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North Dakota 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 North DakotaNorth Dakota _______ Notary public [SEAL] Self-proved Will Affidavit _________________________________ , __________________________ , and ___________________________________ witnesses, this _______ day of __________________, 20____. ________________________________________________________________ Subscribed, sworn, and acknowledged before me ________________________________ a notary public, and by _________________________________________, the testator, and by _______________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ____________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ______constraint or undue influence and that each witness is over 18 years of age and otherwise competent to be a witness. _____________________________________________ (Testator) __________________________e 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 of age or older, of sound mind, and under no gly (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 expressed in it, that each of the witnesses, in thy and being first duly sworn, declare to the undersigned authority under penalty of perjury that the testator signed and executed the instrument as the testator's will, that the testator signed willin________________, the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument in those capacities, personally appearing before the undersigned authoritTE OF __________________________ COUNTY OF ________________________ We, ________________________________, and _______________________________, and ________________________________ and _______________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 7 of ______ Self-Proved Will Affidavit STA_______ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ____________________________me: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ ________er 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 Signature: Na 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, menace, fraud or undue influence; The maksight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 6_ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence and at Testator's request, and in the _____________ that the above instrument, which consists of _____ pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by ____________________________llowing clause before signing. The witnesses should not receive assets under this Will.) We, the undersigned, hereby certify and declare under penalty of perjury under the laws of the State of _______ignature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the foo 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 below to witness my signature. Testator's Sam not currently married to anyone. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare this ts Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all other provision should remain effective. 7. No Spouse. I her with the income therefrom shall remain the separate property of a beneficiary hereunder, free from all matrimonial rights or controls by his or her spouse. 6. Severability. If any provision of thior anticipated, or fall into any community of property, partnership or other form of sharing or division of property which may exist between any beneficiary and his or her spouse, and every gift togete respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned audulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising thfrom any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or non-actions as the fiduciary, except for such actions or non-actions which constitute fro 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 such natural person ry is living on the thirtieth day after the date of my death. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 5 of ______ 3. Liability of Fiduciary. Noption. 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiacendant" shall include an adopted person and such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adll genders, and the use of the singular the plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "desinserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include aUS PROVISIONS The provisions in this Will for the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are ll be binding upon all of the beneficiaries and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VII MISCELLANEObeing other than an impartial exercise of their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion sha, of the beneficiaries, whether or not such exercise may have the effect of conferring an advantage on any one or more of the beneficiaries or would otherwise, but for the foregoing, be considered as reason of the exercise of such discretion. The Executor shall exercise the powers, authority and discretion granted herein in what Executor deems to be the best interest, whether monetary or otherwisessional fees. The Executor shall be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with administering my estate, including but not limited to attorney, accountant, agent, broker and other profee against others for such consideration or 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 any partnership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may havretion, entered into by the Executor in good faith. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 4 of ______ 9. Windup, dissolve, settle or continueher beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or by my estate resulting from any election, determination, designation or exercise of discher country, state or territory, and such exercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereof. The Executor shall not be liable to any person, whety 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 any other legislative or governmental body of any ote for any injury to, consumption of or loss of any such property so used. 8. Make or refrain from making, in Executor's absolute discretion, any elections, determinations, and designations permitted by 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 shall not be liable or responsiblture 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 beneficiaries of my estate to use anabsolute 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 my Will. No reversionary or fue 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 death at Executor's arts 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 fair market valur 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 or any part or pmay 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 times, in such manneor payment and the decision of the Executor shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor ayment, and I expressly will and declare that 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 r personal estate or set aside or pay any share or interest therein either wholly or in part in the assets forming my estate at the time of my death or at the time of such division, setting aside or ph real estate upon the security of any mortgage or mortgages and to pay off any mortgage or mortgages which may be in existence at any time forming part of my estate. 