix/Wife f this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardlessthe amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside olties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in tamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penaving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testo pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engra_______________________ Born on _________________ Name: ____________________________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will er to _____________________________________ (name of husband). I have the following child(ren): Name: ____________________________________________ Born on _________________ Name: _____________________ and declare this to be my Last Will and Testament. ARTICLE I SPOUSE & CHILDREN I am married to __________________________________________________ (name of husband). All references to "my Husband" reftament Of ______________________ I, _________________________________________ (name), of ____________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish_____________________________ witnesses, this _______ day of __________________, 20____. __________________________________________ Notary public Self-proved Will Affidavit [SEAL] Last Will And Tese ________________________________ a notary public, and by _________________________________________, the testator, and by ___________________________________ , __________________________ , and _________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before m___ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ___________________________________e and otherwise competent to be a witness. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ________________________________at to the best of 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 agtator executed it as 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 thenalty of perjury 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 tess are signed to the attached or foregoing instrument in those capacities, personally appearing before the undersigned authority and being first duly sworn, declare to the undersigned authority under p______________________________, and _______________________________, and ________________________________ and ________________________________, the testator and the witnesses, respectively, whose name________ Testator __________ Witness __________ __________ Witness Witness Page 9 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: ____________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _____________________________Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ ___________________________________ ___________________________________ _________ witness, and resides at the address set forth after his or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ker is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue influence; The maker is age 18 or older. Each of us is now age 18 or older, is a competentand at testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. We understand this is the Testator's Will; We believe the maesence 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 presence 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 and prunder this Will.) Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 8 of ______ We, the undersigned, hereby certify and declare under penalty of perjury ____________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets nd, that I make this under no constraint or undue influence and ask the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _____ed my name below to this 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 mid that I survived my Wife. In that case, the terms of this Will shall then take precedence over any Will or Codicils of my Wife, except where otherwise directed by law. IN WITNESS WHEREOF, I have sign under circumstances whereby 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 determineed invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all other provision should remain effective. 7. Survival If my Wife and I dieome therefrom shall remain the 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 declaror fall into any community of property, 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 incres shall be determined by such 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 bad faith. 4. Beneficiary 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 shal claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and al under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date of my death. 3. Liability of Fiduciary. No fiduciary whoals: __________ Testator __________ Witness __________ __________ Witness Witness Page 7 of ______ 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions include an adopted person and such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. Initid the use of the singular the plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shalleference purposes only and 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, anThe provisions in this Will for 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 rng upon all of the beneficiaries and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE X MISCELLANEOUS PROVISIONS than an impartial exercise of 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 bindineficiaries, whether or not such 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 otherscretion. The Executor or Trustee shall exercise the powers, authority and discretion granted herein in what Executor or Trustee deems to be the best interest, whether monetary or otherwise, of the be be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such diable 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 or Trustee shallpon such terms and conditions as the Executor or Trustee may deem advisable and to refer to arbitration all such claims if the Executor or Trustee deem same advisable. 11. Pay all necessary and reasonhe 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 consideration and u, designation or exercise of discretion, entered into by the Executor or Trustee in good faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at tnot 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 from any election, determinationbe Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 6 of ______ conclusive and binding upon all the beneficiaries hereof. The Executor or Trustee shall merica, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall king, in Executor's or Trustee's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States of A without liability for any loss or damage. The Executor or Trustee shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or refrain from ma shall be treated as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property or real property, without paying any rent, without giving any bond or security andbe deemed to be authorized investments for all purposes of my Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest not actually producing incometments or assets in the form existing at the date of my death at Executor's or Trustee's absolute discretion without responsibility for loss to the intent that investments or assets so retained shall ey or in other property or partly in both upon the basis of fair market value and cause any share to be composed of money, property or undivided fractional share in property. 