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New York 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 New YorkNew York 20____. __________________________________________ Notary public Self-proved Will Affidavit [SEAL] ___________________, the testator, and by ___________________________________ , __________________________ , and ___________________________________ witnesses, this _______ day of __________________, _________________________ Address: ______________________________________ Subscribed, sworn, and acknowledged before me ________________________________ a notary public, and by _____________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ______________________________ age or older, of sound mind, and under no constraint or undue influence and that each witness is over 18 years of age and otherwise competent to be a witness. _______________________________________ed in it, that each of the witnesses, in the presence and hearing of the testator, signed the will as witness, and that to the best of the witness's knowledge the testator was at that time 18 years oftor's will, that the testator signed willingly (or willingly directed another to sign for the testator), that the testator executed it as the testator's free and voluntary act for the purposes expressy appearing before the undersigned authority and being first duly sworn, declare to the undersigned authority under penalty of perjury that the testator signed and executed the instrument as the testa______________________ and ________________________________, the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument in those capacities, personall of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ________________________________, and _______________________________, and _______________________________________ ___________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 7_____________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ __________________________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ __ menace, fraud or undue influence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his or her name. Dated: ______________ Witness __________ Witness Page 6 of ______ We understand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress,nce and at Testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Initials: __________ Testator __________ Witness ____d presence by _____________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and preseury under the laws of the State of ____________________ that the above instrument, which consists of _____ pages, including the page(s) which contain the witness signatures, was signed in our sight ans witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) We, the undersigned, hereby certify and declare under penalty of perjlow to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign a____________ (city), that I declare this to be my Last Will and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influence and ask the Witnesses named bed affect only that provision and all other provision should remain effective. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ________ matrimonial rights or controls by his or her spouse. 8. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability shoulf property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereunder, free from allr. 7. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of sharing or division obuted between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executouse. I am not currently married to anyone. No Children. I do not have any children at the time of the signing of this Will. 6. Beneficiary Disputes. If any bequest requires that the bequest be distriTestator __________ Witness __________ Witness __________ Witness Page 5 of ______ fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. 5. No Spod my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or non-actions as the Initials: __________ e date of my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, an. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after thnd such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. 2. Thirty Day Survival Requiremente plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shall include an adopted person are not to be considered as forming a part of this Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include all genders, and the use of the singular thfor the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and aes and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VI MISCELLANEOUS PROVISIONS The provisions in this Will their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiarich exercise may have the effect of conferring an advantage on any one or more of the beneficiaries or would otherwise, but for the foregoing, be considered as being other than an impartial exercise of. The Executor shall exercise the powers, authority and discretion granted herein in what Executor deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not suy protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretiononable expenses and costs incurred in connection with administering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor shall be fullr no consideration and upon such terms and conditions as the Executor may deem advisable and to refer to arbitration all such claims if the Executor deem same advisable. 11. Pay all necessary and reastness __________ Witness Page 4 of ______ 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration ood faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. Initials: __________ Testator __________ Witness __________ Wi any loss, claim, tax or other cost experienced by any such person or by my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor in goexercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereof. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of federal government of the United States of America, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, and such s of any such property so used. 8. Make or refrain from making, in Executor's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by therty, without paying any rent, without giving any bond or security and without liability for any loss or damage. The Executor shall not be liable or responsible for any injury to, consumption of or losng into possession and no such interest not actually producing income shall be treated as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property or real prope for loss to the intent that investments or assets so retained shall be deemed to be authorized investments for all purposes of my Will. No reversionary or future interest shall be sold prior to falliney, property or undivided fractional share in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's absolute discretion without responsibilityey may think best. Make any division or distribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and cause any share to be composed of mo or credit or for part cash and part credit as they may in their absolute discretion decide upon, or to postpone such conversion of my estate or any part or parts thereof for such length of time as therty or any part thereof so valued. 