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Pennsylvania e specified time or contingency has occurred. -6- ivorce and that, if applicable, the specified future time or contingency has occurred, is conclusive proof of the nonrevocation or nontermination of the power at that time and conclusive proof that tht he did not have at the time of exercise of the power actual knowledge of the termination of the power by revocation, death or, if applicable, disability or incapacity or the filing of an action in d___________________________ Signature of Agent _______________________________ Date -5- 20 Pa.C.S.A. Section 5606 states that an affidavit executed by the agent under a power of attorney stating tha principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ___ence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of theknowledgment by Agent I, ___________________________________, have read the attached power of attorney and am the person identified as the Agent for the Principal. I hereby acknowledge that in the abs_____________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -4- Acument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced _______________________________________________ City: __________________________________ State: ___________________________________ State of PENNSYLVANIA ) ) ss County of ________________________ ) The foregoing instr_____ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: _______my Agent. Signed on ________________ (date), at _______________________ (city), Pennsylvania. ________________________________ Signature of Principal Witness Signature: ______________________________ailure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. -3- I may revoke this Power of Attorney at any time by providing written notice to otice of such termination, shall be held harmless. Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, f party because of reliance on this power of attorney. If this Durable Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without nhe power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the thirday 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 party who receives a copy of this document may act under it. Revocation of ts 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 any rights or ownership with respect to any life insurance policies I mds to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by thiegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person nee of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, ill behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on myhstanding the lapse of time since its execution. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. Iff capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly. This Durable Power of Attorney shall be valid notwithall not terminate on my subsequent disability, incapacity or lack of mental competence (except as provided by any applicable statute). As used herein, "disability" or "incapacity" shall mean a lack o immediately upon execution of this instrument. The rights, powers, and authority of this document shall be exercisable notwithstanding my subsequent disability or incapacity. This Power of Attorney s" 22. "To pursue tax matters." 23. "To make an anatomical gift of all or part of my body." -2- This Durable Power of Attorney and the rights, powers, and authority of my Agent shall become effectiven insurance transactions." 18. "To engage in retirement plan transactions." 19. "To handle interests in estates and trusts." 20. "To pursue claims and litigation." 21. "To receive government benefits.s transactions." 13. "To engage in commodity and option transactions." 14. "To engage in banking and financial transactions." 15. "To borrow money." 16. "To enter safe deposit boxes." 17. "To engage i authorize medical and surgical procedures." 10. "To engage in real property transactions." 11. "To engage in tangible personal property transaction." 12. "To engage in stock, bond and other securitiesitions." "To withdraw and receive the income or corpus of a trust." "To authorize my admission to a medical, nursing, residential or similar facility and to enter into agreements for my care." 9. "Toy benefit." "To make additions to an existing trust for my benefit." "To claim an elective share of the estate of my deceased spouse." "To disclaim any interest in property." "To renounce fiduciary poo any or all of the following, each of which is defined in 20 Pa.C.S.A.5603 (relating to implementation of power of attorney): 1. 2. 3. 4. 5. 6. 7. 8. "To make limited gifts." "To create a trust for mAgent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall empower him (her) to d, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, item_____________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. MyOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoint ___________AND I UNDERSTAND ITS CONTENTS. _________________________________ Signature of Principal / Grantor _________________________________ Name of Principal / Grantor __________________________ Date -1- KNN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE YOUR AGEN'TS FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY ID, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM GENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATEEAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR A/ GRANTOR: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY Rg or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -4- PENNSYLVANIA DURABLE POWER OF ATTORNEY Effective Immediately NOTICE TO PRINCIPAL tent legal advice. This document does not authorize anyone 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 acceptinof your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain compeonsider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose offered for sale, generally include state specific instructions. -3- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, cd as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Please note that this information is not intendeith any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable Power of Attorney to be recorded as a he Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing wAttorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Grantor. Tng as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person actior "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf, even if the Principal later becomes incapacitated. This particular Form becomes effective of Use found at findlegalforms.com. -2- Information Durable Power of Attorney Effective Immediately A Durable Power of Attorney allows a natural "mentally" competent person (called the "Principal" ulting with -1- 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 Disclaimers and Termsl 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 and should not be used without conscomplete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legae Agent should be prepared to make copies for different transactions he undertakes. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should hould keep the original document, as well as a copy. The Agent should have access to the original document as needed. The Agent could also have an original document (i.e. with original signatures). Thnt. The Agent shall exercise reasonable caution and prudence. The Agent shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the Principal. [_] The Principal st at the bottom of the Power of Attorney document. The Agent shall exercise the powers for the benefit of the Principal. The Agent shall keep separate the assets of the Principal from those of the Agerded as a public record, if necessary. [_] The Principal must also sign the "Notice to Principal" at the beginning of the Power of Attorney document. [_] The Agent will have to sign the Acknowledgemenby blood or marriage to the Principal, Agent or Notary. Although not necessary, signing the document before a Notary is suggested. Notarization will also allow the Durable Power of Attorney to be recoom is 18 years of age or older. A witness shall not be the individual who signed the power of attorney on behalf of and at the direction of the principal. Furthermore, witnesses should not be related wer of Attorney is executed by mark (when the Principal is incapable of signing) or by another individual (at the direction of the Principal), then it shall be witnessed by two individuals, each of whe even if the Principal (i.e. the Grantor) becomes subsequently incapacitated. [_] The Principal (i.e. the person granting the power of Attorney) must be mentally competent. In Pennsylvania, if the Poformation for Durable Power of Attorney Effective Immediately; (3) Durable Power of Attorney Effective Immediately [_] This Durable Power of Attorney becomes effective immediately and remains effectivInstructions & Checklist Pennsylvania Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) In PennsylvaniaPennsylvania contingency has occurred, is conclusive proof of the nonrevocation or nontermination of the power at that time and conclusive proof that the specified time or contingency has occurred. -7- knowledge of the termination of the power by revocation, death or, if applicable, disability or incapacity or the filing of an action in divorce and that, if applicable, the specified future time or _________________ Date -6- 20 Pa.C.S.A. Section 5606 states that an affidavit executed by the agent under a power of attorney stating that he did not have at the time of exercise of the power actualle caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ______________________________ Signature of Agent ______________attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonab the attached power of attorney and am the person identified as the alternate Agent for the Principal. I hereby acknowledge that in the absence of a