6. Retain any of my inveson decide upon, or to postpone such conversion of my estate or any part or parts thereof for such length of time as they may think best. Make any division or distribution of my residuary estate in monrt of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cash or credit or for part cash and part credit as they may in their absolute discretiarket value and notwithstanding that one or more of the Executor or Trustee may be beneficially interested in the property or any part thereof so valued. 5. Sell, call in and convert into money any pahe purpose of making any such division, setting aside or payment and the decision of the Executor or Trustee shall be final and binding upon all persons concerned, notwithstanding any fluctuation in me time of such division, setting aside or payment, and I expressly will and declare that the Executor or Trustee shall in their absolute discretion fix the value of my estate or any part thereof for ty estate. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly or in part in the assets forming my estate at the time of my death or at thny part thereof, to borrow money on any such real estate upon the security of any mortgage or mortgages and to pay off any mortgage or mortgages which may be in existence at any time forming part of mnts and generally to manage any such property. The Executor or Trustee shall also have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my estate or ar, in the manner and to the extent that the Executor or Trustee shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improveme_______ Witness __________ __________ Witness Witness Page 5 of ______ therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repai. Take charge of any real property as part of the probate administration of my estate for such period as the Executor or Trustee shall determine; collect any income Initials: __________ Testator ___ds, mortgages, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2nd upon such terms, credits and conditions as may be deemed advisable, without order of court and without notice to anyone. I also give to the Executor or Trustee power to execute and deliver such deertition, exchange, mortgage, or otherwise encumber or dispose of all or part of any real or personal property that may be included in my estate in such manner and for such purposes, for such prices, aority granted by law or necessary or appropriate for proper administration of my estate and the Trust, the Executor and the Trustee shall have the right and power to: 1. Lease, sell, grant options, paion to the existing authority of the Executor with regards to the Will and of any Trustee with regards to the administration of any Trust created by this Will, and in addition to other powers and authgned to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any Executor serving hereunder. ARTICLE IX POWERS OF EXECUTOR & TRUSTEE In additadminister my estate without adjudication, order or direction of the court having jurisdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation desiestate or any portion thereof who may be acting as such from time to time whether original or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to ___, to be the Executor of this my Will in the place and stead of my Wife. References to "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my Will, my _________, as the Executor of this my Will. If my Wife cannot, does not or is unable to serve or continue to serve as Executor for any reason, I appoint _______________________________________________ of such child(ren) and act as the guardian of the property of such child pursuant to the provisions of applicable law. ARTICLE VIII NOMINATION OF EXECUTOR I appoint my Wife __________________________inor child(ren) in the place and stead of the first aforementioned Guardian. It is my wish that before the expiration of ___ days from the date of my death the appointed Guardian apply to have custodyWitness Witness Page 4 of ______ person cannot, does not or is unable to serve or continue to serve as Guardian for any reason, I appoint ___________________________________, as the Guardian of my mder the age of eighteen years, I appoint ___________________________________, as the Guardian of my minor child(ren). If such Initials: __________ Testator __________ Witness __________ __________ ting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE VII GUARDIAN If my Wife predeceases me or if it becomes otherwise necessary to appoint a Guardian for any of my minor child(ren) unrustee serving hereunder. The Trustee shall provide an accounting to the beneficiaries under the Trust once a year. If a beneficiary is a minor or has a disability, the Trustee may provide such accoun, I appoint ___________________________________, , to be the Trustee under this Will in the place and stead of the first aforementioned Executor. No bond, security or surety shall be required of any TVI TRUSTEE I appoint ___________________________________, as the Trustee under this Will. If such person or entity cannot, does not or is unable to serve or continue to serve as Trustee for any reasonor principal to any beneficiaries under the Trust if Trustee, in Trustee's own opinion and judgment, feels that the `proceeds' may be subject to any type of seizure or other legal proceeding. ARTICLE renunciation occurred within nine months following the date of my death and the beneficiary has not accepted any of the benefits so renounced. The Trustee may withhold the distribution of any income or upon any power of appointment herein granted. As to any interest in the trust renounced by a beneficiary, the trust shall be construed as though such beneficiary predeceased me if the beneficiary'sgal process. this provision shall not be deemed to be a limitation upon the right of any beneficiary to renounce, in whole or in part, any provisions of the trust for the benefit of such beneficiary, at such time and owning such property. 5. The interest of any beneficiary in the Trust shall not be subject to any assignment, anticipation, creditor's claim, seizure, attachment or other manner of lebute the property to whomever and in the same proportions as, my Executor would have been required to distribute it had I died intestate, unmarried, and a resident of the state of ___________________ stirpes. 