4. Make any division of my real osuch 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 estate or any part thereof, to borrow money on any suc______ Witness __________ Witness Page 3 of ______ 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any ding the cost of keeping such property in adequate condition and repair, in the manner and to the extent that the Executor shall deem advisable. Initials: __________ Testator __________ Witness ____rge of any real property as part of the probate administration of my estate for such period as the Executor shall determine; collect any income therefrom; and pay the taxes and expenses thereof, incluges, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take chaand upon such terms, credits and conditions as may be deemed advisable, without order of court and without notice to anyone. I also give to the Executor power to execute and deliver such deeds, mortgaartition, exchange, mortgage, or otherwise encumber or dispose of all or part of any real or personal property that may be included in my estate in such manner and for such purposes, for such prices, dition to other powers and authority granted 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, pon by the probate court. No bond, security or surety shall be required of any Executor serving hereunder. ARTICLE VI POWERS OF EXECUTOR In addition to the existing authority of the Executor and in ader or direction of the court having jurisdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary interventig as such from time to time whether original or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to administer my estate without adjudication, ordrst aforementioned 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 actinot, does not or is unable to serve or continue to serve as Executor for any reason, I appoint ___________________________________, , to be the Executor of this my Will in the place and stead of the fi be a sufficient discharge to the Executor. ARTICLE V NOMINATION OF EXECUTOR I appoint ___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannrson, person with whom the beneficiary resides at the time of the distribution or to any other person the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shallficiary or to a parent, guardian, conservator, Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 2 of ______ committee of such person, trustee of such peany 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 directly to the bened 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 become entitled to 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 effect, as if I ha ____________________________________________________________________________ ____________________________________________________________________________ If any such beneficiary does not survive me, 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: ___________________________________________queathed and given to my child(ren) _____________________________________________________________________ (name(s)). If more than one child is named, then the distribution shall be in equal shares perne 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, be distributed, bemy residuary estate. Primary Residence All my interest in my primary residence or homestead, if any, shall be distributed to my child(ren) ___________________________________ (name(s)). If more than ouary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with ate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my resid__________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary est 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 from my estate. ___ection 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 transferee upon oror shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 1 of ______ This dirit 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 beneficiary. The Executshall 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 any gift or benef 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 payment of the taxes ged 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 the residue of myr 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 paid out of and charial 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 fixed by statute o_____________________ 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, cremation or bur child(ren) from that marriage: Name: _______________________________________ Born on _________________ Name: _______________________________________ Born on _________________ Name: __________________d publish and declare this to be my Last Will and Testament. ARTICLE I MARRIAGE & CHILDREN I was married to __________________________________________, who is now deceased. I have the following adultll And Testament Of ______________________ I, _____________________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils an 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. Last Wind 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 U.S. citizen, the deduction is limited (it was $100,000 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 aeach individual may leave an unlimited amount to his 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; [] individual retirement accounts and qualified employee benefit plans; [] the face value of any life insurance policy; [] property you are holding in trust; any joint property you own In addition, ] real estate; [] stocks and bonds; [] bank accounts; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interestsill and should consult with tax professionals and an 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: [xceeds that amount, the greater your need for professional estate tax planning Information about Wills ­ Page 2 advice. If your assets come near the $2,000,000 level, you really shouldn't use this wyears. The credit is available to each individual and his or her spouse. Estates totaling $2,000,000 or more could be subject to federal estate tax. As your estate approaches $2,000,000 in value and enst the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying in 2006- 2008, that credit is $2,000,000. The amount of the credit increases over the next few 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 agaimat 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 may 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 specific for 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 latitude 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 is afidavit, 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 (as ofneed 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 the Afome 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 the . 