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Minnesota 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 MinnesotaMinnesota ______ day of __________________, 20____. __________________________________________ Notary public Self-proved Will Affidavit [SEAL] lic, and by _________________________________________, the testator, and by ___________________________________ , __________________________ , and ___________________________________ witnesses, this __ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before me ________________________________ a notary pub___ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ____________________________________________________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ___________________________________tator was at that time 18 years of age or older, of sound mind, and under no constraint or undue influence and that each witness is over 18 years of age and otherwise competent to be a witness. _____ntary act for the purposes expressed in it, that each of the witnesses, in the presence and hearing of the testator, signed the will as witness, and that to the best of the witness's knowledge the tesecuted the instrument as the testator's will, that the testator signed willingly (or willingly directed another to sign for the testator), that the testator executed it as the testator's free and voluent in those capacities, personally appearing before the undersigned authority and being first duly sworn, declare to the undersigned authority under penalty of perjury that the testator signed and ex__________________, and ________________________________ and ________________________________, the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrum__________ Witness Witness Page 9 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ________________________________, and _________________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ ___________________________________ ___________________________________ ___________________________________ Witness Signature: Name: Address: City: State: ___________________________________ _____________ ___________________________________ ___________________________________ Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ ___________________________________ __________ Witness Witness Page 8 of ______ influence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue Initials: __________ Testator __________ Witness ____the Testator's sight and presence and at testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. We understand this is the es, was signed in our sight and presence by _____________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in declare under penalty of perjury under the laws of the State of ____________________ that the above instrument, which consists of _____ pages, including the page(s) which contain the witness signatur: 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.) We, the undersigned, hereby certify and and ask the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses__________, ______. at ____________________ (city), that I declare this to be my Last Will and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influenceality or unenforceability should affect only that provision and all other provision should remain effective. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of __________iciary 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 invalidity, illegr 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 of a benefgree, 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, partnership or otheires 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 if they can ahat 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 bequest requh natural person from any and all claims or Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 7 of ______ expenses in connection with or arising out of ty of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify sucng the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date of my death. 3. Liabilitdants, if, but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. 2. Thirty Day Survival Requirement. For the purposes of determininy 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 descening 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. and ate 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 as form 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 my estanot 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 subject tot 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 or as 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 the effecthem 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 powers,ring 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 granted to 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 administe 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 Trustee may ch I may have an interest at the time of my death. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 6 of ______ 10. Compromise, settle, waive or pay anyom any election, determination, 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 whiThe Executor or Trustee shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or by my estate resulting frany other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereof. ctions, 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 by ustee 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 elearies 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 Tr 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 benefici 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 myair 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 deathr 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 f, 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 otor 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 timesent 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 Execuessly 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 paymor 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 expr 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 estate forming part of my estate or any part thereof, to borrow Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 5 of ______ money on any such real estate uponions, rebuilding and improvements 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 n adequate condition and repair, 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, alteratinistration of my estate for such period as the Executor or Trustee shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property iay be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate admdvisable, 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 m of all or part of any real or personal property that may be included in my estate in such manner and for such purposes, for such prices, and upon such terms, credits and conditions as may be deemed administration 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 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 authority granted by law or necessary or appropriate for proper ae court. 