4. If at any time prior to the termination of the Trust created under this Will or when the trust is ended, none of the intended beneficiaries of the trust is living, the Trustee shall distriiving him or her, then such share or the amount thereof then remaining shall be divided among any of my other children, who shall be living at the time of the death of such child, in equal shares per Will for any of my minor children. If any of my child(ren) should die before receiving the whole of his or her share under the Trust created by this Will, and if such child leaves no descendants surv shall be divided among the descendants of such child in equal shares per stirpes. The Trustee shall administer such shares for any descendants under the age of _____________ years as directed by this___ Witness __________ __________ Witness Witness Page 3 of ______ receiving the whole of his or her share under the Trust created by this Will, then such share or the amount thereof then remainingears, this Trust will terminate and the Trustee shall give that child any remaining income and principal of the Trust. If any of my child(ren) should die before Initials: __________ Testator _______l terminate as to that child alone and the Trustee shall give that child his or her share of the Trust, including any share of undistributed income. When my youngest child reaches the age of _______ ye income from the trust is not paid to or applied for the benefit of the child(ren) such portion shall be added to the principal. 3. As each minor child reaches the age of _______ years, the Trust wiluch payments shall not be deducted from or charged to the child(ren)'s share of the final distribution at the termination of the trust. If during any year that the Trust is in effect any portion of thhe Trustee, such amounts paid to my child(ren) need not be equal among my children, but should be based on the individual need(s) of my child(ren) and on the availability of assets in the trust. Any sriate for their maintenance, support, health and education (including college and professional education) until such time as each child is no longer a minor as defined herein. If deemed necessary by torder to make the administration of the Trust easier. 2. The Trustee shall pay any minor child(ren) or their descendants such sums from the income or principal of the Trust as the Trustee deems appropssing to any minor children shall be held in trust by the Trustee and treated as part of the Trust assets. In Trustee's discretion, the Trust assets may be converted into cash or other instruments in ovide for the care, health, support, maintenance and education of any minor child(ren). The share of the proceeds of any life insurance policy on my life, any pension plan, contract or other policy passets") for the benefit of my child(ren). 1. The Trust assets shall be retained, held, managed, invested, administered and distributed by the Trustee, under the provisions of this Will, in order to prer all assets that have passed under this Will to any minor child(ren) to the Trustee named in this Will, to invest and to hold in trust, as a private trust, (herein referred to as "Trust" or "Trust a) are under the age of ____________ years, those children shall be deemed and referred to as "minor child(ren)" for purposes of this Will and the Trust created thereby. I direct the Executor to transfhereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE V TRUST FOR MINOR CHILDREN If my Wife predeceases me and, at the time of my death, any of my child(ren, 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 recipient tge 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, conservatorbution 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 the ator __________ Witness __________ __________ Witness Witness Page 2 of ______ the laws of the State of ____________________, then in effect, as if I had died intestate at the time fixed for distri above mentioned beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective shares to be determined under Initials: __________ Testa__________________________________________________________ (name(s) of beneficiary(ies)). If more than one beneficiary is named, then the distribution shall be in equal shares per stirpes. If any such survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed to: ______________________________________________________________ ___________deceases me and leaves no descendants, then that child's share shall be distributed equally among any surviving child(ren) or their descendants per stirpes. If none of my children or their descendantsce. Each share created for a deceased child of mine who has one or more descendants then living shall be distributed to the then living descendants of the deceased child, per stirpes. If any child pre______________________________________________________________ _____________________________________________________________________(name(s)), while trying to maintain regard for each child's preferenf my Wife does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed in equal shares per stirpes to my child(ren) _______________with my residuary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed and given to my Wife. _______________________________. Iidence My interest in my primary residence or homestead, if any, shall be distributed to my Wife ___________________________________. If my Wife does not survive me, this bequest shall be distributed __________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. Primary Res__________________ 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. ___________________________ agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. ___________________________________nclude any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchaser or transferee upon or after my death pursuant to anyt from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 1 of ______ This direction shall not extend to or ither during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not seek reimbursemenether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me eieate, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whal estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall crrder of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my generthe disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including _______________________________________ Born on _________________ Name: ____________________________________________ Born on _________________ Name: ____________________________________________ Born o___________________________________________ (name of wife). All references to "my Wife" refer to __________________________________________ (name of wife). I have the following child(ren): Name: ___________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I SPOUSE & CHILDREN I am married to _______nces arising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, _________________________________________ (name), of ______________out consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequeded and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed withility. This is referred to as the "Marital Deduction". If the recipient spouse is not a U.S. citizen, the deduction is limited (it was $100,000 in 1999). This information and these forms are not inten policy; [] property you are holding in trust; any joint property you own In addition, each individual may leave an unlimited amount to his or her spouse upon death without any federal estate tax liabrniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified employee benefit plans; [] the face value of any life insurancemine the value of all of the assets in your estate. Assets may include the following: [] real estate; [] stocks and bonds; [] bank accounts; [] tangible personal