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 witnesses cgment 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 Will, 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 acknowledich 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 plans)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 assets wh 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 This ey 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 thistute 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 attorn 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 substi 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 impliedeck 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 signed.rney 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 beneficiary's percentage's equal 100%. Chst 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 attoe 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.. Mong, deleting, or changing words on the face of the Will. Such changes are usually disregarded. If changes are desired, the original and all copies should be destroyed and an entirely new Will should baxable estate and other matters. The tax results of the choices made in this Will should be discussed with a competent tax advisor. If it becomes necessary to change the Will, do not modify it by addiother contracts and plans are not normally governed by a will. Checklist & Instructions ­ Page 4 This Will is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total toperty 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 in is 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 of prto 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 Representative. Ther legal instruments where multiple originals are prepared, only one original "copy" of a will should be prepared. While photocopies may used for reference purposes, only the original can be admitted k 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 oth 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 banrsonal 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 appropriatelyormalities 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 Pethe 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 required ft 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 contains 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 note 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, includinges 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 daf pages. The witnesses should also initial the bottom of each page of the Will. All witnesses must sign their names in the presence of the Testator and each other and of the notary public. The witness and voluntarily", or similar words. 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 o to read or know the contents of the Will. For example, the Testator can say: "The document Checklist & Instructions ­ Page 3 I am about to sign is my Last Will and Testament. I am signing it freelyt. 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 needor 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 affidavional 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. Fpresence 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 additihe 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 the 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 and te 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" when 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 latitudproving 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 is 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 self idavit: 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 signed ,ds 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 Aff representative to deal with matters like taxes, taking care of the property, and making distributions to the beneficiaries Article VII: Contains miscellaneous provisions Signature Block: Testator neewill pay whatever is left to the beneficiaries named in the will. Testator must provide and fill out [] the name of executor; [] name of alternate executor. Article VI: Powers of Executor empowers the Personal Representative is also responsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Representative 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 Checklist & Instructions ­ Page 2 the will is made Article V: 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, ande of child(ren) to whom the 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 [] name(s) of person/entity property is given to (three blank paragraphs are provided, but you can add as many as you need). []name of child(ren) to whom the primary residence (if any) is given; []namroperty to specific persons 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); Article III: Authorizes payments of debts and expenses. Article IV: Disposes of specific property, primary residence and residuary property.. Allows Testator to give specific dollar amounts or other p and date of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and Burial expenses. t: []name, [] county and []state Article I: Gives the name of deceased spouse and the name(s) of the child(ren). Testator must provide and fill out [] name of deceased spouse; [] name(s) of child(ren)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. Testator must provide and fill ou0. This Will is divided into various sections. The content of each section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also needs . It distributes the assets of the Testator (i.e. person making the will) to the child(ren) and to specific beneficiaries named in the Will. This Will is suitable for estates worth less than $2,000,00ill ­ Widow/Widower with Adult Children and selfproved affidavit. This Will is for a Widow or Widower with Adult Children from the marriage, who has not remarried, and includes a self-proved affidavitChecklist and Instructions Will ­ Widow/Widower with Adult Children This package contains (1) Checklist and Instruction for Will ­ Widow/Widower with Adult Children; (2) Information about Wills; (3) W North DakotaNorth Dakota ______________ (Signature of Witness Two) Print Name: ___________________________________ Address: ______________________________________ 4 or long-term care provider giving direct care to the declarant, I must initial this box: [_____]. I certify that the information in (1) through (3) is true and correct _______________________________d the person signing this document to sign on the declarant's behalf. 3 (2) I am at least eighteen years of age. (3) If I am a health care or long-term care provider or an employee of a health care _____ Witness Two: (1) In my presence on _________ (date), _____________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that the declarant directe1) through (3) is true and correct. _____________________________________________ (Signature of Witness One) Print Name: ___________________________________ Address: _________________________________th care or long-term care provider or an employee of a health care or long-term care provider giving direct care to the declarant, I must initial this box: [_____]. I certify that the information in (s signature on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant's behalf. (2) I am at least eighteen years of age. (3) If I am a healission expires __________________________ , 20__. i. Option 2: Two Witnesses Witness One: (1) In my presence on _________ (date), _____________________ (name of declarant) acknowledged the declarant'e on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant's behalf. ______________________________ (Signature of Notary Public) My comme _______________________________ 2 h. Option 1: Notary Public In my presence on _______________ (date), ____________________________________(name of declarant) acknowledged the declarant's signaturdeclaration. g. I understand that I may revoke this declaration at any time. _____________________________________________________________ (Declarant's Signature) City, County, and State of Residencregnancy. f. I understand the importance of this declaration, I am voluntarily signing this declaration, I am at least eighteen years of age, and I am emotionally and mentally competent to make this lly harmful or would cause unreasonable physical pain. e. If I have been diagnosed as pregnant and that