specific provision to the contrary in the power of ehalf of the principal. ______________________________ Signature of Agent _______________________________ Date -5- Acknowledgment by Alternate Agent I, ___________________________________, have readhall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on backnowledge that in the absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I srinted, or stamped -4- Acknowledgment by Agent I, ___________________________________, have read the attached power of attorney and am the person identified as the Agent for the Principal. I hereby roduced ________________________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, p_____ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has p_______________ Name: ___________________________________ City: __________________________________ State: ___________________________________ State of PENNSYLVANIA ) ) ss County of _____________________________________________________ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: ____________________y providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), Pennsylvania. ________________________________ Signature of Principal Witness Signature: _able 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 revoke this Power of Attorney at any time bty of this document, without notice of such termination, shall be held harmless. -3- Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be lis that arise against the third party because of reliance on this power of attorney. If this Durable Power of Attorney is terminated by operation of law, any person relying in good faith on the authori 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 to indemnify the third party for any claimny 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 party who receives a copy of this document mayers 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 any rights or ownership with respect to atial 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 to my Agent based on this document. The powent is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any parPower 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 herein in any manner. If any part of this documtive 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 Attorney shall be construed as broadly as a General 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 by myself or any authorized personal representaAttorney shall be valid notwithstanding the lapse of time since its execution. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provisiond evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly, as certified in writing by a licensed medical doctor. This Durable Power of y subsequent disability, incapacity or lack of mental competence, except as provided by any applicable statute. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive ans, powers, and authority of this document shall remain in full force and effect thereafter until my death or recovery from any disability or incapacity. This Power of Attorney shall not terminate on mdy." This Durable Power of Attorney and all rights and powers therein shall become effective upon my subsequent disability or incapacity as certified in writing by a licensed medical doctor. The rightnterests in estates and trusts." 20. "To pursue claims and litigation." 21. "To receive government benefits." 22. "To pursue tax matters." -2- 23. "To make an anatomical gift of all or part of my boking and financial transactions." 15. "To borrow money." 16. "To enter safe deposit boxes." 17. "To engage in insurance transactions." 18. "To engage in retirement plan transactions." 19. "To handle i11. "To engage in tangible personal property transaction." 12. "To engage in stock, bond and other securities transactions." 13. "To engage in commodity and option transactions." 14. "To engage in banion to a medical, nursing, residential or similar facility and to enter into agreements for my care." 9. "To authorize medical and surgical procedures." 10. "To engage in real property transactions." hare of the estate of my deceased spouse." "To disclaim any interest in property." "To renounce fiduciary positions." "To withdraw and receive the income or corpus of a trust." "To authorize my admisslementation of power of attorney): 1. 2. 3. 4. 5. 6. 7. 8. "To make limited gifts." "To create a trust for my benefit." "To make additions to an existing trust for my benefit." "To claim an elective sower of attorney and the rights hereby granted. My Agent's powers and authority shall empower him (her) to do any or all of the following, each of which is defined in 20 Pa.C.S.A.5603 (relating to impr whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this pbligation whatsoever 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 matte as my alternate or successor Agent, as necessary, to serve with the same powers, rights and discretions. My Agent shall have full power and authority to perform any act, power, duty, legal right or o my behalf. If the above named Agent is unable to serve for any reason, I appoint _____________________________________ maintaining an address at: _____________________________________________________nt ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me and in my name, and in Date -1- KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ do hereby make and appoiE THIS NOTICE AND I UNDERSTAND ITS CONTENTS. _________________________________ Signature of Principal / Grantor _________________________________ Name of Principal / Grantor __________________________D MORE FULLY IN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO MSEPARATE FROM YOUR AGEN'TS FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINEE INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS RCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOMSPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXE TO PRINCIPAL / GRANTOR: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DIy accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -4- PENNSYLVANIA DURABLE POWER OF ATTORNEY Effective upon Disability NOTICEtain competent legal advice. This document does not authorize anyone 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: Br dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obocument, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage o packages offered for sale, generally include state specific instructions. -3- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this dot intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the formsable Power of Attorney be witnessed, it is always a very good idea to do so. Two witnesses are necessary, if the Agent will deal with any real estate in Florida. Please note that this information is nrd party to challenge the validity of the Power of Attorney and will allow the Durable Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durwer 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 make it more difficult for any thid or incompetent, an alternate Agent can be designated, at the time this Power of Attorney is signed, in the event the original Agent is unable to serve or continue to serve as the Agent. A Durable Poo effect, or the Agent undertakes the acts. The Principal can revoke a Durable Power of Attorney at any time. Since this Durable Power of Attorney takes effect only after the Principal becomes disablegent, within the scope of the Power of Attorney document, will be legally binding upon the Principal. This is especially important if the Principal is incapacitated when the Power of Attorney goes into be a lawyer. Almost anyone can be appointed an attorney-in-fact by a power of attorney. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Afective upon the disability or incapacity of the Principal. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the attorney-in-fact for the Principal does not need tpal" or "Principal") to authorize someone else (called the "Agent" or "AttorneyIn-Fact") to act on his or her behalf, even if the Principal later becomes incapacitated. This particular Form becomes efs of Use found at findlegalforms.com -2- Information Durable Power of Attorney Effective upon Disability A Durable Power of Attorney allows a natural "mentally competent " person (called the "Princiout consulting with an attorney first. An Attorney should be consulted before negotiating a document with another party. [_] The purchase and use of these forms, is subject to the Disclaimers and Termialed) or the words "no one" can be entered. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used withment offers the option of nominating an alternate Agent in the event that the first choice as Agent is unable to serve or continue to serve as the Agent. This section can be removed, deleted (and init selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. -1- [_] This docutransactions he undertakes. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the Agent should have access to the original document as needed. The Agent could also have an original document (i.e. with original signatures). The Agent should be prepared to make copies for different gent at the bottom of the Power of Attorney document. The Alternate Agent will have the same powers and duties as the Agent. [_] The Principal should keep the original document, as well as a copy. Thence. The Agent shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the Principal. [_] The alternate Agent will have to sign the Acknowledgement of Alternate Aent shall exercise the powers for the benefit of the Principal. The Agent shall keep separate the assets of the Principal from those of the Agent. The Agent shall exercise reasonable caution and prudemust also sign the "Notice to Principal" at the beginning of the Power of Attorney document. [_].The Agent will have to sign the Acknowledgement at the bottom of the Power of Attorney document. The Aglthough not necessary, signing the document before a Notary is suggested. Notarization will also allow the Durable Power of Attorney to be recorded as a public record, if necessary. [_] The Principal e individual who signed the power of attorney on behalf of and at the direction of the principal. Furthermore, witnesses should not be related by blood or marriage to the Principal, Agent or Notary. As incapable of signing) or by another individual (at the direction of the Principal), then it shall be witnessed by two individuals, each of whom is 18 years of age or older. A witness shall not be thity of the Principal. [_] The Principal (i.e. the person granting the power of Attorney) must be mentally competent. In Pennsylvania, if the Power of Attorney is executed by mark (when the Principal i; (2) Information for Durable Power of Attorney Effective upon Disability; (3) Durable Power of Attorney Effective upon Disability [_] This Durable Power of Attorney becomes effective upon the DisabilInstructions & Checklist Pennsylvania Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability PennsylvaniaPennsylvania t the specified time or contingency has occurred. -6- in divorce and that, if applicable, the specified future time or contingency has occurred, is conclusive proof of the nonrevocation or nontermination of the power at that time and conclusive proof tha that he did not have at the time of exercise of the power actual knowledge of the termination of the power by revocation, death or, if applicable, disability or incapacity or the filing of an action ______________________________ Signature of Agent _______________________________ Date -5- 20 Pa.C.S.A. Section 5606 states that an affidavit executed by the agent under a power of attorney statingthe principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. absence of a specific provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of Acknowledgment by Agent I, ___________________________________, have read the attached power of attorney and am the person identified as the Agent for the Principal. I hereby acknowledge that in the ________________ as identification. _________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -4- strument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ______________________________________________ City: __________________________________ State: ___________________________________ State of PENNSYLVANIA ) ) ss County of ________________________ ) The foregoing in______ Name: ___________________________________ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: _____my Agent. Signed on ________________ (date), at _______________________ (city), Pennsylvania. ________________________________ Signature of Principal Witness Signature: _____________________________ailure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. -3- I may revoke this Power of Attorney at any time by providing written notice to otice of such termination, shall be held harmless. Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, f party because of reliance on this power of attorney. If this General Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without nhe power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the thirday 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 party who receives a copy of this document may act under it. Revocation of ts 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 any rights or ownership with respect to any life insurance policies I mds to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by thiegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person nee of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, ill my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed broadly as a General Power of Attorney. The listing If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting onmanage my financial resources and affairs properly. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney.h or until my disability or incapacity. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to rity of my Agent shall become effective immediately upon execution of this instrument. The rights, powers, and authority of this document shall remain in full force and effect thereafter until my deat." 21. "To receive government benefits." 22. "To pursue tax matters." 23. "To make an anatomical gift of all or part of my body." -2- This General Power of Attorney and the rights, powers, and author safe deposit boxes." 17. "To engage in insurance transactions." 18. "To engage in retirement plan transactions." 19. "To handle interests in estates and trusts." 20. "To pursue claims and litigationgage in stock, bond and other securities transactions." 13. "To engage in commodity and option transactions." 14. "To engage in banking and financial transactions." 15. "To borrow money." 16. "To enteer into agreements for my care." 9. "To authorize medical and surgical procedures." 10. "To engage in real property transactions." 11. "To engage in tangible personal property transaction." 12. "To enin property." "To renounce fiduciary positions." "To withdraw and receive the income or corpus of a trust." "To authorize my admission to a medical, nursing, residential or similar facility and to entimited gifts." "To create a trust for my benefit." "To make additions to an existing trust for my benefit." "To claim an elective share of the estate of my deceased spouse." "To disclaim any interest uthority shall empower him (her) to do any or all of the following, each of which is defined in 20 Pa.C.S.A.5603 (relating to implementation of power of attorney): 1. 2. 3. 4. 5. 6. 7. 8. "To make lonfirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and a with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and c and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connectiono hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-in-fact for me_______________________ Date -1- KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _______________________________________________ dD OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. _________________________________ Signature of Principal / Grantor _________________________________ Name of Principal / Grantor ___F ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE REAT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGEN'TS FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OE, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENBUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIMTO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, OWER OF ATTORNEY NOTICE TO PRINCIPAL / GRANTOR: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -4- PENNSYLVANIA GENERAL PIf you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisions for you. You may revoke this power behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally binding upon you. nt are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legal matters on yourpriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -3- CAUTION! PRINCIPAL: The Powers granted by this power of attorney documeacitated. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever approood idea to do so. Another type of Power of Attorney, called a Durable Power of Attorneys (available at findlegalforms.com as well), stays in effect even if the Grantor later becomes disabled or incapy and will allow the General Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a General Power of Attorney be witnessed, it is always a very gtate does not require it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorner of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a General Power of Attorney at any time. A General Power of Attorney should always be notarized, even if your swer of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Powe word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a po act on his or her behalf. This particular Form becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitated. Note that the Power of Attorney A General Power of Attorney allows a natural "mentally" competent person (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") tod before negotiating any document with another party. -1- [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -2- Information Generalintended and are not a substitute for legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consultection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. [_] These forms are not actions he undertakes. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be very careful in the selet should have access to the original document as needed. The Agent could also have an original document (i.e. with original signatures). The Agent should be prepared to make copies for different trans The Agent shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the Principal. [_] The Principal should keep the original document, as well as a copy. The Agenshall exercise the powers for the benefit of the Principal. The Agent shall keep separate the assets of the Principal from those of the Agent. The Agent shall exercise reasonable caution and prudence.o Principal" at the beginning of the Power of Attorney document. [_] The Agent (i.e. Attorney in Fact) will have to sign the Acknowledgement at the bottom of the Power of Attorney document. The Agent y, signing the document before a Notary is suggested. Notarization will also allow the Power of Attorney to be recorded as a public record, if necessary. [_] The Principal must also sign the "Notice tned the power of attorney on behalf of and at the direction of the principal. Furthermore, witnesses should not be related by blood or marriage to the Principal, Agent or Notary. Although not necessarng) or by another individual (at the direction of the Principal), then it shall be witnessed by two individuals, each of whom is 18 years of age or older. A witness shall not be the individual who sig. [_] The Principal (i.e. the person granting the power of Attorney) must be mentally competent. In Pennsylvania, if the Power of Attorney is executed by mark (when the Principal is incapable of signi) General Power of Attorney [_] This General Power of Attorney becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitatedInstructions & Checklist Pennsylvania General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3 PennsylvaniaPennsylvania e Agent / Surrogate _______________________________ Date -5- asonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ___________________________________ Signature of Substituter of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise retached power of attorney and am the person identified as the Substitute Agent / Surrogate for the Principal. I hereby acknowledge that in the absence of a specific provision to the contrary in the powwer of attorney unless the agent has first executed and affixed to the power of attorney an acknowledgment in substantially the following form I, ___________________________________, have read the at______ Signature of Agent / Surrogate _______________________________ Date -4- Acknowledgment by Substitute Agent (Substitute Surrogate) An agent shall have no authority to act as agent under the porom my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. ________________________ovision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate f___________________________, have read the attached power of attorney and am the person identified as the Agent / Surrogate for the Principal. I hereby acknowledge that in the absence of a specific prave no authority to act as agent under the power of attorney unless the agent has first executed and affixed to the power of attorney an acknowledgment in substantially the following form I, ________________ Witness's signature: ____________________________________________ Witness's address: ______________________________________________ -3- Acknowledgment by Agent (Surrogate) An agent shall hly and voluntarily signed this writing by signature or mark in my presence. Witness's signature: ____________________________________________ Witness's address: ______________________________________: ___________________________________________ Declarant's address: ____________________________________________ The declarant, or the person on behalf of and at the direction of the declarant, knowing___________________ Phone: _______________________________________________________ I made this declaration on the _________________ day of _________________. (day) (month, year) Declarant's signature Name and address of substitute surrogate (if surrogate designated above is unable to serve): Name: _______________________________________________________ Address: ___________________________________sciousness. Name: _______________________________________________________ Address: ______________________________________________________ Phone: _______________________________________________________-making: I do do not want to designate another person as my surrogate to make medical treatment decisions for me if I should be incompetent and in a terminal condition or in a state of permanent unconif I do not specifically indicate my preference regarding any of the forms of treatment listed above, I may receive that form of treatment. Other instructions (or write none): -2- Surrogate decisionon (water). I do do not want blood or blood products. I do do not want any form of surgery or invasive diagnostic tests. do not want kidney dialysis. I do I do do not want antibiotics. I realize that rms of treatment: I do do not want cardiac resuscitation. I do do not want mechanical respiration. do not want tube feeding or any other artificial or invasive form of I do nutrition (food) or hydratin, including any pain that might occur by withholding or withdrawing life-sustaining treatment. In addition, if I am in the condition described above, I feel especially strongly about the following foong the process of my dying, if I should be in a terminal condition or in a state of permanent unconsciousness. I direct that treatment be limited to measures to keep me comfortable and to relieve paittled commitment to refuse life-sustaining treatment under the circumstances indicated below. I direct my attending physician to withhold or withdraw life-sustaining treatment that serves only to prol_________________________________________________, being of sound mind, willfully and voluntarily make this declaration to be followed if I become incompetent. This declaration reflects my firm and seS. _________________________________ Signature of Principal / Grantor _________________________________ Name of Principal / Grantor __________________________ Date -1- Pennsylvania Declaration I, __E IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTCAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56. IF THERT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGEN'TS FUNDS. A COURT T FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITwith a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com 2 Pennsylvania Declaration Notice NOTICE THE PURPOSE OF THits your particular situation. 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 should only be a starting 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 fpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These formsided in section 5604 (durable powers of attorney). [_] 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 purrney to act on behalf of that principal. § 5601.1. Powers of attorney presumed durable. Unless specifically provided otherwise in the power of attorney, all powers of attorney shall be durable as provrecord of all actions, receipts and disbursements on behalf of the principal. 1 (f) Definition.--As used in this chapter, the term "agent" means a person designated by a principal in a power of atto to: · Exercise the powers for the benefit of the principal. · Keep separate the assets of the principal from those of an agent. · Exercise reasonable caution and prudence. · Keep a full and accurate under a power of attorney has a fiduciary relationship with the principal. In the absence of a specific provision to the contrary in the power of attorney, the fiduciary relationship includes the duty of an agent to exercise a power under a power of attorney, the agent shall have the burden of demonstrating that the exercise of this authority is proper. e) Fiduciary relationship.--An agent acting ude the following notice in capital letters at the beginning of the power of attorney. The notice shall be signed by the principal. In the absence of a signed notice, upon a challenge to the authoritym is 18 years of age or older. A witness shall not be the individual who signed the power of attorney on behalf of and at the direction of the principal. (c) Notice.--All powers of attorney shall inclark, or by another on behalf of and at the direction of the principal. If the power of attorney is executed by mark or by another individual, then it shall be witnessed by two individuals, each of whoxpressly directs to the contrary, shall be construed in accordance with the provisions of this chapter. (b) Execution.--A power of attorney shall be signed and dated by the principal by signature or melegated to an agent, any or all of the powers referred to in section 5602(a) (relating to form of power of attorney) may lawfully be granted in writing to an agent and, unless the power of attorney e CH. 56. The following are useful excerpts from the Statutes relating to the Pennsylvania Declaration Form. § 5601. General provisions. (a) General rule.--In addition to all other powers that may be dvania Declaration Form; (2) Pennsylvania Declaration Form (Power of Attorney for Health Care / Living Will) Form. This Pennsylvania Declaration Form is based on the Pennsylvania Statutes at 20 PA.C.S.e contains (1) Information and Instruction for Pennsylvania Declaration Form (Power of Attorney for Health Care / Living Will) including excerpts from the Pennsylvania Statutes relating to the PennsylPennsylvania Declaration Form Information The Pennsylvania Declaration Form is a document which contains both a Living Will and a Power of Attorney for Health Care for use in Pennsylvania. This packag PennsylvaniaPennsylvania _ day of __________________, 20____. __________________________________________ Notary public [SEAL] Self-proved Will Affidavit _____________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced ______________________ as identification, this ______ly known to me or who has produced ______________________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced ____________________, the testator, who is personally known to me or who has produced _____________________ as identification, and by _______________________________________________, a witness, who is personal______________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed and sworn to before me by __________________________________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ _______________ age to witness a will. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______ng, of the age of majority (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of propere will upon the request of the testator, in the presence and hearing of the testator and in the presence of each other; 4) to the best knowledge of each witness, the testator was, at the time of signior foregoing instrument is the last will of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presence of the witnesses; 3) the witnesses signed ths are signed to the attached or foregoing instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, each then declared to me that: 1) the attached __________________________, the testator and _______________________________________, and __________________________________, and ___________________________________________, the witnesses, whose name Will Affidavit STATE OF __________________________ COUNTY OF ________________________ I, the undersigned, an officer authorized to administer oaths, certify that ______________________________________ ___________________________________ ___________________________________ Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 7 of ______ Self-Proved_____________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ______________ Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ ______________________________luence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his or her name. Dated: ____________________, ______ Witnessthe date shown above. We understand this is the Testatrix's Will; We believe the Testatrix is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue infent and we, at the Testatrix's request and in the Testatrix's sight and presence and at Testatrix's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on e __________ Witness __________ __________ Witness Witness Page 6 of ______ presence by _____________________________ (the "Testatrix"), who declared this instrument to be her Last Will and Testam__________________ that the above instrument, which consists of _____ pages, including the page(s) which contain the witness signatures, was signed in our sight and Initials: __________ Testatrix/Wifhe following clause before signing. The witnesses should not receive assets under this Will.) We, the undersigned, hereby certify and declare under penalty of perjury under the laws of the State of __ix's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read tthis to be my Last Will and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influence and ask the Witnesses named below to witness my signature. Testatrs, except where otherwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare e other Spouse or who died first, I direct that it be determined that my Husband survived me. In that case, the terms of his Will shall then take precedence over the terms of this Will or it's Codicilon should remain effective. 7. Survival If my Husband and I die under circumstances whereby it is difficult or impractical to determine the order of deaths or to determine who survived the death of thse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all other provisi and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereunder, free from all matrimonial rights or controls by his or her spouherefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of sharing or division of property which may exist between any beneficiarythe specific items of property comprising the 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 th actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or non-actions as the fiduciary, except for sucge 5 of ______ 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and myo have survived me unless the beneficiary is living on the thirtieth day after the date of my death. Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Paate of the court order granting such adoption. 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not ter or number The terms "child" and "descendant" 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 dany gender shall be deemed to include all 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 gendven to the paragraphs of this Will are inserted 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 or whomsoever. ARTICLE VII MISCELLANEOUS 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 gieir powers, authority and discretion shall 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 whatsoeverbut for the foregoing, be considered as being 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 th interest, whether monetary or otherwise, 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, ir heirs or personal representatives by 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 bestaccountant, agent, broker and other professional 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 thell such claims if the Executor deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with administering my estate, including but not limited to attorney, g by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and conditions as the Executor may deem advisable and to refer to arbitration a 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or claims at any time owinon, designation or exercise of discretion, entered into by the Executor in good faith. Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 4 of ______l not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or by my estate resulting from any election, determinatitive or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereof. The Executor shaltions, and designations permitted by any statute or regulation enacted by the federal government of the United States of America, by the legislature or government of any state, or by any other legislar shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or refrain from making, in Executor's absolute discretion, any elections, determinaeneficiaries of my estate to use any tangible personal property or real property, without paying any rent, without giving any bond or security and without liability for any loss or damage. The Executos of my Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest not actually producing income shall be treated as producing income. 7. Permit any bthe date of my death at Executor's absolute discretion without responsibility for loss to the intent that investments or assets so retained shall be deemed to be authorized investments for all purpose upon the basis of fair market value and cause any share to be composed of money, property or undivided fractional share in property. 6. Retain any of my investments or assets in the form existing at rsion of my estate or any part or parts thereof for such length of time as they may think best. Make any division or distribution of my residuary estate in money or in other property or partly in botht such time or times, in such manner and upon such terms, and either for cash or credit or for part cash and part credit as they may in their absolute discretion decide upon, or to postpone such conveg that one or more of the Executor may be beneficially interested in the property or any part thereof so valued. 5. Sell, call in and convert into money any part of my estate not consisting of money ag any such division, setting aside or payment and the decision of the Executor shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstandinf such division, setting aside or payment, 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 makin. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly or in part in the assets forming my estate at the time of my death or at the time othereof, to borrow money on any such real estate upon the security of any mortgage or mortgages and to pay off any mortgage or mortgages which may be in existence at any time forming part of my estateements and generally to manage any such property. The Executor shall also have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my estate or any part atrix/Wife __________ Witness __________ __________ Witness Witness Page 3 of ______ 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improvs and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the manner and to the extent that the Executor shall deem advisable. Initials: __________ Testnd not mandatory. 2. Take charge of any real property as part of the probate administration of my estate for such period as the Executor shall determine; collect any income therefrom; and pay the taxend deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary ah purposes, for such prices, and 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 aLease, sell, grant options, partition, 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 sucity of the Executor and in addition 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. without unnecessary intervention 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 authortate without adjudication, order or direction of the court having jurisdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate rtion thereof who may be acting as such from time to time whether original or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to administer my esutor of this my Will in the place and stead of my Husband. References to "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my Will, my estate or any po_, as the Executor of this my Will. If my Spouse cannot, does not or is unable to serve or continue to serve as Executor for any reason, I appoint ___________________________________, , to be the Exece a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE V NOMINATION OF EXECUTOR I appoint my Husband __________________________________at Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 2 of ______ the time of the distribution or to any other person the Executor may consider to bmake any distribution for any such person directly to the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of such person, person with whom the beneficiary resides ted otherwise by law, if any person should become entitled to any share in my estate before attaining the age of majority or while under any other disability, I authorize the Executor to nevertheless State of ________________________, then in effect, as if I had died intestate at the time fixed for distribution under this provision. Except as may be specifically otherwise provided herein or direcres per stirpes. If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective shares to be determined under the laws of the____________________ _____________________________________________________________________(name(s) beneficiary(ies)). If more than one