property (household furnishings and fus ­ Page 2 your assets come near the $1,000,000 level, you really shouldn't use this will and should consult with tax professionals and an attorney. Before using this Will, it may be helpful to deterd be subject to federal estate tax. As your estate approaches $1,000,000 in value and exceeds that amount, the greater your need for professional estate tax planning advice. If Information about Will 2003, that credit is $1,000,000. The amount of the credit increases over the next few years. The credit is available to each individual and his or her spouse. Estates totaling $1,000,000 or more coulx laws. Federal tax law provides that upon the death of an individual, there is a credit against the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying inis to be used as the principal estate planning document. If you have a large estate, you may need more complicated planning to reduce or limit death taxes. Testators should have an understanding of tastify. New Hampshire permits self proving, but requires the affidavit to be in a specific format similar to the one included in our wills. The Will is for anyone in any life situation where this Will l. In Ohio, Maryland, California and the District of Columbia, the courts have some latitude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to te However, including the affidavit in those states will not invalidate the Will (since it is a separate document from the Will). In those states it will have to be "proven" in court, like any other wilcapacity, or prior revocation. A few states like Louisiana, Maryland, Ohio and Vermont (as of 1999).do not have statutes permitting self proving wills. The affidavit will be of no use in those states.lso be useful if witnesses are not available when they are needed.. However, even with the Affidavit, the Will may still be subject to contest on such grounds as undue influence, lack of testamentary l and that the formalities for signing a Will were followed. The Affidavit may eliminate the need to have witnesses testify, that the formalities in signing the Will were followed. The Affidavit can a adoption of more modern laws, all wills were proved by having one or more of the witnesses come into court and testify under oath, or through sworn affidavits, that each saw the Testator sign the wil when the Will was signed. The Affidavit does not affect the validity or legality of the Will. However, it can speed up the admission of the Will to probate after the death of the Testator. Before theill. The Will has an enclosed self-proving affidavit, which contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary, that all required formalities were observedship, assets with beneficiary designations (such as life insurance or employee benefit plans), and assets held in trust generally will not be required to be probated and will not be governed by this Wis Will does not avoid probate for the Testator's estate. It merely directs how the assets which are individually owned by the Testator will be distributed. Assets held jointly with rights of survivoro the Disclaimers and Terms of Use found at findlegalforms.com Information about Wills This Will distributes the assets of the person making the Will (the "Testator") as specified by the Testator. Th when dealing 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 tnly be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommendeds to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should oto make sure it meets 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 aom place to place. All wills should be reviewed by a lawyer before they are signed. If the Testator/Testatrix moves to another state, the current will should be checked by a lawyer in their new state es, make sure that the total of all of the beneficiary's percentages equal 100%. Check the totals before signing the Will. State and federal laws which affect estate planning can vary over time and fr if a spouse receives nothing or only a small portion of the estate. Consult an attorney if you wish to disinherit a spouse or any children. If any part of the Will calls for distribution in percentagthe Testator has a child or if a named beneficiary or one of the Executors dies.. Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Will may be invalidd, the original and all copies should be destroyed and an entirely new Will should be signed. New wills are commonly necessary when, for example, the Testator's/Testatrix's marital status changes, if ge 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 Checklist & Instructions ­ Page 5 desire 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 advisor. If it becomes necessary to chan 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 designed to reduce taxes. Estate taxes, if any,n of law or by any contract. For example, the Will does not dispose of property held in joint tenancy with rights of survivorship or property held in trust. In addition, the distribution of retirementbe provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Testator, would automatically pass to another person by operatioy 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/Testatrix so wish) ch 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 photocopies maake 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 location su be trusted to handle financial matters and to deal appropriately with family members. It is best to talk to people (and banks or trust companies) before naming them as a Personal Representative, to mhould 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) that cants 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 affidavit) sch it to the end of the Will. The Affidavit contains the Testator's/Testatrix's acknowledgment and the affidavit of the witnesses, made before a Notary or other person authorized to take acknowledgmen not be counted because the affidavit is not a part of the Will itself. The Testator/Testatrix and the witnesses should sign the self-proving affidavit (called "Proof of Will" in some states) and atta). The Witnesses should indicate the total number of pages in the Will, including the page(s) on which the witness signature lines appear. The page with the self-proving affidavit, if included, shouldould 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 revokes an earlier Willher and of the notary public. The witnesses must be satisfied that the Testator/Testatrix is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever requested, the date shes. The witnesses should also initial the bottom of each page of the Will. Checklist & Instructions ­ Page 4 All witnesses must sign their names in the presence of the Testator/Testatrix and each oty", or similar words. Although not required in most states, it is a good idea for the Testator/Testatrix to initial the bottom of each page of the Will. This can prevent subsequent substitution of pager, the witnesses don't need to read or know the contents of the Will. For example, the v can say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and voluntarilelf proved affidavit. Before signing the Will, the Testator/Testatrix should orally declare that the document that is about to be signed is intended to be the Testator's Last Will and Testament. Howeve Will. For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testator/Testatrix sign the Will. The notary public is needed for the sde additional protection if the signature of one of the witnesses is deemed to be invalid for any reason or if one of the witnesses can't be located. The witnesses should not be beneficiaries under thx in the 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 provie 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/Testatriigning 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 and tha will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. The Testator/Testatrix (i.e. the person who is writing the Will) must be of "sound mind" when sdocument 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 latitude to accept s. 