diagnosis is known to my physician, this declaration is not effective during the course of my ptending physician may withhold or withdraw nutrition or hydration if the physician determines that I cannot physically assimilate nutrition or hydration or that nutrition or hydration would be physicamake no statement concerning the administration of hydration. d. Concerning the administration of nutrition and hydration, I understand that if I make no statement about nutrition or hydration, my ation would be physically harmful or would cause unreasonable physical pain, or hydration would only prolong the process of my dying. (3) [________] I do not wish to receive hydration. (4) [________] I n when my death is imminent (initial only one statement): (1) [________] I wish to receive hydration. (2) [________] I wish to receive hydration unless I cannot physically assimilate hydration, hydrat___] I do not wish to receive nutrition. (4) [________] I make no statement concerning the administration of nutrition. c. I have made the following decision concerning the administration of hydratioon unless I cannot physically assimilate nutrition, nutrition would be physically harmful or would cause unreasonable physical pain, or nutrition would only prolong the process of my dying. (3) [_____ng decision concerning the administration of nutrition when my death is imminent (initial only one statement): (1) [________] I wish to receive nutrition. 1 (2) [________] I wish to receive nutritis the final expression of my legal right to direct that medical or surgical treatment be provided. (3) [________] I make no statement concerning life-prolonging treatment. b. I have made the followireversible condition which, without the administration of life-prolonging treatment, will result in my imminent death. It is my intention that this declaration be honored by my family and physicians asal, which is death. (2) [________] I direct that life-prolonging treatment, which could extend my life, be used if two physicians certify that I am in a terminal condition that is an incurable or irention that this declaration be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and that they accept the consequences of that refu treatment, will result in my imminent death; (b) The application of life-prolonging treatment would serve only to artificially prolong the process of my dying; and (c) I am not pregnant. It is my inthat I be permitted to die naturally if two physicians certify that: (a) I am in a terminal condition that is an incurable or irreversible condition which, without the administration of life-prolongingnth, day, year): a. I have made the following decision concerning life-prolonging treatment (initial 1, 2, or 3): (1) [________] I direct that life-prolonging treatment be withheld or withdrawn and tx professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION I declare on ____________________________(moicular 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 discussed with a tavary 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 fits your partr 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 advice. Laws physician or other health care provider shall make the revocation a part of the declarant's medical record. [_] These forms are provided "as is" and no implied or express warranties have been made ot's direction; or c. An oral expression of intent to revoke. 2. A revocation is effective upon communication to the attending physician or other health care provider by the declarant. 3. The attendingdeclarant is competent, including by: a. A signed, dated writing; b. Physical cancellation or destruction of the declaration by the declarant or another in the declarant's presence and at the declaranapply to emergency treatment performed in a prehospital situation. 23-06.4-05. Revocation of declaration. 1. A declaration may be revoked at any time and in any manner by the declarant, provided the hholding, or withdrawal of such treatment and must be given great weight by the physic ian in determining the intent of the incompetent declarant. A declaration made under section 23-06.4-03 does not ion made under section 23-06.4-03 does not obligate the physician to use, withhold, or withdraw life-prolonging treatment but is presumptive evidence of the declarant's desires concerning the use, witrant is determined by the attending physician and another physician to be in a terminal condition and no longer able to make decisions regarding administration of life-prolonging treatment. A declarate declarant. Living Will Information & Instructions ­ Page 3 23-06.4-04. When declaration operative. A declaration becomes operative when it is communicated to the attending physician, and the decla or other health care provider who is furnished a copy of the declaration shall make it a part of the declarant's medical record and, if unwilling to comply with the declaration, promptly so advise thctives. Another form may be used if it complies with this chapter. The invalidity of any additional specific directives does not affect the validity of the declaration. (see form below) 3. A physicianicians of the declarant. 2. The following statutory form is a preferred form, but not a required form, by which a person may execute a declaration. The declaration may include additional specific direClaimants against any portion of the estate of the declarant at the time of the execution of the declaration; d. Directly financially responsible for the declarant's medical care; or e. Attending physb. Entitled to any portion of the estate of the declarant under any will of the declarant or codicil to the will or deed, existing by operation of law or otherwise, at the time of the declaration; c. er providing direct care to the declarant on the date of execution. The notary public or any witness may not be: a. The declarant's spouse or related to the declarant by blood, marriage, or adoption; irect care to the declarant. At least one witness to the execution of the declaration must not be a health care provider providing direct care to the declarant or an employee of the health care providrant, either by notary public or by two witnesses who are at least eighteen years of age. A person notarizing the declaration may be an employee of a health care or long-term care provider providing dby the declarant, or another at the declarant's direction, and contain verification of the declarant's signature or the signature of the person directed by the declarant to sign on behalf of the declaighteen or more years of age may execute at any time a declaration governing the use, withholding, or withdrawal of life-prolonging treatment, nutrition, and hydration. The declaration must be signed or physical impairment, including comatose conditions that will not result in imminent death. 23-06.4-03. Declaration relating to use of life-prolonging treatment. 1. An individual of sound mind and e, will result, in the opinion of the attending physician, in imminent death. The term does not include any form of senility, Alzheimer's disease, mental retardation, mental illness, or chronic mental ho has personally examined the patient to be in a terminal condition. 7. "Terminal condition" means an incurable or irreversible condition that, without the administration of life-prolonging treatmentstructions ­ Page 2 6. "Qualified patient" means a patient eighteen or more years of age who has executed a declaratio n and who has been determined by the attending physician and another physician wr intervention performed in an emergency, prehospital situation. 