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 toof the court having jurisdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probatime to 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 ed Executor. 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 tis 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 the first aforementionitness Page 4 of ______ ARTICLE VIII NOMINATION OF EXECUTOR I appoint ___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or such child(ren) and act as the guardian of the property of such child pursuant to the provisions of applicable law. Initials: __________ Testator __________ Witness __________ __________ Witness Wr 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 custody ofof my minor child(ren). If such 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 minotee. ARTICLE VII GUARDIAN If it becomes necessary to appoint a Guardian for any of my minor child(ren) under the age of eighteen years, I appoint ___________________________________, as the Guardian ccounting to 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 Trus 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 Trustee serving hereunder. The Trustee shall provide an a, 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 reason, I appoint ___________________________________, , to betee, in Trustee'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 ___________________________________ate 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 principal to any beneficiaries under the Trust if Trusy interest in 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 dimitation upon 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 an any beneficiary 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 l as, my Executor 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 ofe Trust created 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 proportionsf such child, in equal shares per stirpes. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 3 of ______ 4. If at any time prior to the termination of thh child leaves no descendants surviving 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 o________ years as directed by this 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 suc the amount thereof then remaining 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 _____e that child any remaining income and principal of the Trust. If any of my child(ren) should die before receiving the whole of his or her share under the Trust created by this Will, then such share orgive that child his 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 giv 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 will terminate as to that child alone and the Trustee shall 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 the income from the trust is not paid to or applied for thee 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 such payments shall not be deducted from or charged to then (including college 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 bThe Trustee shall pay 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 educatio 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 order to make the administration of the Trust easier. 2. ation 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 passing to any minor children shall be held in trust by thesets shall be retained, 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 educor 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 assets") for the benefit of my child(ren). 1. The Trust as 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 transfer all assets that have passed under this Will to any minstribution shall be a sufficient discharge to the Executor. ARTICLE V TRUST FOR MINOR CHILDREN If at the time of my death, any of my child(ren) are under the age of ____________ years, those childrenWitness __________ __________ Witness Witness Page 2 of ______ the time of the distribution or to any other person the Executor may consider to be a proper recipient thereof. Receipt of any such dictly to the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of such person, person with whom the beneficiary resides at Initials: __________ Testator __________ ome entitled to any share in my estate before attaining the age of majority or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person direfect, as if I had died intestate at the time fixed for distribution under this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, if any person should becnot survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective shares to be determined under the laws of the State of ________________________, then in ef________________ ____________________________________________________________________________ ____________________________________________________________________________ If any such beneficiary does equal shares per stirpes. If none of the named child(ren) or their descendants, survive me, I direct that my residuary estate be distributed in equal shares per stirpes to: ___________________________ distributed, bequeathed and given to my child(ren) _____________________________________________________________________ (name(s)). If more than one child is named, then the distribution shall be in . If more than one child is named, then the distribution shall be in equal shares per stirpes. Residuary Estate I direct that my residuary estate, including any real property and personal property, beistributed with my residuary estate. Primary Residence All my interest in my primary residence or homestead, if any, shall be distributed to my child(ren) ___________________________________ (name(s))ed with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be dmy residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributm my estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with ansferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made fro______ This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchaser or triary. The Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 1 of ny gift or benefit given or conferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficnt of the taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or ahe residue of my estate. The Executor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payme out of and charged to the capital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of txed 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, testamentary expenses and expenses of last illness be first paidcremation or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fi_____________________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, been married. I have the following child(ren): Name: _______________________________________ Born on _________________ Name: _______________________________________ Born on _________________ Name: ___ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I MARRIAGE & CHILDREN I am single. I have neverarising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, _________________________________________ (name), of ___________________onsulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences nd 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 without c. 