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 is a separate trix, 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 self proving willffidavit (although technically not part of the Will) states that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signed , by the Testator/Testaonth year city; [] signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; [] witness signatures and info Affidavit: The enclosed Ang a provision dealing with situations of simultaneous death of both husband and wife. · · · · · · Checklist & Instructions ­ Page 3 · · · Signature Block: Testator needs to fill out: [] day ms of Executor and Trustee empowers them to deal with matters like taxes, taking care of the property, and making distributions to the beneficiaries Article X: Contains miscellaneous provisions includitative will pay whatever is left to the beneficiaries named in the will. Testator/Testatrix must provide and fill out [] the name of executor (spouse); [] name of alternate executor. Article IX: Powerty. The Personal Representative is also responsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Represene an Executor to administer the estate, and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's properpointed as guardian of child(ren). Article VIII: Deals with the appointment of the Testator's/Testatrix's Personal Representative (i.e. Executor) and alternate; It allows the Testator/Testatrix to names the Testator/Testatrix. Testator/Testatrix must provide and fill out [] the name of Guardian; [] name of alternate Guardian; [] number of days within which Guardian has to apply to be officially approvide and fill out [] the name of Trustee; [] name of alternate Trustee. Article VII: Deals with appointment of the Guardian and an alternate for the minor children in the event the spouse predeceass the Testator/Testatrix to name a person and an alternate to act as the Trustee that will administer the assets passing under the Will for any child(ren) under a certain age. Testator/Testatrix must needs to be entered four (4) times in this section); [] state under whose laws the will is made. Article VI: Deals with appointment of Trustee and Trustee's specific duties/responsibilities. It allowy minor children if spouse predeceases Testator/Testatrix. Testator/Testatrix must provide and fill out: [] age when children should not be considered minors any longer for purposes of the Trust (thises in the event that all children predecease the Testator and there are no descendants of the children; [] state under whose laws the will is made. Article V: Deals with the creation of a trust for ans given; [] name of Spouse to whom the Residuary Estate is given to; [] name of child(ren) to whom residuary estate is given in event spouse does not survive Testator; [] name of alternate beneficiari); [] name(s) of person/entity property is given to (three blank paragraphs are provided, but you can add as many as you need). [] name of Spouse to whom Testator's interest in any primary residence iAllows Testator/Testatrix to give specific dollar amounts or other property to specific persons or charities. Testator/Testatrix must provide and fill out: [] description of property (or dollar amountrial expenses. Article III: Authorizes payments of debts and expenses. · · Checklist & Instructions ­ Page 2 · Article IV: Disposes of specific property, primary residence and residuary property. e of child(ren) and date of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and buprovide and fill out: [] name, [] county and [] state Article I: Gives the name of the spouse and any child(ren). Testator/Testatrix must provide and fill out [] name of spouse (in two places); [] namompleted. · · · Title: Enter name of Testator/Testatrix in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator/Testatrix must into various sections. The content of each section is explained below. Some sections require information to be provided and filled out in the space provided. The enclosed Affidavit also needs to be csband. The second Will and Affidavit is to be used by the Wife. The instructions for both wills are the same. It is suggested that both Wills be executes/signed at the same time. The Wills are dividedx to make specific gifts to others as well. This Will is suitable for estates worth less than $1,000,000. There are two Wills in this form package. The first Will and Affidavit is to be used by the Hus pre-deceased the Testator, the Will allows the appointment of a Guardian for any minor child(ren) and a Trustee to administer the minor children's assets. This Will also allows the Testator/Testatriath of both husband and wife. If the Spouse does not survive the Testator/Testatrix the assets will go to the children. If the children are minors at the time of the Testator's death and the spouse ha The Wills distribute the assets of the Husband to the Wife and the assets of the Wife to the Husband in the event of their death. They also have a provision dealing with situations of simultaneous deis form package contains two "Mutual Wills" and is for use by a married couple (husband and wife i.e. Testator and Testatrix) with one or more minor children. It also includes a self-proved affidavit.out Wills; (3) Husband's Mutual Will for ­ Married Couple with Minor Children with self-proved affidavit; (4) Wife's Mutual Will for ­ Married Couple with Minor Children with self-proved affidavit. ThChecklist and Instructions Mutual Will - Married Couple with Minor Children This package contains (1) Checklist and Instruction for Mutual Will ­ Married Couple with Minor Children; (2) Information ab MarylandMaryland : ___________________________________ Address: ______________________________________ Phone: _______________________________________ Date: ________________ -6- ___ Address: ______________________________________ Phone: _______________________________________ Date: ________________ _____________________________________________ (Witness Signature) Print Namein my presence and based upon personal observation appears to be a competent individual. _____________________________________________ (Witness Signature) Print Name: ________________________________larant) (At least one of your witnesses may not be a person who may financially benefit by reason of Declarant's death). The declarant signed