beneficiary is named, then the distribution shall be in equal sha_______. If my Spouse does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed to: ____________________________________________iduary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed, bequeathed and given to my Spouse. _______________________________t in my primary residence or homestead, if any, shall be distributed to my Husband ___________________________________. If my Husband does not survive me, this bequest shall be distributed with my res_________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. Primary Residence My interes_ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. ____________________________________be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. ____________________________________________espect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. _____________________________________________ shall y such Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 1 of ______ purchaser or transferee upon or after my death pursuant to any agreement with rfor the payment of the taxes. This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired b by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The Executor shall not be seek reimbursement from any beneficiary n property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit given or conferred by me either during my lifetime ora separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the taxes are owed ouding income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executor shall create, out of the residue, III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of and charged to the capital of my general estate. All taxes (incles or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of any court. ARTICLEE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and interment, including the disposition of the ashied to ___________________________________________ (name of husband). All references to "my Husband" refer to _____________________________________ (name of husband). I don't have any children. ARTICLme), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I SPOUSE I am marr__, 20____. __________________________________________ Notary public [SEAL] Self-proved Will Affidavit Last Will And Testament Of ______________________ I, _____________________________________ (nacation, and by ____________________________________________, a witness, who is personally known to me or who has produced ______________________ as identification, this _______ day of ________________ produced ______________________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced ______________________ as identifi, who is personally known to me or who has produced _____________________ as identification, and by _______________________________________________, a witness, who is personally known to me or who has_____ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed and sworn to before me by _____________________________________, the testator_______ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ____________________________________________________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: _______________________________y (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of proper age to witness a will. _f the testator, in the presence and hearing of the testator and in the presence of each other; 4) to the best knowledge of each witness, the testator was, at the time of signing, of the age of majorits the last will of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presence of the witnesses; 3) the witnesses signed the will upon the request ohed or foregoing instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, each then declared to me that: 1) the attached or foregoing instrument i_, the testator and _______________________________________, and __________________________________, and ___________________________________________, the witnesses, whose names are signed to the attac__________________________ COUNTY OF ________________________ I, the undersigned, an officer authorized to administer oaths, certify that ________________________________________________________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 7 of ______ Self-Proved Will Affidavit STATE OF __ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _________________________________ddress: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ _____________s 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: Name: Aove. We understand this is the Testator's Will; We believe the Testator is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue influence; The maker iand presence of each other, do hereby Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 6 of ______ subscribe our names as witnesses on the date shown ab(the "Testator"), who declared this instrument to be his 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 sight ___________ 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 _____________________________ owing 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 _________gnature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the follo 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 Siept where otherwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare this tof the other Spouse or who died first, I direct that it be determined that I survived my Wife. In that case, the terms of this Will shall then take precedence over any Will or Codicils of my Wife, exc provision should remain effective. 7. Survival If my Wife and I die under circumstances whereby it is difficult or impractical to determine the order of deaths or to determine who survived the death her spouse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all othereficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereunder, free from all matrimonial rights or controls by his or income therefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of sharing or division of property which may exist between any beniaries, the specific items of property comprising the 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 for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more benefic___ Testator __________ Witness __________ __________ Witness Witness Page 5 of ______ connection with or arising out of that fiduciary's good faith actions or non-actions as the fiduciary, except of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in Initials: _______e deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date of my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absencef age on the date of the court order granting such adoption. 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall brdless of gender or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, but only if, the adopted person is not more than twelve years oll the use of any gender shall be deemed to include all 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 rega The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. Throughout this Winal whatsoever or whomsoever. ARTICLE VII MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender.exercise of their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question or review, by any person, official, authority, court or tribuld otherwise, but for the foregoing, be considered as being other than an impartial exercise of their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such to be the best interest, whether monetary or otherwise, 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 wouciaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor shall exercise the powers, authority and discretion granted herein in what Executor deems to attorney, accountant, agent, broker and other professional fees. The Executor shall be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the benefi arbitration all such claims if the Executor deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with administering my estate, including but not limited any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and conditions as the Executor may deem advisable and to refer toterest at the time of my death. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 4 of ______ 10. Compromise, settle, waive or pay any claim or claims atlection, determination, designation or exercise of discretion, entered into by the Executor in good faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an inf. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or by my estate resulting from any eby any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereoelections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States of America, by the legislature or government of any state, or damage. The Executor shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or refrain from making, in Executor's absolute discretion, any ome. 7. Permit any beneficiaries of my estate to use any tangible personal property or real property, without paying any rent, without giving any bond or security and without liability for any loss orents for all purposes of my Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest not actually producing income shall be treated as producing inche form existing at the date of my death at Executor's absolute discretion without responsibility for loss to the intent that investments or assets so retained shall be deemed to be authorized investmty or partly in both upon the basis of fair market value and cause any share to be composed of money, property or undivided fractional share in property. 6. Retain any of my investments or assets in t postpone such conversion of my estate or any part or parts thereof for such length of time as they may think best. Make any division or distribution of my residuary estate in money or in other properonsisting of money at such time or times, in such manner and upon such terms, and either for cash or credit or for part cash and part credit as they may in their absolute discretion decide upon, or toe and notwithstanding that one or more of the Executor may be beneficially interested in the property or any part thereof so valued. 