5. Sell, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cashr shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor may be beneficially interested in the prophat the Executor shall in their absolute discretion fix the value of my estate or any part thereof for the purpose of making any such division, setting aside or payment and the decision of the Executoshare or interest therein either wholly or in part in the assets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and declare ttgage or mortgages and to pay off any mortgage or mortgages which may be in existence at any time forming part of my estate. 4. Make any division of my real or personal estate or set aside or pay any e or any part thereof, to borrow money on any such Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 3 of ______ real estate upon the security of any moring and improvements and generally to manage any such property. The Executor shall also have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my estatadequate condition and repair, in the manner and to the extent that the Executor shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuildobate administration of my estate for such period as the Executor shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in ents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take charge of any real property as part of the prs as may be deemed advisable, without order of court and without notice to anyone. I also give to the Executor power to execute and deliver such deeds, mortgages, leases or other instruments and docum encumber or dispose of all or part of any real or personal property that may be included in my estate in such manner and for such purposes, for such prices, and upon such terms, credits and conditioned by law or necessary or appropriate for proper administration of my estate, the Executor shall have the right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwisey or surety shall be required of any Executor serving hereunder. ARTICLE V POWERS OF EXECUTOR In addition to the existing authority of the Executor and in addition to other powers and authority grantdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, securitnal or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to administer my estate without adjudication, order or direction of the court having juriso "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my Will, my estate or any portion thereof who may be acting as such from time to time whether origitinue to serve as Executor for any reason, I appoint ___________________________________, , to be the Executor of this my Will in the place and stead of the first aforementioned Executor. References t_ ARTICLE IV NOMINATION OF EXECUTOR I appoint ___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or is unable to serve or cont thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 2 of _____tor, committee of such person, trustee of such person, person with whom the beneficiary resides at the time of the distribution or to any other person the Executor may consider to be a proper recipiene age of majority or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservatribution under this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, if any person should become entitled to any share in my estate before attaining tho my heirs-at-law, their identities and respective shares to be determined under the laws of the State of ________________________, then in effect, as if I had died intestate at the time fixed for dis_________________________________________________, ____________________________________________________________, If any such beneficiary does not survive me, my residuary estate shall be distributed trt of the rest of my estate. Residuary Estate I direct that my residuary estate be distributed in equal shares per stirpes to: ____________________________________________________________, ___________l distribute the rest of my tangible personal property not disposed of in this Article, or all of my tangible personal property if there are no specific bequests of tangible personal property, as a pale personal property shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. The Executor shal__________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. My remaining tangib__________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. ________________________________________ Witness Page 1 of ______ ARTICLE III DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. ___________________________________________r acquired by such purchaser or transferee upon or after my death pursuant to any agreement with respect to such property. Initials: __________ Testator __________ Witness __________ Witness _____beneficiary for the payment of the taxes. This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to o my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not seek reimbursement from any axes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me either duringf the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the tAll taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall create, out o court. ARTICLE II PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. tion of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of anystament. ARTICLE I FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposi_______________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Tealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, ______ starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when de,000 in 2006). This information and these forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a or her spouse upon death without any federal estate tax liability. This is referred to as the "Marital Deduction". If the recipient spouse is not a U.S. citizen, the deduction is limited (it was $100ployee benefit plans; [] the face value of any life insurance policy; [] property you are holding in trust; any joint property you own In addition, each individual may leave an unlimited amount to his; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified em attorney. Before