or acknowledged signing the foregoing advance directive y competent to make this advance directive and that I understand the purpose and effect of this document. ______________________ (Date) ____________________________________________ (Signature of Dec_____________________________________________________ _____________________________________________________________________________ -5- By signing below, I indicate that I am emotionally and mentalllowing space, indicate any other instructions regarding receipt or nonreceipt of any health care) _____________________________________________________________________________ ________________________d that my estate will not be charged for any costs associated with my decision to donate my organs, tissues, or eyes or the actual disposition of my organs, tissues, or eyes. (8) I direct (in the folth, I direct that all support measures be continued to maintain the viability for transplantation of my organs, tissues, and eyes until organ, tissue, and eye recovery has been completed. I understan_____ For medical education _____ For any purpose authorized by law. I understand that before any vital organ, tissue, or eye may be removed for transplantation, I must be pronounced dead. After dear eyes: _______________ ________________________________________________________ I authorize the use of my organs, tissues, or eyes: _____ For transplantation _____ For therapy _____ For research ____________________________________________________________________ -4- (7) Upon my death, I wish to donate: _____ Any needed organs, tissues, or eyes. _____ Only the following organs, tissues, oures shall be modified as follows: _____________________________________________________________________________ _____________________________________________________________________________ _________ect that no matter what my condition, I be given all available medical treatment in accordance with accepted health care standards. (6) If I am pregnant, my decision concerning life-sustaining procedive nutrition and hydration artificially. (4) I direct that no matter what my condition, medication not be given to me to relieve pain and suffering, if it would shorten my remaining life. (5) I dirdministration of nutrition and hydration artificially. __________ I direct that my life not be extended by life-sustaining procedures, except that if I am unable to take food by mouth, I wish to recee degree of medical certainty, treatment of the irreversible condition would be medically ineffective - __________ I direct that my life not be extended by life-sustaining procedures, including the a caused by injury, disease, or illness, as a result of which I have suffered severe and permanent deterioration indicated by incompetency and complete physical dependency and for which, to a reasonablnded by life-sustaining procedures, except that if I am unable to take food by mouth, I wish to receive nutrition and hydration artificially. (3) If I have an end-stage condition, that is a conditiony - __________ I direct that my life not be extended by life-sustaining procedures, including the administration of nutrition and hydration artificially. __________ I direct that my life not be exte- (2) If I am in a persistent vegetative state, that is, if I am not conscious and am not aware of my environment or able to interact with others, and there is no reasonable expectation of my recoverficially. __________ I direct that my life not be extended by life-sustaining procedures, except that if I am unable to take food by mouth, I wish to receive nutrition and hydration artificially. -3e used there is no reasonable expectation of my recovery - __________ I direct that my life not be extended by life-sustaining procedures, including the administration of nutrition and hydration artit my health care providers to follow my instructions as set forth below. (Initial all those that apply.) (1) If my death from a terminal condition is imminent and even if life-sustaining procedures artial those statements you want to be included in the document and cross through those statements that do not apply.) If I am incapable of making an informed decision regarding my health care, I direcrt B Advance Medical Directive Health Care Instructions (Optional Form) (Cross through if you do not want to complete this portion of the form. If you do want to complete this portion of the form, ini_________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ Phone: _______________________________________ Date: ________________ Pant Name: ___________________________________ Address: ______________________________________ Phone: _______________________________________ Date: ________________ ____________________________________his appointment of a health care agent in my presence and based upon my personal observation appears to be a competent individual. _____________________________________________ (Witness Signature) Priand that I understand its purpose and effect. ______________________ (Date) ____________________________________________ (Signature of Declarant) -2- The declarant signed or acknowledged signing thall not be liable for the costs of care based solely on this authorization. By signing below, I indicate that I am emotionally and mentally competent to make this appointment of a health care agent nsidering the benefits, burdens, and risks that might result from a given treatment or course of treatment, or from the withholding or withdrawal of a treatment or course of treatment. (6) My agent s wishes as otherwise known to my agent. If my wishes are unknown or unclear, my agent is to make health care decisions for me in accordance with my best interest, to be determined by my agent after coon regarding my health care; or ___________ When this document is signed. (5) My agent is to make health care decisions for me based on the health care instructions I give in this document and on my(4) My agent's authority becomes operative (initial the option that applies): ___________ When my attending physician and a second physician determine that I am incapable of making an informed decisi__________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ng, in appropriate circumstances, life-sustaining procedures. (3) The authority of my agent is subject to the following provisions and limitations (or write none): ___________________________________transfer to another facility) any hospital, hospice, nursing home, adult home, or other medical care facility; and -1- d. Consent to the provision, withholding, or withdrawal of health care, includiot limited to, medical and hospital records, and consent to disclosure of this information; b. Employ and discharge my health care providers; c. Authorize my admission to or discharge from (including r and authority to make health care decisions for me, including the power to: a. Request, receive, and review any information, oral or written, regarding my physical or mental health, including, but n____________________________________________________ _____________________________________________________________________________ (Full Name, Address, and Telephone Number) (2) My agent has full powedress, and Telephone