5. Sell, call in and convert into money any part of my estate not cthe purpose of making any such division, setting aside or payment and the decision of the Executor shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market valuath or at the time of such division, setting aside or payment, 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 ng part of my estate. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly or in part in the assets forming my estate at the time of my de estate or any part thereof, to borrow money on any such real estate upon the security of any mortgage or mortgages and to pay off any mortgage or mortgages which may be in existence at any time formiator __________ Witness __________ __________ Witness Witness Page 3 of ______ shall also have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor Initials: __________ Testherefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the manner and to the extent that the Executor shall deem advisable. herein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate administration of my estate for such period as the Executor shall determine; collect any income txecutor power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of salein such manner and for such purposes, for such prices, and 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 Ehe right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of any real or personal property that may be included in my estate ion to the existing authority of the Executor and in addition to other powers and authority granted by law or necessary or appropriate for proper administration of my estate, the Executor shall have tation designed to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any Executor serving hereunder. ARTICLE VI POWERS OF EXECUTOR In addit right to administer my estate without adjudication, order or direction of the court having jurisdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legisl Will, my estate or any portion thereof who may be acting as such from time to time whether original or substituted and whether one or more. To the extent permitted by law, the Executor shall have the___________, , to be the Executor of this my Will in the place and stead of my Wife. References to "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my_________________, as the Executor of this my Will. If my Wife cannot, does not or is unable to serve or continue to serve as Executor for any reason, I appoint _______________________________________arge to the Executor. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 2 of ______ ARTICLE V NOMINATION OF EXECUTOR I appoint my Wife __________________ the beneficiary resides at the time of the distribution or to any other person the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient dischExecutor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of such person, person with whom provided herein or directed otherwise by law, if any person should become entitled to any share in my estate before attaining the age of majority or while under any other disability, I authorize the ned under the laws of the State of ________________________, then in effect, as if I had died intestate at the time fixed for distribution under this provision. Except as may be specifically otherwiseion shall be in equal shares per stirpes. If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective shares to be determi_____________________________________________ _____________________________________________________________________(name(s) beneficiary(ies)). If more than one beneficiary is named, then the distribut________________________________. If my Spouse does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed to: ___________________e distributed with my residuary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed, bequeathed and given to my Spouse. ______e. Primary Residence My interest in my primary residence or homestead, if any, shall be distributed to my Wife ___________________________________. If my Wife does not survive me, this bequest shall b________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estat________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my residuary estate. _____________ursuant 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. _____________________property transferred to or acquired by such Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 1 of ______ purchaser or transferee upon or after my death pk reimbursement from any beneficiary for the payment of the taxes. This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any erred 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 Executor shall not seegardless 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 benefit given or confcutor 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 shall be made real 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 my estate. The Exe 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 charged to the capitnt, 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 or rule of courtwife). I don't have any children. ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, cremation or burial and intermeto be my Last Will and Testament. ARTICLE I SPOUSE I am married to _____________________________________ (name of wife). All references to "my Wife" refer to ________________________________ (name of _______________ I, _____________________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this lways recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of _______se 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 from a local attorney is an is limited (it was $100,000 in 1999). This information and these forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. Then 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 U.S. citizen, the deductioaccounts and qualified employee benefit plans; [] the face value of any life insurance policy; [] property you are holding in trust; any joint property you own In addition, each individual may leave ad bonds; [] bank accounts; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement 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: [] real estate; [] stocks aneater your need for professional estate tax planning advice If Information about Wills ­ Page 2 your assets come near the $1,000,000 level, you really shouldn't use this will and should consult withable to each individual and his or her spouse. Estates totaling $1,000,000 or more could be subject to federal estate tax. As your estate approaches $1,000,000 in value and exceeds that amount, the grtherwise due on a portion of the value of an individual's estate. For a person dying in 2003, that credit is $1,000,000. The amount of the credit increases over the next few years. The credit is availd 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 against the estate tax 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 need more complicateself 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 format similar to the orom the Will). In those states it will have to be "proven" in court, like any other will. In Ohio, Maryland, California and the District of Columbia, the courts have some latitude to accept a will as tatutes 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 a separate document fy 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 of 1999).do not have ses 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 Affidavit, the Will maestify 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 need to have witnesseed 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 come into court and tvit 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. However, it can sp 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 acknowledgment and the affida 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), and assets held in 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 which are individuallydiscussed 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 Will distributes thee 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 should be r 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 attorney first to make sures 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 and/oes 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 implied or express warrantie 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. If the Testator movdisinherit 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%. Check the totals befortee 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 attorney if you wish to . 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.. Most state laws guarandifying words on the face of the Will. Such changes are usually disregarded. Instead when changes are desired, the original and all copies should be destroyed and an entirely new Will should be signedther 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 adding, deleting, or moefits arising in other contracts and plans are not normally governed by a will. This Will is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and o 4 dispose of property held in joint tenancy with rights of survivorship or property held in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benspose 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 Checklist & Instructions ­ Pageare 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. This Will does not dis 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 to probate. Copies 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 other legal instruments. 