using this Will, it may be helpful to determine the value of all of the assets in your estate. Assets may include the following: [] real estate; [] stocks and bonds; [] bank accountssional estate tax planning advice. If your assets come near the $2,000,000 level, Information about Wills ­ Page 2 you really shouldn't use this will and should consult with tax professionals and and his or her spouse. Estates totaling $2,000,000 or more could be subject to federal estate tax. As your estate approaches $2,000,000 in value and exceeds that amount, the greater your need for profesagainst the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying from 2006 to 2008, that credit is $2,000,000. The credit is available to each individual anmay need more complicated planning to reduce or limit death taxes. Testators should have an understanding of tax laws. Federal tax law provides that upon the death of an individual, there is a credit format similar to the one included in our wills. The Will is for anyone in any life situation where this Will is to be used as the principal estate planning document. If you have a large estate, you ude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. New Hampshire permits self proving, but requires the affidavit to be in a specificis a separate document from the Will). In those states it will have to be "proven" in court, like any other will. In Ohio, Maryland, California and the District of Columbia, the courts have some latits of 2003) do not have statutes permitting self proving wills. The affidavit will be of no use in those states. However, including the affidavit in those states will not invalidate the Will (since it e Affidavit, the Will may still be subject to contest on such grounds as undue influence, lack of testamentary capacity, or prior revocation. A few states like Louisiana, Maryland, Ohio and Vermont (athe need to have witnesses testify, that the formalities in signing the Will were followed. The Affidavit can also be useful if witnesses are not available when they are needed.. However, even with thes come into court and testify under oath, or through sworn affidavits, that each saw the Testator sign the will and that the formalities for signing a Will were followed. The Affidavit may eliminate Will. However, it can speed up the admission of the Will to probate after the death of the Testator. Before the adoption of more modern laws, all wills were proved by having one or more of the witnesswledgment and the affidavit of the witnesses, made before a Notary, that all required formalities were observed when the Will was signed. The Affidavit does not affect the validity or legality of the ans), and assets held in trust generally will not be required to be probated and will not be governed by this Will. The Will has an enclosed self-proving affidavit, which contains the Testator's acknos which are individually owned by the Testator will be distributed. Assets held jointly with rights of survivorship, assets with beneficiary designations (such as life insurance or employee benefit plhis Will distributes the assets of the person making the Will (the "Testator") as specified by the Testator. This Will does not avoid probate for the Testator's estate. It merely directs how the assetthis document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information about Wills Ttorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of bstitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an atlied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a suned. If the Testator moves to another state, the current will should be checked by a lawyer in their new state to make sure it meets local requirements. [_] These forms are provided "as is" and no imp. Check the totals before signing the Will. State and federal laws which affect estate planning can vary over time and from place to place. All wills should be reviewed by a lawyer before they are sigttorney if you wish to disinherit a spouse or any children. If any part of the Will calls for distribution in percentages, make sure that the total of all of the beneficiaries' percentage's equal 100% Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Will may be invalid if a spouse receives nothing or only a small portion of the estate. Consult an ald be written and signed. New wills are commonly necessary when, for example, the Testator's marital status changes, if the Testator has a child or if a named beneficiary or one of the Executors dies.on the face of the Will. Such changes are usually disregarded. If changes are desired, the Checklist & Instructions ­ Page 4 original and all copies should be destroyed and an entirely new Will shou The tax results of the choices made in this Will should be discussed with a competent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or changing words in other contracts and plans are not normally governed by a will. This Will is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and other matters.f property held in joint tenancy with rights of survivorship or property held in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benefits arising. This Will does not dispose of property that, on the death of the Testator, would automatically pass to another person by operation of law or by any contract. For example, the Will does not dispose oted to probate. Copies are rarely accepted. A copy of the Will should be kept by the Testator and may also (if Testator so wishes) be provided to the person named as Executor / Personal Representativeher legal instruments where multiple originals are prepared, only one original "copy" of a will should be prepared. While photocopies may be used for reference purposes, only the original can be admitnk or trust company, be sure to check into their fees for such services. The original of the Will should be kept in a secure location such as a safe deposit box at a bank or lawyer's office. Unlike oty with family members. It is best to talk to people (and banks or trust companies) before naming them as a Personal Representative, to make sure that they are willing and can serve. If you select a baPersonal Representative / Executor should be picked carefully. It is very important to pick a person (or bank or trust company) that can be trusted to handle financial matters and to deal appropriatel formalities were observed when the Will was signed. The total number of pages (excluding i.e. not counting the self-proving affidavit) should be entered by hand in the bottom right of each page. The s the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary or other person authorized to take acknowledgments and administer oaths. The affidavit states that