5. "Physician" means an individual licensed to practice medicine in this state pursuant to chapter 43-17. Living Will Information & Ines not include the provision of appropriate nutrition and hydration or the performance of any medical procedure necessary to provide comfort care or alleviate pain; or medical procedures, treatment, oed to a qualified patient, will serve only to prolong the process of dying and where, in the judgment of the attending physician, death will occur whether or not the treatment is utilized. The term doe to administer health care in the ordinary course of business or practice of a profession. 4. "Life-prolonging treatment" means any medical procedure, treatment, or intervention that, when administerexecuted in accordance with the requirements of subsection 1 of section 23-06.4-03. 3. "Health care provider" means a person who is licensed, certified, or otherwise authorized by the law of this statchapter, unless the context otherwise requires: 1. "Attending physician" means the physician who has primary responsibility for the treatment and care of the patient. 2. "Declaration" means a writing mercy killing, euthanasia, or assisted suicide or permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying. 23-06.4-02. Definitions. In this Communication about such matters is encouraged between each person and the person's family, the physician, and other health care providers. This chapter does not condone, authorize, approve, or permithe decisions relating to the adult's own medical care, including the decision to ha ve medical or surgical means or procedures calculated to prolong the adult's life provided, withheld, or withdrawn. akota Statutes relating to Living Wills. CHAPTER 23-06.4 (UNIFORM RIGHTS OF TERMINALLY ILL ACT) 23-06.4-01. Legislative intent. Every competent adult has the right and the responsibility to control tg Will. This North Dakota Living Will is based on Title 23 Chapter 23-06.4 Section 23-06.4-01 et. Seq. of the North Dakota Code. For your convenience, we have included useful excerpts from the North Dignature of alternate agent/date) -6- Information and Instructions North Dakota Living Will This package contains (1) Information and Instruction for North Dakota Living Will; (2) North Dakota Livinncapable of making the principal's health care decisions, I must notify the principal's physician. ___________________________________ (Signature of agent/date) ___________________________________ (Sr of attorney at any time in any manner. If I choose to withdraw during the time the principal is competent, I must notify the principal of my decision. If I choose to withdraw when the principal is incipal only if the principal becomes incapable. I understand that I must act in good faith in exercising my authority under this power of attorney. I understand that the principal may revoke this powederstand I have a duty to act consistently with the desires of the principal as expressed in this appointment. I understand that this document gives me authority over health care decisions for the priof Witness Two) ____________________________________ (Address) 10. ACCEPTANCE OF APPOINTMENT OF POWER OF ATTORNEY. I accept this appointment and agree to serve as agent for health care decisions. I unrovider giving direct care to the declarant, I must initial this box: [______]. I certify that the information in (1) through (3) is true and correct. ____________________________________ (Signature the declarant directed the person signing this document to sign on the declarant's behalf. (2) I am at least eighteen years of age. (3) If I am a health care provider or an employee of a health care p_ (Address) Witness Two: (1) In my presence on _________ (date), ____________________________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that tial this box: [______]. I certify that the information in (1) through (3) is true and correct. -5- ____________________________________ (Signature of Witness One) ___________________________________ to sign on the declarant's behalf. (2) I am at least eighteen years of age. (3) If I am a health care provider or an employee of a health care provider giving direct care to the declarant, I must ini__ (date), ____________________________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that the declarant directed the person signing this document declarant's behalf. _________________________ (Signature of Notary Public) My commission expires __________________________ , 20__. Option 2: Two Witnesses Witness One: (1) In my presence on ______________ (date), ________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that the declarant directed the person signing this document to sign on thetitled to inherit any part of your estate upon your death; or 5. A person who has, at the time of executing this document, any claim against your estate. Option 1: Notary Public In my presence on ___the following may be used as a notary or witness: 1. A person you designate as your agent or alternate agent; 2. Your spouse; 3. A person related to you by blood, marriage, or adoption; 4. A person enf the document must not be a health care or long-term care provider providing you with direct care or an employee of the health care or long-term care provider providing you with direct care. None of nessed by two qualified adult witnesses. The person notarizing this document may be an employee of a health care or long-term care provider providing your care. At least one witness to the execution o MUST DATE AND SIGN EACH OF THE ADDITIONAL PAGES AT THE SAME TIME YOU DATE AND SIGN THIS POWER OF ATTORNEY.) -4- NOTARY PUBLIC OR STATEMENT OF WITNESSES This document must be (1) notarized or (2) witY WILL NOT BE VALID UNLESS IT IS NOTARIZED OR SIGNED BY TWO QUALIFIED WITNESSES WHO ARE PRESENT WHEN YOU SIGN OR ACKNOWLEDGE YOUR SIGNATURE. IF YOU HAVE ATTACHED ANY ADDITIONAL PAGES TO THIS FORM, YOUAttorney For Health Care on _____________ (date) at _____________________ (city) ______________________ (state) ________________________________________________ (You sign here) (THIS POWER OF ATTORNED. I revoke any prior durable power of attorney for health care. DATE AND SIGNATURE OF PRINCIPAL (YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY) I sign my name to this Statutory Form Durable Power of _________________________________ _________________________________________________________________ (Insert name, address, and telephone number of second alternate agent.) 