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 2006). This information and these forms are not intended acy; [] 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 liabilityre, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified employee benefit plans; [] the face value of any life insurance polithe 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 furnitu,000,000 level, Information about Wills ­ Page 2 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 determine subject to federal estate tax. As your estate approaches $2,000,000 in value and exceeds that amount, the greater your need for professional estate tax planning advice. If your assets come near the $2an individual's estate. For a person dying from 2006 to 2008, that credit is $2,000,000. The credit is available to each individual and his or her spouse. Estates totaling $2,000,000 or more could be Testators should have an understanding of tax 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 anyone in any life situation where this Will is to be used as the principal estate-planning document. If you have a large estate, you may need more complicated planning to reduce or limit death taxes.e witnesses or to require the witnesses to testify. 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 e 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 a will as self proved, to require an affidavit of th affidavit will be of no use in those states. 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 havnds as undue influence, lack of testamentary capacity, or prior revocation. A few states like Louisiana, Maryland, Ohio and Vermont (as of 2003) do not have statutes permitting self proving wills. Theg the Will were followed. The Affidavit can also 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 grouvits, that each saw the Testator sign the will and that the formalities for signing a Will were followed. The Affidavit may eliminate the need to have witnesses testify, that the formalities in signine after the death of the Testator. Before the 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 affida, that all required formalities were observed 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 probated and will not be governed by this Will. The Will has an enclosed self-proving affidavit, which contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary. Assets held jointly with rights of survivorship, assets with beneficiary designations (such as life insurance or employee benefit plans), and assets held in trust generally will not be required to bTestator") as specified by the Testator. This 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 distributedurchase and use of these forms is subject to 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 "from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The pd from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice r suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time an be checked by a lawyer in their new state to 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 theiich affect estate planning, can vary over time and from place to place. All wills should be reviewed by a lawyer before they are signed. If the Testator moves to another state, the current will shouldions ­ Page 5 calls for distribution in percentages, make sure that the total of all of the beneficiaries' percentages equal 100%. Check the totals before signing the Will. State and federal laws, whmay be invalid 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 Checklist & Instructus changes, if the 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 ead when changes are desired, the original and all copies should be destroyed and an entirely new Will should be signed. New wills are commonly necessary when, for example, the Testator's marital statd with a competent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or modifying words on the face of the Will. Such changes are usually disregarded. Insthis Will is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and other matters. The tax results of the choices made in this Will should be discusseerty held in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benefits arising in other contracts and plans are not normally governed by a will. Testator, would automatically pass to another person by operation of law or by any contract. For example, the Will does not dispose of property held in joint tenancy with rights of survivorship or propd be kept by the Testator and may also (if Testator so wishes) be provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Te original "copy" of a will should be prepared. While photocopies may be used for reference purposes, only the original can be admitted to probate. Copies are rarely accepted. A copy of the Will shoulces. The original of the Will should be kept in a secure location such as a safe deposit box at a bank or lawyer's office. Unlike other legal instruments where multiple originals are prepared, only one (and banks or trust companies) before naming them as Trustee, to make sure that they are willing and can serve. If you select a bank or trust company, be sure to check into their fees for such servithe Trustee. It is very important to pick a person (or bank or trust company) that can be trusted to manage and administer the Trust that may be set up for your child(ren). It is best to talk to peoplke care of the child(ren). It is best to talk to people before naming them as the Guardian of the child(ren), to make sure that they are willing and can serve. Great care should be taken in selecting their fees for such services. The Guardian should be picked carefully as this person may have custody of the Testator's child(ren). It is also very important to pick a person that can be trusted to tao people (and banks or trust companies) before naming them as a Personal Representative, to make sure that they are willing and can serve. If you select a bank or trust company, be sure to check into e picked carefully. It is very important to pick a person (or bank or trust company) that can be trusted to handle financial matters and to deal appropriately with family members. It is best to talk t­ Page 4 The total number of pages (excluding i.e. not counting the self-proving affidavit) should be entered by hand in the bottom right of each page. The Personal Representative / Executor should b a Notary or other person authorized to take acknowledgments and administer oaths. The affidavit states that all required formalities were observed when the Will was signed. Checklist & Instructions elf-proving