all requirednot a part of the Will itself. The Testator and the witnesses should sign the self-proving affidavit (called "Proof of Will" in some states) and attach it to the end of the Will. The Affidavit containng the page(s) on which the witness signature lines appear, should be indicated by the Witnesses. The page with the self-proving affidavit, if included, should not be counted because the affidavit is date of the actual signing. This step could be crucial to determine the validity of the Will at a later date (i.e. if this Will revokes an earlier Will). The total number of pages in the Will, includisses must be satisfied that the Testator is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever requested, the date should be filled in (preferably by hand), with the initial the bottom of each page of the Will. Checklist & Instructions ­ Page 3 All witnesses must sign their names in the presence of the Testator and each other and of the notary public. The witnes. Although not required in most states, it is a good idea for the Testator to initial the bottom of each page of the Will. This can prevent subsequent substitution of pages. The witnesses should alsoed to read or know the contents of the Will. For example, the Testator can say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and voluntarily," or similar wordvit. Before signing the Will, the Testator should orally declare that the document that is about to be signed, is intended to be the Testator's Last Will and Testament. However, the witnesses don't ne For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testator sign the Will. The notary public is needed for the self proved affidational protection if the signature of one of the witnesses is deemed to be invalid for any reason or if one of the witnesses can't be located. The witnesses should not be beneficiaries under the Will.e presence of three (3) qualified, competent, disinterested and adult witnesses and a notary public. Important Note: Vermont requires three witnesses. The signature of a third witness can provide addi the value thereof and knows about relatives and others who might be entitled to a share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in thn signing the Will and must be of legal age (i.e. eighteen in most states). Being of "sound mind" usually means that the Testator knows that he/she is signing a Will, is familiar with the property andude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. The Testator (i.e. the person who is writing the Will) must be of "sound mind" wheis a separate document from the Will). In those states it will have to be "proven" in court, like any other Will. In Ohio, Maryland, California and the District of Columbia, the courts have some latitf proving wills. The affidavit will be of no use in those states and does not need to be completed. However, signing and including the affidavit in those states will not invalidate the Will (since it d, by the Testator, all Witnesses and a Notary in front of each other. Important Note: A few states like Louisiana, Maryland, Ohio and Vermont (as of 2003).do not have specific statutes permitting selAffidavit: The enclosed Affidavit (although technically not part of the Will) states that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signeeds to fill out: [] day month year city; [] Signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; [] witness signatures and info rs like taxes, taking care of the property, and making distributions to the beneficiaries Checklist & Instructions ­ Page 2 Article VI: Contains miscellaneous provisions Signature Block: Testator nebeneficiaries named in the will. Testator must provide and fill out [] the name of executor; [] name of alternate executor. Article V: Powers of Executor empowers the representative to deal with matteresponsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Representative will pay whatever is left to the and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is also s the will is made Article IV: Deals with the appointment of the Testator's Personal Representative (i.e. Executor) and alternate; It allows the Testator to name an Executor to administer the estate, ut you can add as many as you need). [] name(s) of person(s)/entity(s) remaining tangible property is given to; [] name(s) of person(s)/entity(s) Residuary Estate is given to; [] state under whose lawecific persons or charities. Testator must provide and fill out: [] description of property (or dollar amount); [] name(s) of person/entity property is given to (three blank paragraphs are provided, b funeral and burial expenses. Article II: Authorizes payments of debts and expenses. Article III: Disposes of specific property. Allows Testator to give specific dollar amounts or other property to sper title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator must provide and fill out: []name, [] county and []state Article I: Authorizes payment ofh section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also needs to be completed. Title: Enter name of Testator in blank space undciaries named in the Will. This Will is suitable for estates worth less than $2,000,000. This Will also includes a self-proved affidavit. This Will is divided into various sections. The content of eacSingle Person with no Children with self-proved affidavit. This Will is for a Single Person with no Children. It distributes the assets of the Testator (i.e. person making the will) to specific benefiChecklist and Instructions Will - Single Person with No Children This package contains (1) Checklist and Instruction for Will ­ Single Person with no Children; (2) Information about Wills; (3) Will ­ New YorkNew York _____________________ _____________________________ Grantors Address: _____________________________ _____________________________ Quitclaim Deed - 2 ______ _______________________________ Signature of Notary Public _______________________________ Printed Name of Notary My commission expires: _________________________ Grantee's Address: ________or other political subdivision and the State or Country or other place the acknowledgment was taken.) _______________________________ Printed Name of Notary My commission expires: ___________________on behalf of which the individual(s) acted, executed the instrument, and that such individual made such appearance before the undersigned in the _____________________________________ (Insert the City he within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), that by his/her/their signature(s) on the instrument, the individual(s), or the person up personally appeared ______________________________________ personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose names(s) is (are) subscribed to th State, Country, Province or Municipality.) _______________________________ Signature of Notary Public On the _______ day of _________________in the year ______________, before me, the undersigned,. Acknowledgment for use outside New York State Only: (Out of State or Foreign General Acknowledgment Certificate) STATE OF ___________________, COUNTY OF _________________} SS.: (Complete Venue wit the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person on behalf of which the individual(s) acted, executed the instrumently known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executedK, COUNTY OF _________________} SS.: On the _______ day of _________________in the year ______________, before me, the undersigned, personally appeared ______________________________________, personal Deed - 1 Signed in my presence: _____________________________________ (Witness Signature) Print Name: ___________________________ Acknowledgment for use within New York State Only: STATE OF NEW YORntee, and assigns forever. EXECUTED this day of ________, 20 _______. ____________________________________________ ____________________________________________ Type or Print Name of Grantor Quitclaim__________, County of ______________________________, State of New York, with the following legal description: (Insert Legal Description) . To have and to hold the premises herein granted unto the Gra quitclaim unto Grantee, and assigns forever, all right, title, interest and claim to the plot, piece or parcel of land, with the buildings and improvements thereon erected in the City of ____________ose address is , ("Grantee"), whose address is : , , and Witnesseth, that the Grantor, in consideration of $ , lawful money of the United States, paid by the Grantee, does hereby remise, release, andplease return this deed and tax statements to: Above reserved for official use only QUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: This indenture, made the day of , 20 , between ("Grantor"), whegotiating any document with another party. The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Recording requested by: and when recorded, nd are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before nIf you are a buyer taking a Quitclaim 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 aept a Quitclaim Deed as the only form 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. erest, or even if any interest exists 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 accim Deed form is used to convey an interest 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 intnegotiating any document with another party. 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 Quitclaand are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before imilar) office. Depending on the type of document, additional requirements may apply. Nonconforming documents may be returned unrecorded or may be charged additional fees These forms are not intended ption of the land. Verify that the legal description is correct. A Quitclaim Deed may require other documents to be filed with it. Please check your local requirements with your local Recorder's (or sim Deed may not be effective against third parties. Although witnesses are not required in all states, it is generally a good idea to use them. Documents referencing land should include a legal descrir should date and sign the Quitclaim Deed before a Notary and one witness. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the QuitclaInstructions & Checklist New York Quitclaim Deed This packet includes: (1) Instructions and Checklist for Quitclaim Deed; (2) Information for Quitclaim Deed; and (3) New York Quitclaim Deed The Granto New YorkNew York ________________ _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________________________ 2 arant, nor am I a health care agent of the Declarant. _____________________________________________ (Witness Signature) Print Name: ___________________________________ Address: ______________________larant. I did not sign the Declarant's signature above for or at the direction of the Declarant. At the date of this instrument, I am not a beneficiry entitled to any portion of the estate of the Decllarant sign the declaration in my presence (or the Declarant acknowledged in my presence that he or she had signed the declaration) and I signed the declaration as a witness in the presence of the Dec______________________ ______________________________________ Zip Code: ___________________________ The Declarant is personally known to me and I believe him or her to be of sound mind. I saw the Decl import of this declaration. Date: _________________________________ Signature: _________________________________________________________________ Address: ____________________________________________eatment, under the law of New York. I intend my instructions to be carried out, unless I have rescinded them in a new writing or by clearly indicating that I have changed my mind. I understand the ful______________________________________________________________________ ____________________________________________________________________________ These directions express my legal right to refuse trics. However, I do want maximum pain relief, even if it may hasten my death. 1 Additional Instructions (optional): ____________________________________________________________________________ ______tatement with which you do not agree): I do not want cardiac resuscitation. I do not want artificial or mechanical respiration. I do not want artificial nutrition and hydration. I do not want antibiotm not legally required to be specific about future treatments if I am in the condition(s) described above I feel especially strongly about the following forms of treatment (cross out and initial any st I direct that my treatment be limited to measures to keep me comfortable and to relieve pain, including any pain that might occur by withholding or withdrawing treatment. While I understand that I aI am in a permanent coma or persistent vegetative state which is an irreversible condition in which I am at no time aware of myself or the environment and show no behavioral response to the environmenition which, without the administration of life support systems, will, in the opinion of my attending physician, result in death within a relatively short time. By permanently unconscious I mean that scious but have irreversible brain damage and will never regain the ability to make decisions and express my wishes. By terminal condition, I mean that I have an incurable or irreversible medical condersible mental or physical condition with no