9. PRIOR DESIGNATIONS REVOKE___________ __________________________________________________________________ (Insert name, address, and telephone number of first alternate agent.) b. Second Alternate Agent: ______________________my agent to make health care decisions for me as authorized in this document, such persons to serve in the order listed below: a. First Alternate Agent: _______________________________________________th care decisions for me, or if I revoke that person's appointment or authority to act as my agent to make health care decisions for me, then I designate and appoint the following persons to serve as er agent.) If the person designated as my agent in paragraph 1 is not available or becomes ineligible to act as my agent to make a health care decision for me or loses the mental capacity to make healIf the agent you designated is your spouse, he or she becomes ineligible to act as your agent if your marriage is dissolved. Your agent may withdraw whether or not you are capable of designating anothernate agent you designate will be able to make the same health care decisions as the agent you designated in paragraph 1, above, in the event that agent is unable or ineligible to act as your agent. is space ONLY if you want the authority of your agent to end on a specific date.) 8. DESIGNATION OF ALTERNATE AGENTS. (You are not required to designate any alternate agents but you may do so. Any alt a shorter period in the space below, this power of attorney will exist until it is revoked.) -3- This durable power of attorney for health care expires on _______________________________ (Fill in the a "Refusal to Permit Treatment" and "Leaving Hospital Against Medical Advice". b. Any necessary waiver or release from liability required by a hospital or physician. 7. DURATION. (Unless you specifyhe health care decisions that my agent is authorized by this document to make, my agent has the power and authority to execute on my behalf all of the following: a. Documents titled or purporting to bour agent to receive and disclose information relating to your health, you must state the limitations in paragraph 4 above.) 6. SIGNING DOCUMENTS, WAIVERS, AND RELEASES. Where necessary to implement txecute on my behalf any releases or other documents that may be required in order to obtain this information. c. Consent to the disclosure of this information. (If you want to limit the authority of ypower and authority to do all of the following: a. Request, review, and receive any information, verbal or written, regarding my physical or mental health, including medical and hospital records. b. Ee chapter 23-06.2, the Uniform Anatomical Gift Act. 5. INSPECTION AND DISCLOSURE OF INFORMATION RELATING TO MY PHYSICAL OR MENTAL HEALTH. Subject to any limitations in this document, my agent has the you must date and sign EACH of the additional pages at the same time you date and sign this document.) If you wish to make a gift of any bodily organ you may do so pursuant to North Dakota Century Cod____ ______________________________________________________________________________ (You may attach additional pages if you need more space to complete your statement. If you attach additional pages, d limitations regarding health care decisions: ______________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ______________________________________________________________________________ b. Additional statement of desires, special provisions, anted below: a. Statement of desires concerning life-prolonging care, treatment, services, and procedures: ______________________________________________________________________________ ________________rcising the authority under this durable power of attorney for health care, my agent shall act consistently with my desires as stated below and is subject to the special provisions and limitations stas in the space below. If you do not state any limits, your agent will have broad powers to make health care decisions for you, except to the extent that there are limits provided by law.) -2- In exef treatment that you do not want to be used, you should state them in the space below. If you want to limit in any other way the authority given your agent by this document, you should state the limites concerning other matters relating to your health care. You can also make your desires known to your agent by discussing your desires with your agent or by some other means. If there are any types o below. You should consider whether you want to include a statement of your desires concerning life-prolonging care, treatment, services, and procedures. You can also include a statement of your desirSPECIAL PROVISIONS, AND LIMITATIONS. (Your agent must make health care decisions that are consistent with your known desires. You can, but are not required to, state your desires in the space providedlth care decisions for you, you can state the limitations in paragraph 4 below. You can indicate your desires by including a statement of your desires in the same paragraph.) 4. STATEMENT OF DESIRES, my agent, including my desires concerning obtaining or refusing or withdrawing life-prolonging care, treatment, services, and procedures. (If you want to limit the authority of your agent to make heamyself if I had the capacity to do so. In exercising this authority, my agent shall make health care decisions that are consistent with my desires as stated in this document or otherwise made known to GRANTED. Subject to any limitations in this document, I hereby grant to my agent full power and authority to make health care decisions for me to the same extent that I could make such decisions for ysical or mental condition. 2. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE. By this document I intend to create a durable power of attorney for health care. 3. GENERAL STATEMENT OF AUTHORITYes of this document, "health care decision" means consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or procedure to maintain, diagnose, or treat an individual's phcare facility, or a nonrelative employee of an operator of a long-term care facility) as my attorney in fact (agent) to make health care decisions for me as authorized in this document. For the purpos decisions for you. None of the following may be designated as your agent: your treating health care provider, a nonrelative employee of your treating health care provider, an operator of a long-term ___________________________________________ _______________________________________________________ (insert name, address, and telephone number of one individual only as your agent to make health care 1. DESIGNATION OF HEALTH CARE AGENT. I, __________________________________ ____________________________________________________ (insert your name and address) do hereby designate and appoint: _______nt where it is immediately available to your agent and alternate agents, if any, or give each of them an executed copy of this document. You should give your doctor an executed copy of this document. you should ask a lawyer to explain it to you. Your agent may need this document immediately in case of an emergency that requires a -1- decision concerning your health care. Either keep this documetnessing procedure described at the end of this form. This document will not be valid unless you comply with the witnessing procedure. If there is anything in this document that you do not understand, and to consent to their disclosure unless you limit this right in this document. This document revokes any prior durable power of attorney for health care. You should carefully read and follow the wi of your agent by notifying your agent or your treating doctor, hospital, or other health care provider orally or in writing of the revocation. Your agent has the right to examine your medical recordsyour best interest. Unless you specify a specific period, this power will exist until you revoke it. Your agent's power and authority ceases upon your death. You have the right to revoke the authorityke health care decisions for you if your agent authorizes anything that is illegal; acts contrary to your known desires; or where your desires are not known, does anything that is clearly contrary to res and any