Number) Optional: If this agent is unavailable or is unable or unwilling to act as my agent, then I appoint the following person to act in this capacity _________________________health care decisions for me: _____________________________________________________________________________ _____________________________________________________________________________ (Full Name, Ad_______________________________________________________, residing at _____________________________________________________________________________ appoint the following individual as my agent to make an agent, cross through any items in the form that you do not want to apply. If you decide to select a health care agent that person may not be a witness to your advance directive.) (1) I, _________ Advance Directive Part A Appointment of Health Care Agent (optional) (Cross through if you do not want to appoint a health care agent to make health care decisions for you. If you do want to appointences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com. -6-hout consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequnded and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed wited "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not inteord. (c) It shall be the responsibility of the declarant, to the extent reasonably possible, to notify any person to whom the declarant has provided a copy of the directive. [_] These forms are provide directive by an oral statement to a health care practitioner, the practitioner and a witness to the oral revocation shall document the substance of the oral revocation in the declarant's medical recigned and dated writing, by physical cancellation or destruction, by an oral statement to a health care practitioner or by the execution of a subsequent directive. (b) If a declarant revokes an advancservices provided to the declarant. A statement of medications preferred by the declarant for psychiatric treatment; § 5-604. (a) An advance directive may be revoked at any time by a declarant by a st the declarant would prefer to provide mental health services; (3) and (4) Instruction regarding the notification of third parties and the release of information to third parties about mental health services may include: (1) declarant; The designation of an agent to make mental health services decisions for the (2) The identification of mental health professionals, programs, and facilities tha under § 5-604 of this subtitle for the revocation of an advance directive shall apply to the revocation of an advance directive for mental health services. (d) An advance directive for mental health ) An individual making an advance directive for mental health services shall follow the procedures for making an advance directive provided under § 5-602 of this subtitle. (2) The procedur es providedhealth services which may be provided to the individual if the individual becomes incompetent and has a need for mental health services either during, or as a result of, the incompetency. -5- (c) (1 5-602.1. (a) In this section, "mental health services" has the meaning stated in § 4-301(i)(1) of this article. (b) An individual who is competent may make an advance directive to outline the mental nce with the provisions of § 5-605(c) of this subtitle. (i) The absence of an advance directive creates no presumption as to the patient's intent to consent to or refuse life-sustaining procedures. §e agent that the agent has been named in an advance directive to act on the declarant's behalf. (h) Unless otherwise provided in the patient's advance directive, a patient's agent shall act in accordag the date the advance directive was made and the name of the attending physician, a part of the declarant's medical records. (g) It shall be the responsibility of the declarant to notify a health carake the advance directive or a copy of the advance directive a part of the declarant's medical records; or (ii) If the advance directive is oral, make the substance of the advance directive, includ in the physician of the existence of an advance directive. (2) An attending physician who is notified of the existence of the advance directive shall promptly: (i) If the advance directive is written, mo notify the attending physician that an advance directive has been made. In the event the declarant becomes comatose, incompetent, or otherwise incapable of communication, any other person may notifyscious, or unable to communicate by any means, the certification of a second physician is not required under paragraph (1) of this subsection. (f) (1) It shall be the responsibility of the declarant tective shall become effective when the declarant's attending physician and a second physician certify in writing that the patient is incapable of making an informed decision. (2) If a patient is unconed as part of the individual's medical record. The documentation shall be dated and signed by the attending physician and the witness. (e) (1) Unless otherwise provided in the document, an advance dirce directive shall have the same effect as a written advance directive if made in the presence of the attending physician and one witness and if the substance of the oral advance directive is documentance directive to authorize the providing, withholding, or withdrawing of any life-sustaining procedure or to appoint an agent to make health care decisions for the individual. -4- (2) An oral advangly entitled to any portion of the estate of the declarant or knowingly entitled to any financial benefit by reason of the death of the declarant. (d) (1) Any competent individual may make an oral advn caring for the declarant if acting in good faith. (ii) The health care agent of the declarant may not serve as a witness. (iii) At least one of the witnesses must be an individual who is not knowin) (i) Except as provided in items (ii) and (iii) of this paragraph, any competent individual may serve as a witness to an advance directive, including an employee of a health care facility or physicia subtitle to make health care decisions for a declarant. (c) (1) A written advance directive shall be dated, signed by or at the express direction of the declarant, and subscribed by two witnesses. (2ld qualify as a surrogate decision maker under § 5-605(a) of this subtitle. (3) An agent appointed under this subtitle has decision making priority over any individuals otherwise authorized under thisted in the advance directive. (2) An owner, operator, or employee of a health care facility from which the declarant is receiving health care may not serve as a health care agent unless the person wouom that individual. (b) (1) Any competent individual may, at any time, make a written advance directive appointing an agent to make health care decisions for the individual under the circumstances sta § 5-602. (a) Any competent individual may, at any time, make a written advance directive regarding the provision of health care to that individual, or the withholding or withdrawal of health care frby injury, disease, or illness which, to a reasonable degree of medical certainty, makes death imminent and from which, despite the application of life-sustaining procedures, there can be no recovery.ician" means