affidavit (called "Proof of Will" in some states) and attach it to the end of the Will. The Affidavit contains the Testator's acknowledgment and the affidavit of the witnesses, made beforeture lines appear. The page with the self-proving affidavit, if included, should not be counted because the affidavit is not a part of the Will itself. The Testator and the witnesses should sign the s validity of the Will at a later date (i.e. if this Will revokes an earlier Will). The Witnesses should indicate the total number of pages in the Will, including the page(s) on which the witness signahe/she is signing the Will freely and willingly. Wherever requested, the date should be filled in (preferably by hand), with the date of the actual signing. This step could be crucial to determine the the Will. All witnesses must sign their names in the presence of the Testator and each other and of the notary public. The witnesses must be satisfied that the Testator is an adult of sound mind and ates, it is a good idea for the Testator to initial the bottom of each page of the Will. This can prevent subsequent substitution of pages. The witnesses should also initial the bottom of each page ofthe Will. For example, the Testator can say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and voluntarily," or similar words. Although not required in most stestator should orally declare that the document that is about to be signed, is intended to be the Testator's Last Will and Testament. However, the witnesses don't need to read or know the contents of rs or executors should not be witnesses. All witnesses and the notary should watch the Testator sign the Will. The notary public is needed for the self proved affidavit. Before signing the Will, the Tof one of the witnesses is deemed to be invalid for any reason or if one of the witnesses can't be located. The witnesses should not be beneficiaries under the Will. For example children, spouses, heicompetent, disinterested and adult witnesses and a notary public. Important Note: Vermont requires three witnesses. The signature of a third witness can provide additional protection if the signature relatives and others who might be entitled to a share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in the presence of three (3) qualified, egal 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 the value thereof and knows about , to require an affidavit of the witnesses or to require the witnesses to testify. The Testator (i.e. the person who is writing the Will) must be of "sound mind" when signing the Will and must be of lbe "proven" in court, like any other Will. In Ohio, Maryland, California and the District Checklist & Instructions ­ Page 3 of Columbia, the courts have some latitude to accept a will as self provedes not need to be completed. However, signing and 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 Important Note: A few states like Louisiana, Maryland, Ohio and Vermont (as of 2003) do not have specific statutes permitting self proving wills. The affidavit will be of no use in those states and do Will) states that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signed, by the Testator, all Witnesses and a Notary in front of each other. Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; [] witness signatures and info Affidavit: The enclosed Affidavit (although technically not part of theoperty, and making distributions to the beneficiaries Article X: Contains miscellaneous provisions. Signature Block: Testator needs to fill out: [] day month year city; [] Signature; []name Witnesses:st provide and fill out [] the name of executor (spouse); [] name of alternate executor. Article IX: Powers of Executor and Trustee empowers them to deal with matters like taxes, taking care of the prministration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Representative will pay whatever is left to the beneficiaries named in the will. Testator munnot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is also responsible for paying outstanding debts, ade appointment of the Testator's Personal Representative (i.e. Executor) and alternate; It allows the Testator to name an Executor to administer the estate, and an alternate in case the first choice ca fill out [] the name of Guardian; [] name of alternate Guardian. [] number of days within which Guardian has to apply to be officially appointed as guardian of child(ren). Article VIII: Deals with thr must provide 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. Testator must provide and/responsibilities. It allows the Testator 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. Testatopurposes of the Trust (this 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 Deals with the creation of a trust for any minor children. Testator must provide and fill out: [] age when children should not be considered minors any longer Checklist & Instructions ­ Page 2 for residuary estate will be given; []name of "alternate" beneficiaries to whom the residuary estate will be given if child(ren) predecease Testator. [] state under whose laws the will is made Article V: property is given to (three blank paragraphs are provided, but you can add as many as you need). []name of child(ren) to whom the primary residence (if any) is given; []name of child(ren) to whom the or charities and gives any primary residence and the residuary estate to the child(ren). Testator must provide and fill out: [] description of property (or dollar amount); [] name(s) of person/entityments of debts and expenses. Article IV: Disposes of specific property, primary residence and residuary property.. Allows Testator to give specific dollar amounts or other property to specific personsh child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary Article II: Authorizes payment of funeral and burial expenses. Article III: Authorizes payTestator must provide and fill out: [] name, [] county and []state Article I: Gives the name(s) of the child(ren). Testator must provide and fill out [] name(s) of child(ren) and date of birth for eache enclosed Affidavit also needs to be completed. Title: Enter name of Testator in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. ss than $2,000,000. This Will is divided 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. Tfor any minor child(ren) and a Trustee to administer the minor children's assets. The Will also allows the Testator to make specific gifts to others as well. This Will is suitable for estates worth let distributes the assets of the Testator (i.e. person making the will) to the child(ren). If the children are minors at the time of the Testator's death, the Will allows the appointment of a Guardian ill ­ Single Person with Minor Children with selfproved affidavit. This Will is for a Single Person with one or more minor children, who has never been married, and includes a self-proved affidavit. IChecklist and Instructions Will - Single Person with Minor Children This package contains (1) Checklist and Instruction for Will ­ Single Person with Minor Children; (2) Information about Wills; (3) W MinnesotaMinnesota your physician's office and at the hospital, home care agency, hospice, or nursing facility where you receive your care. -8- your doctors, family, close friends, health care agent, and alternate health care agent. Make sure your doctor is willing to follow your wishes. This document should be part of your medical record at_____________________________ Address: ______________________________________ REMINDER: Keep this document with your personal papers in a safe place (not in a safe deposit box). Give signed copies to initial this box: [______________] I certify that the information in (i) through (iv) is true and correct. _____________________________________________ (Signature of Witness Two) Print Name: ______care agent or an alternate health care agent in this document. (iv) If I am a health care provider or an employee of a health care provider giving direct care to the person listed above in (A), I must/her signature on this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf. (ii) I am at least 18 years of age. (iii) I am not named as a health ________________ Address: ______________________________________ Witness Two: (i) In my presence on ________________________ (date), ___________________________________________(name) acknowledged his [______________] I certify that the information in (i) through (iv) is true and correct. _____________________________________________ (Signature of Witness One) -7- Print Name: ___________________lternate health care agent in this document. (iv) If I am a health care provider or an employee of a health care provider giving direct care to the person listed above in (A), I must initial this box:this document or acknowledged that he/she authorized the person signing this document to sign on his/her behalf. (ii) I am at least 18 years of age. (iii) I am not named as a health care agent or an aect care to me on the day I sign this document. Witness One: (i) In my presence on ________________________ (date), ___________________________________________(name) acknowledged his/her signature on (Signature of Notary) (Notary Stamp) Option 2: Two Witnesses Two witnesses must sign. Only one of the two witnesses can be a health care provider or an employee of a health care provider giving dir the person signing this document to sign on his/her behalf. I am not named as a health care agent or alternate health care agent in this document. ___________________________________________________my presence on ________________________ (date), __________________________________________________________ (name) acknowledged his/her signature on this document or acknowledged that he/she authorizedo sign this document for me) -6- __________________________________________________________________ (Printed name of the person who I asked to sign this document for me) Option 1: Notary Public In ___________________ If I cannot sign my name, I can ask someone to sign this document for me. __________________________________________________________________ (Signature of the person who I asked t_____________________________________ My Signature Date signed: ________________________________ Date of birth: _______________________________ Address: _______________________________________________itnesses (Option 2). It must be dated when it is verified or witnessed. I am thinking clearly, I agree with everything that is written in this document, and I have made this document willingly. _________________________________________________ PART III: MAKING THE DOCUMENT LEGAL This document must be signed by me. It also must either be verified by a notary public (Option 1) OR witnessed by two wr things: _____________________________________________________________________________ _____________________________________________________________________________ __________________________________dy when I die (cremation, burial): _____________________________________________________________________________ _____________________________________________________________________________ Any othe -5- _____________________________________________________________________________ _____________________________________________________________________________ My wishes about what happens to my bo__________________________________________________________________ _____________________________________________________________________________ My wishes about donating parts of my body when I die: ______________________________________________ _____________________________________________________________________________ Where I would like to die and other wishes I have about dying: _________________________________________________ _____________________________________________________________________________ Where I would like to live to receive health care: _________________________________________________________________________ There are other things that I want or do not want for my health care, if possible: Who I would like to be my doctor: _______________________________________feel about pain relief if it would affect my alertness or if it could shorten my life: _____________________________________________________________________________ _________________________________________________________ _____________________________________________________________________________ In all circumstances, my doctors will try to keep me comfortable and reduce my pain. This is how I ___________________________________ If I were completely dependent on others for my care and unable to decide or speak for myself, I would want: _______________________________________________________permanently unconscious and unable to decide or speak for myself, I would want: _____________________________________________________________________________ __________________________________________k for myself, I would want: _____________________________________________________________________________ _____________________________________________________________________________ -4- If I were _____________________________________________________________________________ _____________________________________________________________________________ If I were dying and unable to decide or spea: You can discuss general feelings, specific treatments, or leave any of them blank) If I had a reasonable chance of recovery, and were temporarily unable to decide or speak for myself, I would want: dialysis, antibiotics, and blood transfusions. Most medical treatments can be tried for a while and then stopped if they do not help. I have these views about my health care in these situations: (Noten or to prolong my life. Examples include artificial breathing by a machine connected to a tube in the lungs, artificial feeding or fluids through tubes, attempts to start a stopped heart, surgeries, _______ THIS IS WHAT I WANT AND DO NOT