limitation that you include in this document. You may state in this document any types of treatment that you do not desire. In addition, a court can take away the power of your agent to mat for any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition if you are unable to do so yourself. This power is subject to any statement of your desi yourself so long as you can give informed consent with respect to the particular decision. This document gives your agent authority to request, consent to, refuse to consent to, or to withdraw consen to consent to your doctor not giving treatment or stopping treatment necessary to keep you alive. Notwithstanding this document, you have the right to make medical and other health care decisions forr you. Your agent must act consistently with your desires as stated in this document or otherwise made known. Except as you otherwise specify in this document, this document gives your agent the powerst eighteen years of age for this document to be legally valid and binding. This document gives the person you designate as your agent (the attorney in fact) the power to make health care decisions foCUTING THIS DOCUMENT This is an important legal document that is authorized by the general laws of this state. Before executing this document, you should know these important facts: You must be at lea [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -4- Statutory Form Durable Power Of Attorney For Health Care WARNING TO PERSON EXEation. You should also consult an attorney whenever a document is negotiated with another party. Any possible tax consequences arising out of this document should be discussed with a tax professional.ng point for you and should not be used 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 situl effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a startienalties provided by law. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legar of attorney or willfully alters or forges a revocation of a power of attorney is guilty of a class A misdemeanor. 3. The penalties provided in this section do not preclude application of any other pining procedures which hastens the death of the principal is guilty of a class C felony. 2. A person who, without authorization of the principal, willfully alters, forges, conceals, or destroys a powerization of the principal, willfully alters or forges a power of attorney or willfully conceals or destroys a revocation with the intent and effect of causing a withholding or withdrawal of life-susta chapter. 23-06.5-17. Statutory form of durable power of attorney. The statutory form of durable power of attorney is as follows (see form below): 23-06.5-18. Penalties. 1. A person who, without autho durable power of attorney for health care pursuant to this chapter. It is known as "the statutory form of durable power of attorney for health care". Another form may be used if it complies with this. Use of statutory form. The statutory form of durable power of attorney described in section 23-06.5-17 may be used and is the preferred form, but not a required form, by which a person may execute aal records; -3- 2. Execute any releases or other documents which may be required in order to obtain such medical information; and 3. Consent to the disclosure of such medical information. 23-06.5-16may for the purpose of making health care decisions: 1. Request, review, and receive any information, oral or written, regarding the principal's physical or mental health, including medical and hospit.5-08. Inspection and disclosure of medical information. Subject to any limitatio ns set forth in the durable power of attorney for health care by the principal, an agent whose authority is in effect he principal's care of the revocation. 3. If the spouse is the principal's agent, the divorce of the principal and spouse revokes the appointment of the divorced spouse as the principal's agent. 23-06tion of a durable power of attorney for health care shall immediately record the revocation in the principal's medical record and notify the agent, the attending physician, and staff responsible for t. By execution by the principal of a subsequent durable power of attorney for health care. 2. A principal's health care or long-term care services provider who is informed of or provided with a revoca a. By notification by the principal to the agent or a health care or long-term care services provider orally, or in writing, or by any other act evidencing a specific intent to revoke the power; or bnding physician. The attending physician shall cause the withdrawal to be recorded in the principal's medical record. 23-06.5-07. Revocation. 1. A durable power of attorney for health care is revoked:s incapable. Until the principal becomes incapable, the agent may withdraw by giving notice to the principal. After the principal becomes incapable, the agent may withdraw by giving notice to the atteent in writing. Subject to the right of the agent to withdraw, the acceptance creates a duty for the agent to make health care decisions on behalf of the principal at such time as the principal becomeitten by some other person in the principal's presence and at the principal's express direction. 23-06.5-06. Acceptance of appointment - Withdrawal. To be effective, the agent must accept the appointms medical care, or the attending physician of the principal. If the principal is physically unable to sign, the durable power of attorney for health care may be signed by the principal's name being wred in existence or by operation of law, any other person who has, at the time of execution, any claims against the estate of the principal, a person directly financially responsible for the principal'pal's spouse or heir, a person related to the principal by blood, marriage, or adoption, a person entitled to any part of the estate of the principal upon the death of the principal under a will or def a health care or long-term care provider providing direct care to the principal on the date of execution. The notary public or any witness may not be, at the time of execution, the agent, the princioviding direct care to the principal. At least one witness to the execution of the document must not be a health care or long-term care provider providing direct care to the principal or an employee oary public or at least two or more subscribing witnesses who are at least eighteen years of age. A person notarizing -2- the document may be an employee of a health care or long-term care provider pripal's long-term care services provider. 23-06.5-05. Execution and witnesses. The durable power of attorney for health care must be signed by the principal and that signature must be verified by a note of the principal who is an employee of the principal's health care provider; 3. The principal's long-term care services provider; or 4. A nonrelative of the principal who is an employee of the princ.5-04. Restrictions on who can act as agent. A person may not exercise the authority of agent while serving in one of the following capacities: 1. The principal's health care provider; 2. A nonrelativiod of more than forty-five days without a mental health proceeding or other court order, or to psychosur gery, abortion, or sterilization, unless the procedure is first approved by court order. 23-06proposed treatment, or of any proposal to withdraw or withhold treatment. 