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 bank or trust company,ve / 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 appropriately with family membererved 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 Personal Representatiowledgment 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 formalities were obsl 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 Testator's acknch 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 not a part of the Wilgning. 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, including the page(s) on whid 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 date of the actual sises 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 witnesses must be satisfieor 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 of pages. The witnesnesses don't need to read or know the contents of the Will. For example, the Testator can say: "The document I am about to sign is my Last Will and Testament. I am signing it freely and voluntarily", tructions ­ Page 3 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 wit, 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 affidavit. Checklist & Insthe 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. For example children signed by the Testator in the presence of three (3) qualified, competent, disinterested and adult witnesses and a notary public. The signature of a third witness can provide additional protection if amiliar with the property and the value thereof and knows about relatives and others who might be entitled to a share of the estate. Although most states only require two witnesses, the Will should be) must be of "sound mind" when 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 f Will was signed. The Affidavit needs to be completed and signed , by the Testator, all Witnesses and a Notary in front of each other. · · · · · The Testator (i.e. the person who is writing the Willr of pages; [] name of testator; []witness signatures and info Affidavit: The enclosed Affidavit (although technically not part of the Will) states that all required formalities were observed when theeous death of both husband and wife. Signature Block: Testator needs to fill out: [] day month year city; []Signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] numbe matters like taxes, taking care of the property, and making distributions to the beneficiaries Article VII: Contains miscellaneous provisions including a provision dealing with situations of simultan 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 representative to deal withalso responsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Representative will pay whatever is left toate, and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is laws 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 estist & Instructions ­ Page 2 Residuary Estate is given to; [] name of beneficiary or beneficiaries to whom the residuary estate is given in event Spouse does not survive Testator; [] state under whoseen to (three blank paragraphs are provided, but you can add as many as you need). [] name of Spouse to whom Testator's interest in any primary residence is given; [] name of Spouse to whom the Checklecific dollar amounts or other property to specific persons or charities. Testator must provide and fill out: [] description of property (or dollar amount); [] name(s) of person/entity property is giv of funeral and Burial expenses. Article III: Authorizes payments of debts and expenses. Article IV: Disposes of specific property, primary residence and residuary property. Allows Testator to give spvide and fill out: []name, [] county and []state Article I: Gives the name of the spouse. Testator/Testatrix must provide and fill out [] name of spouse (in two places); Article II: Authorizes payment · · · · · · Title: Enter name of Testator/Testatrix in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator/Testatrix must proious sections. The content of each section is explained below. Some sections require information to be provided and filled out in the space provided. The enclosed Affidavit also needs to be completed.lls are the same. The Wills can be executed at different times although it is suggested (plus for practical purposes) that both Wills be executes/signed at the same time. This Will is divided into vares a self-proved affidavit. There are two Wills in this form package. The first Will and Affidavit is to be used by the Husband. The second Will is to be used by the Wife. The instructions for both wigo to other beneficiary(ies). This Will also allows the Testator/Testatrix to make specific gifts to others as well. This Will is suitable for estates worth less than $1,000,000. This Will also includ also has a provision dealing with situations of simultaneous death of both husband and wife. If the Spouse does not survive the Testator/Testatrix (i.e. man or woman making the will) the assets will ains two "Mutual Wills" and is for use by a married couple (husband and wife) with no children. The Wills distribute the assets of the Husband to the Wife and the assets of the Wife to the Husband. Itlls; (3) Husband's Mutual Will ­ Married Couple with No Children with self-proved affidavit; (4) Wife's Mutual Will ­ Married Couple with No Children with self-proved affidavit. This form package contChecklist and Instructions Mutual Will - Married Couple with No Children This package contains (1) Checklist and Instruction for Mutual Will ­ Married Couple with No Children; (2) Information about Wi PennsylvaniaPennsylvania : _____________________________ _____________________________ Quitclaim Deed - 2 ____________________ Name typed, printed, or stamped My commission expires: _________________________ Grantee's Address: _____________________________ _____________________________ Grantors Address____________________________ as identification. In witness thereof, I set my hand and seal ___________________________________ Signature of person taking acknowledgment (Notary Public) _______________e foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by __________________________ (name of Grantor), who is personally known to me or who has produced ________________ Quitclaim Deed - 1 ___________________________________ (Witness Signature) Print Name: ___________________________ State of PENNSYLVANIA ) ) ss County of ________________________ ) Th___________________________ ____________________________________________ Grantor's Typed Name Signed in our presence: ________________________________ (Witness Signature) Print Name: _______________s and/or assigns shall have, claim or demand any right or title to the aforesaid property, premises or appurtenances or any part thereof. EXECUTED this day of ________, 20 _______ . _________________scribed property unto the said Grantee, Grantee's heirs, administrators, executors, successors and/or assigns forever; so that neither Grantor nor Grantor's heirs, administrators, executors, successor_____, County of ___________________________________, State of Pennsylvania with the following legal description: TO HAVE AND TO HOLD all of Grantor's right, title and interest in and to the above de, AND FOREVER QUITCLAIMS to ______________________________________________________ ("Grantee"), all right, title, interest and claim to the following real property in the City of _____________________and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned, _________________________________________ ("Grantor"), hereby REMISES, RELEASESnd tax statements to: Above reserved for official use only QUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: FOR A VALUABLE CONSIDERATION, in the amount of TEN AND NO/100 DOLLARS ($10.00) in hand ith another party. The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Recording requested by: and when recorded, please return this deed aor legal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document w a Quitclaim Deed, make sure that it satisfies your needs. Consult a real estate attorney and title insurance company to protect your interests. These forms are not intended and are not a substitute fhe only form of conveyance when buying a property. Quitclaim deeds are mainly used in family situations or to correct possible technical defects in the title to the property. If you are a buyer takingerest exists at all. This type of deed may be useful in cases where a party is unable to transfer a fee simple estate or make promises about the title. A buyer will rarely accept a Quitclaim Deed as tonvey an interest in real estate. A Quitclaim Deed does not include any promise or guarantee by the person making it (i.e. the Grantor) about the nature or quality of that interest, or even if any int another party. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information for Quitclaim Deed This Quitclaim Deed form is used to clegal advice. These forms should only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document withtype of document, additional requirements may apply. Nonconforming documents may be returned unrecorded or may be charged additional fees [_] These forms are not intended and are not a substitute for description is correct. [_] A Quitclaim Deed may require other documents to be filed with it. Please check your local requirements with your local Recorder's (or similar) office. [_] Depending on the rties. Although witnesses are not required in all states, it is generally a good idea to use them. [_] Documents referencing land should include a legal description of the land. Verify that the legal e a Notary and two witnesses. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the Quitclaim Deed may not be effective against third paInstructions & Checklist for Quitclaim Deed [_] This package contains (1) Instructions and Checklist for Quitclaim Deed (2) Quitclaim Deed [_] The Grantor should date and sign the Quitclaim Deed befor PennsylvaniaPennsylvania _____________ 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 Pennsylvania