WANT FOR MY HEALTH CARE (I know I can change these choices or leave any of them blank) Many medical treatments may be used to try to improve my medical conditiodition might affect my family: ____________________ _____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ My thoughts about how my medical con_______________________________________ _____________________________________________________________________________ My beliefs about when life would be no longer worth living: _______________________________________________________________________________________ -3- My spiritual or religious beliefs and traditions: _______________________________________ _______________________________________________________________ My fears about my health care: ____________________________________________________ _____________________________________________________________________________ ____________my health care: _____________________________________________________ _____________________________________________________________________________ ____________________________________________________S AND VALUES ABOUT MY HEALTH CARE (I know I can change these choices or leave any of them blank) I want you to know these things about me to help you make decisions about my health care: My goals for h care directive. These are instructions for my health care when I am unable to decide or speak for myself. These instructions must be followed (so long as they address my needs). THESE ARE MY BELIEFis Part II is optional but would be very helpful to your agent. However, if you chose not to appoint an agent in Part I, you MUST complete some or all of this Part II if you wish to make a valid healt________________________________________ PART II: HEALTH CARE INSTRUCTIONS NOTE: Complete this Part II if you wish to give health care instructions. If you appointed an agent in Part I, completing th here: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________d eyes, when I die. (2) To decide what will happen with my body when I die (burial, cremation). If I want to say anything more about my health care agent's powers or limits on the powers, I can say itany of the powers in (1) and (2), I must INITIAL the line in front of the power; then my agent WILL HAVE that power. (1) To decide whether to donate any parts of my body, including organs, tissues, an _____________________________________________________________________________ -2- My health care agent is NOT automatically given the powers listed below in (1) and (2). If I WANT my agent to have er in (A) through (D), I MUST say that here: _____________________________________________________________________________ _____________________________________________________________________________d have the same rights that I would have to give my medical records to other people. If I DO NOT want my health care agent to have a power listed above in (A) through (D) OR if I want to LIMIT any powe mental health treatment. (B) Choose my health care providers. (C) Choose where I live and receive care and support when those choices relate to my health care needs. (D) Review my medical records an withdraw consent to any care, treatment, service, or procedures. This includes deciding whether to stop or not start health care that is keeping me or might keep me alive, and deciding about intrusivct in my best interest. Whenever I am unable to decide or speak for myself, my health care agent has the power to: (A) Make any health care decision for me. This includes the power to give, refuse, orD). My health care agent must follow my health care instructions in this document or any other instructions I have given to my agent. If I have not given health care instructions, then my agent must aHEALTH CARE AGENT TO BE ABLE TO DO IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF (I know I can change these choices) My health care agent is automatically given the powers listed below in (A) through (___________ Address of my alternate health care agent: __________________________________________ _____________________________________________________________________________ THIS IS WHAT I WANT MY to be my health care agent instead. Relationship of my alternate health care agent to me: __________________________________ Telephone number of my alternate health care agent: _____________________________________________ -1- (OPTIONAL) APPOINTMENT OF ALTERNATE HEALTH CARE AGENT: If my health care agent is not reasonably available, I trust and appoint __________________________________________ health care agent: _________________________________________ Address of my health care agent: __________________________________________________ ______________________________________________________________ to make health care decisions for me. This person is called my health care agent. Relationship of my health care agent to me: __________________________________________ Telephone number of my t wish to appoint an agent, you may leave Part I blank and go to Part II. When I am unable to decide or speak for myself, I trust and appoint __________________________________________________________nd I know I do not have to appoint an agent or an alternate agent) NOTE: If you appoint an agent, you should discuss this health care directive with your agent and give your agent a copy. If you do no I: APPOINTMENT OF HEALTH CARE AGENT THIS IS WHO I WANT TO MAKE HEALTH CARE DECISIONS FOR ME IF I AM UNABLE TO DECIDE OR SPEAK FOR MYSELF (I know I can change my agent or alternate agent at any time aare to be used by the agent. These instructions may also be used by my health care providers, others assisting with my health care and my family, in the event I cannot make decisions for myself. PARTI have not made my health care wishes known. AND/OR PART II: Give health care instructions to guide others making health care decisions for me. If I have named a health care agent, these instructions are agent must make health care decisions for me based on the instructions I provide in this document (Part II), if any, the wishes I have made known to him or her, or must act in my best interest if allows me to do ONE OR BOTH of the following: PART I: Name another person (called the health care agent) to make health care decisions for me if I am unable to decide or speak for myself. My health crms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -5- Health Care Directive I, _______________________________________________________________, understand this document orney whenever a document is negotiated with another party. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these foed without consulting with an attorney first. Before using or signing this document you should have an attorney review it to make sure it fits your particular situation. You should also consult an attrms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be usforms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These fof proceedings for dissolution, annulment, or termination of the principal's -4- marriage or commencement of proceedings for termination of the principal's registered domestic partnership. [_] These th care directive, the appointment by the principal of the principal's spouse or registered domestic partner as health care agent under a health care power of attorney is revoked by the commencement oinstrument. Subd. 2. Effect of dissolution or annulment of marriage or termination of domestic partnership on appointment of health care agent. Unless the principal has otherwise specified in the heale presence of two witnesses who do not have to be present at the same time; or (4) executing a subsequent health care directive, to the extent the subsequent instrument is inconsistent with any prior expressing the principal's intent to revoke the health care directive in whole or in part; (3) verbally expressing the principal's intent to revoke the health care directive in whole or in part in ththe presence of the principal to destroy the health care directive instrument, with the intent to revoke the health care directive in whole or in part; (2) executing a statement, in writing and dated,ole or in part at any time by doing any of the following: (1) canceling, defacing, obliterating, burning, tearing, or otherwise destroying the health care directive instrument or directing another in rwise specified by the principal have been met. 145C.09 Revocation of health care directive. Subdivision 1. Revocation. A principal with the capacity to do so may revoke a health care directive in whctive for a health care decision when the principal, in the determination of the attending physician of the principal, recovers decision- making capacity; or if other conditions for effectiveness otheipal, lacks decision- making capacity to make the health care decision; or if other conditions for effectiveness otherwise specified by the principal have been met. A health care directive is not effective is effective for a health care decision when: (1) it meets the requirements of section 145C.03, subdivision 1; and (2) the principal, in the determination of the attending physician of the princl on the date of execution. A person notarizing a health care directive may be an employee of a health care provider providing direct care to the principal. 145C.06 When effective. A health care dires to the execution of the health care directive must not be a health care provider providing direct care to the principal or an employee of a health care provider providing direct care to the principa a health care power of attorney may not act as a witness or notary public for the execution of the health care directive that includes the health care power of attorney. -3- (b) At least one witnese the health care agent must make decisions for the principal. Subd. 3. Individuals ineligible to act as witnesses or notary public. (a) A health care agent or alternate health care agent appointed inte the health care agent must make decisions for the principal; or (2) an employee of a health care provider attending the principal on the date of execution of the health care directive or on the dation, or unless the principal has otherwise specified in the health care directive: (1) a health care provider attending the principal on the date of execution of the health care directive or on the dab) The following individuals are not eligible to act as the health care agent, unless the individual appointed is related to the principal by blood, marriage, registered domestic partnership, or adoptppointed by the principal under section 145C.05, subdivision 2, paragraph (b), to make the determination of the principal's decision- making capacity is not eligible to act as the health care agent. (s as provided under this chapter; and (6) include a health care instruction, a health care power of attorney, or both. Subd. 2. Individuals ineligible to act as health care agent. (a) An individual aprincipal; (5) contain verification of the principal's signature or the signature of the person authorized by the principal to sign on behalf of the principal, either by a notary public or by witnesserincipal's name; (4) be executed by a principal with capacity to do so with the signature of the principal or with the signature of another person authorized by the principal to sign on behalf of the th care directive. -2- 145C.03 Requirements. Subdivision 1. must: Legal sufficiency. To be legally sufficient in this state, a health care directive (1) be in writing; (2) be dated; (3) state the pagent to make health care decisions for the principal when the principal, in the judgment of the principal's attending physician, lacks decision-making capacity, unless otherwise specified in the heal direct health care providers, others assisting with health care, family members, and a health care agent. A health care directive may include a health care power of attorney to appoint a health care alth care needs. 145C.02 Health care directive. A principal with the capacity to do so may execute a health care directive. A health care directive may include one or more health care instructions to a health care directive. Subd. 9. Reasonably available. "Reasonably available" me ans able to be contacted and willing and able to act in a timely manner considering the urgency of the principal's he means a written statement of the principal's values, preferences, guidelines, or directions regarding health care. Subd. 8. Principal. "Principal" means an individual age 18 or older who has executed44A.02, a home care provider licensed under sections 144A.43 to 144A.47, or a hospice provider licensed under sections 144A.75 to 144A.755. Subd. 7a. Health care instruction. "Health care instruction"er chapter 62D. Subd. 7. Health care facility. "Health care facility" means a hospital or other entity licensed under sections 144.50 to 144.58, a nursing home licensed to serve adults under section 1authorized or permitted by the laws of this state to administer health care directly or through an arrangement with other health care providers, including health maintenance organizations licensed unded under this chapter before August 1, 1998. Subd. 6. Health care provider. "Health care provider" means a person, health care facility, organization, or corporation licensed, certified, or otherwise written instrument that complies with section 145C.03 and includes one or more health care instructions, a health care power of attorney, or both; or a durable power of attorney for health care execut Subd. 5. Health care decision. "Health care decision" means the consent, refusal of consent, or withdrawal of consent to health care. Subd. 5a. Health care directive. "Health care directive" means a the establishment of a person's abode within or without the state and personal security safeguards for a person, to the extent decisions on these matters relate to the health care needs of the person.terally or through intubation but does not -1- include any treatment, service, or procedure that violates the provisions of section 609.215 prohibiting assisted suicide. "Health care" also includes eans any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a person's physical or mental condition. "Health care" includes the provision of nutrition or hydration paren power of attorney. "Health care power of attorney" means an instrument appointing one or more health care agents to make health care decisions for the principal. Subd. 4. Health care. "Health care" mho is appointed by a principal in a health care power of attorney to make health care decisions on behalf of the principal. "Health care agent" may also be referred to as "agent." Subd. 3. Health carecant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision. Subd. 2. Health care agent. "Health care agent" means an individual age 18 or older waith if the person violates the provisions of section 609.215 prohibiting assisted suicide. Subd. 1b. Decision- making capacity. "Decision- making capacity" means the ability to understand the signifignosis and the principal's personal values to the extent known. Notwithstanding any instruction of the principal, a health care agent, health care provider, or any other person is not acting in good finformation do not provide adequate guidance to the actor, "act in good faith" means acting in the best interests of the principal, considering the principal's overall general health condition and pro53B.03, subdivision 6d, or information otherwise made known by the principal, unless the actor has actual knowledge of the modification or revocation of the information expressed. If these sources of istently with a legally sufficient health care directive of the principal, a living will executed under chapter 145B, a declaration regarding intrusive mental health treatment executed under section 2ney for Health Care) Form. 145C.01 Definitions. Subdivision 1. Applicability. The definitions in this section apply to this chapter. Subd. 1a. Act in good faith. "Act in good faith" means to act consney for Health Care and Living Will) is based on Minnesota Statutes Chapter 145C.16. The following are useful excerpts from the Minnesota Statutes relating to the Health Care Directive (Power of Attor (Power of Attorney for Health Care and Living Will); (2) Minnesota Health Care Directive (Power of Attorney for Health Care and Living Will) Form. This Minnesota Health Care Directive (Power of AttorInformation and Instructions Minnesota Health Care Directive (Power of Attorney for Health Care & Living Will) This package contains (1) Information and Instruction for Minnesota Health Care Directive MinnesotaMinnesota Public _______________________________ Printed Name of Notary Check here if part or all of the land is Registered (Torrens). Name of Grantor State of Minnesota County of ______________ } ss. , by , Grantor(s). NOTARY SEAL This instrument was acknowledged before me on _______________________________ Signature of Notary Here IN WITNESS WHEREOF, Grantor has executed this Quitclaim Deed on __________________, 20 __. ____________________________________________ ____________________________________________ Type or Printin this instrument and I certify that the status and number of wells on the described real property have not changed since the last previously filed well disclosure certificate. Affix Deed Tax Stamp ler does not know of any wells on the described real property. If a well does exist on the property, a well disclosure certificate accompanies this document. I am familiar with the property described real property in the county of Minnesota, described as follows: [Insert legal description] together will all hereditaments and appurtenances. Check box if applicable: The seller certifies that the selERATION of _______________________, ("Grantor") of (Grantor's Address) hereby conveys and ("Grantee"), of quitclaims to (Grantee's Address) , all interest in , in the state of the following described LAIM DEED Escrow No.: Recording requested by: and when recorded, please return this deed and tax statements to: Title Order No. DEED TAX DUE: Date: KNOW ALL MEN BY THESE PRESENTS THAT: FOR THE CONSIDparty. The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com : For county auditor/treasurer's use only For county recorder's use only QUITCice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An attorney should be consulted before negotiating any document with another Deed, make sure that it satisfies your needs. Consult a real estate attorney and title insurance company to protect your interests. These forms are not intended and are not a substitute for legal adv of conveyance when buying a property. Quitclaim deeds are mainly used in family situations or to correct possible technical defects in the title to the property. If you are a buyer taking a Quitclaim at all. This type of deed may be useful in cases where a party is unable to transfer a fee simple estate or make promises about the title. A buyer will rarely accept a Quitclaim Deed as the only formerest in real estate. A Quitclaim Deed does not include any promise or guarantee by the person making it (i.e. the Grantor) about the nature or quality of that interest, or even if any interest existsty. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information for Quitclaim Deed This Quitclaim Deed form is used to convey an int. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An attorney should be consulted before negotiating any document with another parertificate (state supplied form is available at http://www.health.state.mn.us/divs/eh/wells/disclosures/certificateform.pdf). [_] These forms are not intended and are not a substitute for legal advicere no wells on the property, the Grantor must disclose that fact to the Grantee in writing prior to the signing of the Quitclaim Deed. If there are wells, the Grantor must complete a Well Disclosure Curned unrecorded or may be charged additional fees [_] In Minnesota, a Quitclaim Grantor must disclose to the Grantee any wells that exist or that have been filled within the deed property. If there ath it. Please check your local requirements with your local Recorder's (or similar) office. [_] Depending on the type of document, additional requirements may apply. Nonconforming documents may be retrd parties. [_] Documents referencing land should include a legal description of the land. Verify that the legal description is correct. [_] A Quitclaim Deed may require other documents to be filed wihe Quitclaim Deed before a notary. Among other things, notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the Quitclaim Deed may not be effective against thiInstructions & Checklist for Quitclaim Deed Minnesota (Individual) [_] This package contains (1) Instructions and Checklist for Quitclaim Deed (2) Quitclaim Deed [_] The Grantor should date and sign t MinnesotaMinnesota _____________ 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 Minnesota