5. Nothing in this chapter permits an agent to consent to admission to a mental health facility or state institution for a perfied in writing by the principal's attending physician and filed in the principal's medical record. 4. The principal's attending physician shall make reasonable efforts to inform the principal of any the principal's best interests. 3. Under a durable power of attorney for health care, the agent's authority is in effect only when the principal lacks capacity to make health care decisions, as certined in the durable power of attorney for health care or in a declaration executed pursuant to chapter 23-06.4; or b. If the principal's wishes are unknown, in accordance with the agent's assessment of health care providers, the agent shall make health care decisions: a. In accordance with the agent's knowledge of the principal's wishes and religious or moral beliefs, as stated orally, or as contaihealth care, the agent has the authority to make any and all health care decisions on the principal's behalf that the principal could make. 2. After consultation with the attending physician and otherealth care. -1- 23-06.5-03. Scope and duration of authority. 1. Subject to the provisions of this chapter and any express limitations set forth by the principal in the durable power of attorney for care facility" or "long-term care services provider" means a long-term care facility as defined in section 50-10.1-01. 8. "Principal" means an adult who has executed a durable power of attorney for hfacility licensed, certified, or otherwise authorized or permitted by law to administer health care, for profit or otherwise, in the ordinary course of business or professional practice. 7. "Long-termof consent to, or request for any care, treatment, service, or procedure to maintain, diagnose, or treat an individual's physical or mental condition. 6. "Health care provider" means an individual or ating to an agent the authority to make health care decisions executed in accordance with the provisions of this chapter. 5. "Health care decision" means consent to, refusal to consent to, withdrawal f a health care decision, including the significant benefits and harms of and reasonable alternatives to any proposed health care. 4. "Durable power of attorney for health care" means a document delegient, who has primary responsibility for the treatment and care of the patient. 3. "Capacity to make health care decisions" means the ability to understand and appreciate the nature and consequences o an adult to whom authority to make health care decisions is delegated under a durable power of attorney for health care. 2. "Attending physician" means the physician, selected by or assigned to a patfirmative or deliberate act or omission to end life, other than to allow the natural process of dying. 23-06.5-02. Definitions. In this chapter, unless the context otherwise requires: 1. "Agent" means periods of incapacity through the prior designation of an individual to make health care decisions on their behalf. This chapter does not condone, authorize, or approve mercy killing, or permit an afating to the North Dakota Power of Attorney for Health Care Form. 23-06.5-01. Statement of purpose. The purpose of this chapter is to enable adults to retain control over their own medical care duringorth Dakota Power of Attorney for Health Care is based Title 23 Chapter 23-06.5 Section 23-06.5-01 of the on North Dakota Statutes. The following are useful excerpts from the North Dakota Statutes reler of Attorney for Health Care This package contains (1) Information and Instruction for North Dakota Power of Attorney for Health Care; (2) North Dakota Power of Attorney for Health Care Form. This N 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 and Instructions North Dakota Pow 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 this document shouldd/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 cons ulting an attorney first to makenties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal an an Advance Health Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implied or express warraNorth Dakota Advance Health Care Directive This package contains both a North Dakota Power of Attorney for Health Care and a North Dakota Living Will. Together these forms are also sometimes known as North DakotaNorth Dakota tary Public _______________________________ Printed Name of Notary My commission expires: Quitclaim Deed - 2 instrument and acknowledged to me that he/she/they executed the same for the purposes therein contained. Witness my hand and official seal. NOTARY SEAL _______________________________ Signature of No_________________, personally appeared __________________________ known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within _______ ____________________________________________ Type or Print Name of Grantor State of North Dakota County of ______________ } ss. On ______________________, 20,___ before me, ________________buildings, appurtenances and improvements thereon. Quitclaim Deed - 1 IN WITNESS WHEREOF, Grantor has executed this Quitclaim Deed on __________________, 20 __. _____________________________________ successors and/or assigns forever; so that neither Grantor nor Grantor's heirs, successors and/or assigns shall have claim or demand any right or title to the property described above, or any of the ay, covenants, conditions, reservations and restrictions of record. TO HAVE AND TO HOLD all of Grantor's right, title and interest in and to the above described property unto Grantee, Grantee's heirs, of __________________________, County of ________________________________, State of North Dakota described as follows: [Insert legal description] SUBJECT TO all, if any, valid easements, rights of wEASES, AND FOREVER QUITCLAIMS to Grantee, all right, title, interest and claim to the plot, piece or parcel of land, with all the buildings, appurtenances and improvements thereon, if any, in the CityION, in the amount of _______________________ DOLLARS ($___________) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Grantor hereby REMISES, REL__________ __________________________________________ and ________________________________ ("Grantee") whose address is _____________________________________________________. FOR A VALUABLE CONSIDERATUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: THIS QUITCLAIM DEED, made and entered into on ___________________, 20_____, between ____________________________ ("Grantor") whose address is _______imers and Terms of Use found at findlegalforms.com Recording requested by: and when recorded, please return this deed and tax statements to: Escrow No.: For recorder's use only Title Order No.: Q be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject to the Discla be returned unrecorded or may be charged additional fees [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should notiled with 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 maynst third 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 f sign the Quitclaim Deed before a Notary. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the Quitclaim Deed may not be effective agaiInstructions & Checklist for Quitclaim Deed North Dakota (Individual) [_] This package contains (1) Instructions and Checklist for Quitclaim Deed and (2) Quitclaim Deed [_] The Grantor should date and North DakotaNorth Dakota _____________ 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 North Dakota