reasonable expectation of recovery. These instructions apply if I am (a) in a terminal condition; (b) permanently unconscious; or (c) if I am minimally conline medical treatment under the circumstances indicated below: I direct my attending physician to withhold or withdraw treatment that merely prolongs my dying, if I should be in an incurable or irrevily make this statement as a directive to be followed if I become permanently unable to participate in decisions regarding my medical care. These instructions reflect my firm and settled desire to decject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION I, __________________________________________________________, being of sound mind, willfully and voluntarmended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subould 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 from a local attorney is always recome 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 and from state to state. These forms shnt. The document does not have to be notarized. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purposses should know the nature of the document being signed and be able to attest that Declarant was of sound mind, under no duress, and understood the nature, and consequences of execution, of the documer. Neither witness can be a person appointed as a health care agent, or a distributee of the Declarant or beneficiary under his or her Will (so that would benefit by the declarant's death). The Witnes in some form of writing like for example a `Living Will Declaration' The Living will should be properly executed by the Declarant and it should also be signed by two witnesses who are eighteen or ove County Medical Center the Court established the need for "clear and convincing" evidence of a patient's wishes and stated that the "ideal situation is one in which the patient's wishes were expressedot personally communicate those wishes. Some of the standards have been set forth in cases like In re Westchester County Medical Center, 72 N.Y.2d 517 (1988) and many other cases. In In re Westchestered in New York, they are recognized by New York courts as the best evidence of an individual's wishes concerning medical treatment in the event that treatment is proposed at a time when he or she cannstructions New York Living Will This package contains (1) Information and Instruction for New York Living Will; (2) New York Living Will. Although Living Will Declarations are not statutorily authoriz__________________ Print Name of Witness 2 _______________________________________________ Address_____________________________________________________________ Page 2 Living Will Information and In______ Print Name of Witness 1 _______________________________________________ Address ____________________________________________________________ Signature of Witness 2 _____________________________d mind and acting of his or her own free will. He or she signed (or asked another to sign for him or her) this document in my presence. Signature of Witness 1 _________________________________________ses (Witnesses must be 18 years of age or older and cannot be the health care agent or alternate) I declare that the person who signed this document is personally known to me and appears to be of soun________________________________________ Address _____________________________________________________________ Date________________________________________________________________ Statement by Witnes__________________ ________________________________________________________________________ ________________________________________________________________________ 5. Signature of Principal _________ravenous line), your agent must reasonably know your wishes. You can either tell your agent what your wishes are or include them in this section. ______________________________________________________________________________________________ In order for your agent to make health care decisions for you about artificial nutrition and hydration (nourishment and water provided by feeding tube and intnce with the following limitations and/or instructions (attach additional pages as necessary): ________________________________________________________________________ ________________________________authority to make health care decisions for you or to give specific instructions, you may state your wishes or limitations here.) I direct my health care agent to make health care decisions in accorda____________ 4. Optional: I direct my health care agent to make health care decisions according to my wishes and limitations, as he or she knows or as stated below. (If you want to limit your agent's hall expire (if you want this proxy to expire specific date or conditions, if desired): ____________________________________________________ ___________________________________________________________ Unless I revoke it, or state an expiration date or circumstances under which it will expire, this proxy shall remain in effect indefinitely, or until the date or conditions stated below. This proxy snt) ________________________________________________________________________ as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise. 3. unable, unwilling or unavailable to act as my health care agent, I hereby appoint ___________________________________________________________ (name, home address and telephone number of Alternate Agexcept to the extent that I state otherwise. This proxy shall take effect only when and if I become unable to make my own health care decisions. 2. Optional: Alternate Agent If the person I appoint is(name, home address and telephone number of Agent) ________________________________________________________________________ as my health care agent to make any and all health care decisions for me, eCare Proxy Form Power of Attorney for Health Care 1. I, __________________________________________________________, Principal hereby appoint __________________________________________________________ with a tax professiona l. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Power of Attorney for Health Care New York State Health your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussedice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fitseen made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advHealth Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implied or express warranties have bNew York Advance Health Care Directive This package contains both a New York Power of Attorney for Health Care and a New York Living Will. Together these forms are also sometimes known as an Advance New YorkNew York _____________ 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 New York