a person licensed to practice medicine in the State or in the jurisdiction where the treatment is to be rendered or withheld. (q) "Terminal condition" means an incurable condition caused onse; and -3- (2) From which, after the passage of a medically appropriate period of time, it can be determined, to a reasonable degree of medical certainty, that there can be no recovery. (p) "Physs of consciousness, exhibiting no behavioral evidence of self-awareness or awareness of surroundings in a learned manner other than reflex activity of muscles and nerves for low level conditioned resplth of an individual; or Prevent the impending death of an individual. "Persistent vegetative state" means a condition caused by injury, disease, or illness: (1) In which a patient has suffered a losy resuscitation. (n) "Medically ineffective treatment" means that, to a reasonable degree of medical certainty, a medical procedure will not: (1) (2) (o) Prevent or reduce the deterioration of the hea recovery from a terminal condition, persistent vegetative state, or end-stage condition. (2) "Life-sustaining procedure" includes artificially administered hydration and nutrition, and cardiopulmonar that: (i) Utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function; and (ii) Is of such a nature as to afford a patient no reasonable expectation ofle to communicate by means other than speech may not be considered incapable of making an informed decision. (m) (1) "Life-sustaining procedure" means any medical procedure, treatment, or intervention evaluation of the burdens, risks, and benefits of the treatment or course of treatment, or is unable to communicate a decision. (2) For the purposes of this subtitle, a competent individual who is abtreatment or course of treatment because the patient is unable to understand the nature, extent, or probable consequences of the proposed treatment or course of treatment, is unable to make a rationalividuals. (l) (1) "Incapable of making an informed decision" means the inability of an adult patient to make an informed decision about the provision, withholding, or withdrawal of a specific medical ractitioner or a facility that provides health care to individuals. (2) "Health care provider" includes agents or employees of a health care practitioner or a facility that provides health care to indicle to provide health care; or (2) The administrator of a hospital or a person designated by the administrator in accordance with hospital policy. (k) (1) "Health care provider" means a health care psible condition would be medically ineffective. (j) "Health care practitioner" means: -2- (1) An individual licensed or certified under the Health Occupations Article or § 13516 of the Education Art That has caused severe and permanent deterioration indicated by incompetency and complete physical dependency; and (2) For which, to a reasonable degree of medical certainty, treatment of the irreverl ventilation, defibrillation, and other related life-sustaining procedures. (i) "End-stage condition" means an advanced, progressive, irreversible condition caused by injury, disease, or illness: (1)mergency medical services personnel to withhold or withdraw cardiopulmonary resuscitation including cardiac compression, endotracheal intubation, other advanced airway management techniques, artificiay Medical Services in conjunction with the State Board of Physician Quality Assurance which, in the event of a cardiac or respiratory arrest of a particular patient, authorizes certified or licensed eting an informed decision. (h) "Emergency medical services `do not resuscitate order'" means a physician's written order in a form established by protocol issued by the Maryland Institute for Emergencatment and who has not been determined to be incapable of making an informed decision. (g) "Declarant" means a competent individual who makes an advance directive while capable of making and communicaetermining best interest. (f) "Competent individual" means a person who is at least 18 years of age or who under § 20-102(a) of this article has the same capacity as an adult to consent to medical trereatment or the withholding or withdrawal of the treatment; and (7) The religious beliefs and basic values of the individual receiving treatment, to the extent these may assist the decision maker in d The effect of the treatment on the life expectancy of the individual; The prognosis of the individual for recovery, with and without the treatment; (6) The risks, side effects, and benefits of the tding or withdrawal of treatment result in a severe and continuing impairment of the dignity of the individual by subjecting the individual to a condition of extreme humiliation and dependency; (4) (5)in or discomfort caused to the individual by the treatment, or the withholding or withdrawal of the treatment; (3) The degree to which the individual's medical condition, the treatment, or the withholndividual resulting from that treatment, taking into account: (1) The effect of the treatment on the physical, emotional, and cognitive functions of the individual; -1- (2) The degree of physical paysician who has primary responsibility for the treatment and care of the patient. (e) "Best interest" means that the benefits to the individual resulting from a treatment outweigh the burdens to the ilt appointed by the declarant under an advance directive made in accordance with the provisions of this subtitle to make health care decisions for the declarant. (d) "Attending physician" means the phhe declarant in accordance with the requirements of this subtitle; or (2) A witnessed oral statement, made by the declarant in accordance with the provisions of this subtitle. (c) "Agent" means an adu Advance Medical Directive. § 5-601. (a) In this subtitle the fo llowing words have the meanings indicated. (b) "Advance directive" means: (1) A witnessed written document, voluntarily executed by tical Directive is based on the following Maryland Statutes: "Health General § 5-601 et. Seq." For your convenience, we have included useful relevant excerpts from the Maryland Statutes relating to the The health care agent may not be a witness to your advance directive. At least one of your witnesses may not be a person who may financially benefit by reason of your death. This Maryland Advance Medion and Instruction for Maryland Advance Medical Directive (Power of Attorney for Health Care & Living Will); (2) Maryland Advance Medical Directive (Power of Attorne y for Health Care & Living Will).he event of terminal condition, persistent vegetative state, or end-stage condition. You can also use the adva nce directive to make any other health care decisions. This package contains (1) Informat health care issues, by allowing you to select a health care agent, give health care instructions, or both. By using the Advance Directive, you can make decisions about life-sustaining procedures in tInformation and Instructions Maryland Advance Medical Directive (Power of Attorney for Health Care & Living Will) The Maryland Advance Medical Directive, allows you to make some decisions about future MarylandMaryland _____________ 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 Maryland