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Wisconsin Address -6- owledgment (Notary Public) _________________________________ Name typed, printed, or stamped This Document Prepared by: _____________________________________Name _______________________________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person taking ackne of __________________________ ) ) ss County of ________________________ ) -5- The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by ___________________ State: ___________________________________ BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT. Notary's Acknowledgment Stat______________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: _______________________________e, the Principal appears to be of sound mind and does not appear to be under duress. Witness Signature: ___________________________________ Name: ___________________________________ City: ____________Signature of ("Principal") On this day ______________ (date) I declare that the Principal indicated that he understands the nature of this document and is signing it freely and voluntarily. Furthermor___________ (name of Principal) has executed this Durable Power of Attorney on ____________ (date) at ____________________ (city), __________________________ (state). ________________________________ ful misconduct, while acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. IN WITNESS WHEREOF, _______________d harmless. Agent shall not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willttorney. If this Durable -4- Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without notice of such termination, shall be hel third party until the third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of a assets to be subject to a general power of appointment by my Agent. Any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policies I may own on the life of my Agent; and/or (c) myr issuance of this power-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by this power-of-attorney are limited to the extenthen the remaining unaffected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person needs to inquire as to the reasons for the use oe not intended to restrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, illegal or unenforceable under applicable law, t for all funds handled and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers arreasonable compensation for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on my behalf, my Agent shall provide an accountingly. My Agent shall be entitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to herein, "disability" or "incapacity" shall mean a lack of capacity to receive and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properfect thereafter until my death. This Power of Attorney shall not terminate on my subsequent disability, incapacity or lack of mental competence (except as provided by any applicable statute). As used the rights, powers, and authority of my Agent shall become effective immediately upon execution of this instrument. The rights, powers, and authority of this document shall remain in full force and efent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and m any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. However, Agse whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the time of such transfer. -3- 17. To disclair the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support which my Agent may owe to others, excluding thogent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, ocalendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests or rights, directly or indirectly, to my Atax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumulative and shall lapse at the end of each guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors may be made to the minor directly or parent, or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons or organizations without regard to whethere and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating to tax matters and to negotiate, compromise 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limited to, federal, state, local or other incomfuture. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment professionals, brokers and real estate agents.ks, bonds, debentures, commodities, options or any other investments. 12. To maintain and/or operate any business that I currently own or have an interest in or may own or have an interest in, in the ny other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, including proxy rights, with respect to stoc draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased by me alone or in conjunction with a, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, -2- negotiate, sell or transfer any note, security, oruding, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificatese accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institution with respect to any of my accounts, inclng Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificates of deposit, investment accounts, brokeragental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Representative Payee" for the purpose of receivig, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government or its agencies in connection with governmeive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurance benefits and government program includince and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and disclaimers under such policies. 8. To recht to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insuranent or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenants and to recover possession; and the rigth all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and to execute any necessary document, instrum or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and at prices my Agent may deem proper) deal wind demands whatsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payable, or belonging to, me or in which I have or may hereafter acquire any interest, to have,l sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposit, any and all documents of title a amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hold, possess and/or invest any and aland obligations and such other instruments in writing of whatever kind and nature as may be. -1- 3. To request, ask, demand, sue and take any and all legal steps necessary to recover and collect anyvings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgments, security agreements and other debts cuments, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit of, or investments with or through banks, saions, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title donto binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreement, including but not limited to applicatt's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter ieby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights hereby granted. My Agenre in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever as I could do if personally present. I hery-in-fact for me and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whatsoever that I now have or may later acqui______________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorneHIS POWER OF ATTORNEY IF YOU LATER WISH TO DO SO. KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _________________________________UPON YOU. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE TRS ON YOUR BEHALF, INCLUDING THE POWER TO SELL, MORTGAGE OR DISPOSE OF YOUR PROPERTY. ANY SUCH ACTION UNDERTAKEN BY YOUR AGENT, WITHIN THE SCOPE OF THIS POWER OF ATTORNEY DOCUMENT, IS LEGALLY BINDING THIS DOCUMENT ARE BROAD AND SWEEPING. BEFORE SIGNING THIS DOCUMENT, CONSIDER ITS CONSEQUENCES. YOU ("GRANTOR") ARE PROVIDING ANOTHER PERSON ("AGENT") WITH THE POWER TO HANDLE BUSINESS AND LEGAL MATTEhe instructions included with the forms packages offered for sale, generally include state specific instructions. -2- DURABLE POWER OF ATTORNEY Effective Immediately (CAUTION): THE POWERS GRANTED BY Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specific. Whenever appropriate, the Durable Power of Attorney to be recorded as a public record, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so.ire it, especially if the Agent will be dealing with any real property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow tment, will be legally binding upon the Grantor. The Grantor can revoke a Durable Power of Attorney at any time. A Durable Power of Attorney should always be notarized, even if your state does not requhe Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney docus not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. Tpacitated. This particular Form becomes effective immediately and remains in full force and effect even if the Principal (i.e. the Grantor) later becomes incapacitated. Note that the word "attorney" intally" competent person (called the "Principal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf, even if the Principal later becomes incahese forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attorney Effective Immediately A Durable Power of Attorney allows a natural "mearting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of t At the bottom of the document, indicate the name and address of the person who prepared it. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a sty careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle business and legal matters on the Principal's behalf. [_] access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks the Agent should complete. The Grantor should also be veresses should be adults. The Agent, the Agent's spouse or children, and the Notary should not be witnesses. [_] The Principal should keep the original document, as well as a copy. The Agent should havehe Durable Power of Attorney to be recorded as a public record, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. The witn Principal (i.e. the Grantor) becomes subsequently incapacitated. [_] The Principal (i.e. the person granting the power of Attorney) should sign the document before a Notary. Notarization will allow t Durable Power of Attorney Effective Immediately; (3) Durable Power of Attorney Effective Immediately [_] This Durable Power of Attorney becomes effective immediately and remains effective even if theInstructions & Checklist Durable Power of Attorney Effective Immediately [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective Immediately; (2) Information for WisconsinWisconsin ________________________________ Signature of person taking acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- his _____ day of ____________________, ______ by __________________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. ________________________ State: ___________________________________ State of __________________________ ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me t_ City: __________________________________ State: ___________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: _______________ (city), __________________________ (state). ________________________________ Signature of Principal Witness Signature: ___________________________________ Name: __________________________________acting under the authority of this Power of Attorney. I may revoke this Power of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at ___________________l not be liable for losses resulting from judgment errors made in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willful misconduct, while le Power of Attorney is terminated by operation of law, any person relying in good faith on the authority of this document, without notice of such termination, shall be held harmless. -4- Agent shal third party has actual knowledge of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. If this Durabto a general power of appointment by my Agent. Any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the(a) my income to be taxable to my Agent; (b) my Agent to have any rights or ownership with respect to any life insurance policies I may own on the life of my Agent; and/or (c) my assets to be subject er-ofattorney or as to the disposition of any proceeds paid to my Agent based on this document. The powers granted to my Agent by this power-of-attorney are limited to the extent necessary to prevent fected parts of the document shall still remain in full force and effect and not be affected by any partial invalidity. No person needs to inquire as to the reasons for the use or issuance of this powrict or limit the definition or scope of powers granted herein in any manner. If any part of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaf and all acts performed as my Agent. This Power of Attorney shall be construed as broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restn for any services provided as my Agent If so requested by myself or any authorized personal representative or fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handledentitled to reimbursement of all reasonable expenses incurred as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensatioe and evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly, as certified in writing by a licensed medical doctor. My Agent shall be on my subsequent disability, incapacity or lack of mental competence, except as provided by any applicable statute. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receivin writing by a licensed medical doctor. The rights, powers, and authority of this document shall remain in full force and effect thereafter until my death. This Power of Attorney shall not terminate rectly or indirectly to my Agent or my Agent's estate. This Durable Power of Attorney and all rights and powers therein shall become effective upon my subsequent disability or incapacity as certified any other person, estate, trust, or other entity, as may be appropriate. However, Agent may not disclaim assets, to -3- which I would be entitled, if the result is that the disclaimed assets pass diust created by me, if such trust exists at the time of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me from ions, including any obligations of support which my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trof appointment I may hold in favor of my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligatassign or designate any of my assets, interests or rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers ar year, and this annual right shall be non-cumulative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, To Minors Act. Any gifts made shall be limited to gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendt tax returns and documents. Gifts to minors may be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers angible or intangible property, to such persons or organizations without regard to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gifncy, including governmental agencies, relating to tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, ther governmental body, including, but not limited to, federal, state, local or other income and tax returns and necessary and/or related documents; to obtain or provide information to and from any ageited to, attorneys, accountants, investment professionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or otess that I currently own or have an interest in or may own or have an interest in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limcontents. 11. To exercise any and all rights, including proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. 12. To maintain and/or operate any businosit box, vault or other storage area owned or leased by me alone or in conjunction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the orm any act necessary to deposit, negotiate, sell or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities. -2- 10. To have access to any safe depuments, obtaining bank statements, passbooks, drafts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perfusiness with any banking or financial institution with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instrhecking accounts, savings accounts, certificates of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any banyone, including my Agent, to act as my "Representative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, c any other reasonable request by any government or its agencies in connection with governmental benefits (including but not limited to, medical, military and social security benefits), and to appoint retirement benefits, retirement plans, insurance benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and performppropriate person and to make any elections and disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension,y reason of such transaction. 7. To apply for, purchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other a may own in the future; the right to remove tenants and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me b(now owned or acquired in the future by me) and to execute any necessary document, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own orest and in any other manner (on such terms and at prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible le, or belonging to, me or in which I have or may hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvts, notes, interests, dividends, certificates of deposit, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due in the future, owned by, due, owing payabst any other person or entity. -1- 5. To receive, hold, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposik, demand, sue and take any and all legal steps necessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf againases, and satisfaction of mortgages, lien, judgments, security agreements and other debts and obligations and such other instruments in writing of whatever kind and nature as may be. 3. To request, asal and deposit slips, certificates of deposit of, or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releeds, security agreements, leases, mortgages, notes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawry to enter into any such contract and/or agreement, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deall lawful business of whatever kind or nature, on my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessaause to be done by virtue of this power of attorney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and l, tangible or intangible, or matter whatsoever as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or c act, power, duty, legal right or obligation whatsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or persona___________________________________ as my alternate or successor Agent, as necessary, to serve with the same powers, rights and discretions. My Agent shall have full power and authority to perform any-fact for me and in my name, and in my behalf. If the above named Agent is unable to serve for any reason, I appoint _____________________________________ maintaining an address at: ____________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: _____________________________________________________ my true and lawful attorney-inLE POWER OF ATTORNEY Effective upon Disability KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an address at _____________________________________revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumes the fiduciary and other legal responsibilities of an agent. -3- DURABbinding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize anyone to make medical and other health-care decisions for you. You may al matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your agent, within the scope of this power of attorney document, is legally of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are providing another person ("agent") with the power to handle business and legic. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific instructions. -2- CAUTION! PRINCIPAL: The Powers granted by this power any real estate in Florida. Please note that this information is not intended as and is not a substitute for legal advice. Furthermore, this information is general information that is not state specifcord, if necessary. Although, some states don't require that a Durable Power of Attorney be witnessed, it is always a very good idea to do so. Two witnesses are necessary, if the Agent will deal with eal property. Notarization will make it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the Durable Power of Attorney to be recorded as a public reis unable to serve or continue to serve as the Agent. A Durable Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any r of Attorney takes effect only after the Principal becomes disabled or incompetent, an alternate Agent can be designated, at the time this Power of Attorney is signed, in the event the original Agent the Principal is incapacitated when the Power of Attorney goes into effect, or the Agent undertakes the acts. The Principal can revoke a Durable Power of Attorney at any time. Since this Durable Powernt and should be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Principal. This is especially important if n acting as the attorney-in-fact for the Principal does not need to be a lawyer. Almost anyone can be appointed an attorney-in-fact by a power of attorney. A Power of Attorney is a "powerful" instrumecipal later becomes incapacitated. This particular Form becomes effective upon the disability or incapacity of the Principal. Note that the word "attorney" is not used here to mean "lawyer". The perso allows a natural "mentally competent " person (called the "Principal" or "Principal") to authorize someone else (called the "Agent" or "AttorneyIn-Fact") to act on his or her behalf, even if the Prinase and use of these forms, is subject to the Disclaimers and Terms of Use found at findlegalforms.com -1- Information Durable Power of Attorney Effective upon Disability A Durable Power of Attorneyhould only be a starting point for you and should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating a document with another party. [_] The purchserve as the Agent. This section can be removed, deleted (and initialed) or the words "no one" can be entered. [_] These forms are not intended and are not a substitute for legal advice. These forms susiness and legal matters on the Principal's behalf. [_] This document offers the option of nominating an alternate Agent in the event that the first choice as Agent is unable to serve or continue to he Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has the power to handle bginal document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact) as to the tasks t real estate in Florida. The witnesses should be adults. Generally, anyone related by blood or marriage to the Principal, Agent or Notary should not be a witness. [_] The Principal should keep the oriecord, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. Two witnesses are necessary if the Agent will be dealing with anyincipal. [_] The Principal (i.e. the person granting the Power of Attorney) should sign the document before a Notary. Notarization will allow the Durable Power of Attorney to be recorded as a public rtion for Durable Power of Attorney Effective upon Disability; (3) Durable Power of Attorney Effective upon Disability [_] This Durable Power of Attorney becomes effective upon the Disability of the PrInstructions & Checklist Durable Power of Attorney Effective upon Disability [_] This package contains (1) Instructions & Checklist for Durable Power of Attorney Effective upon Disability; (2) Informa WisconsinWisconsin king acknowledgment (Notary Public) _________________________________ Name typed, printed, or stamped -5- ___________________ (name of Principal), who is personally known to me or who has produced ________________________________ as identification. _________________________________ Signature of person ta________ State of __________________________ ) ) ss County of ________________________ ) The foregoing instrument was acknowledged before me this _____ day of ____________________, ______ by _________________________________ Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: ________________________________________________ Signature of Principal Witness Signature: ___________________________________ Name: ___________________________________ City: __________________________________ State: _________evoke this Power of Attorney at any time by providing written notice to my Agent. Signed on ________________ (date), at _______________________ (city), __________________________ (state). ___________e in good faith. However, Agent will be liable for breach of fiduciary duty, failure to act in good faith and/or willful misconduct, while acting under the authority of this Power of Attorney. I may rerson relying in good faith on the authority of this document, without notice of such termination, shall be held harmless. -4- Agent shall not be liable for losses resulting from judgment errors madto indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney. If this General Power of Attorney is terminated by operation of law, any py who receives a copy of this document may act under it. Revocation of the power of attorney is not effective as to a third party until the third party has actual knowledge of the revocation. I agree any rights or ownership with respect to any life insurance policies I may own on the life of my Agent; and/or (c) my assets to be subject to a general power of appointment by my Agent. Any third parto my Agent based on this document. The powers granted to my Agent by this power-of-attorney are limited to the extent necessary to prevent (a) my income to be taxable to my Agent; (b) my Agent to have and effect and not be affected by any partial invalidity. No person needs to inquire as to the reasons for the use or issuance of this power-ofattorney or as to the disposition of any proceeds paid tn in any manner. If any part of this document is held to be invalid, illegal or unenforceable under applicable law, then the remaining unaffected parts of the document shall still remain in full forcey shall be construed broadly as a General Power of Attorney. The listing of specific terms, rights, acts or powers are not intended to restrict or limit the definition or scope of powers granted herei myself or any authorized personal representative or fiduciary acting on my behalf, my Agent shall provide an accounting for all funds handled and all acts performed as my Agent. This Power of Attornered as a result of carrying out any provision of this Power of Attorney. If desired, my Agent shall also be entitled to reasonable compensation for any services provided as my Agent If so requested byd evaluate information effectively, to communicate decisions, and/or to manage my financial resources and affairs properly. My Agent shall be entitled to reimbursement of all reasonable expenses incur document shall remain in full force and effect thereafter until my death or until my disability or incapacity. As used herein, "disability" or "incapacity" shall mean a lack of capacity to receive an This General Power of Attorney and the rights, powers, and authority of my Agent shall become effective immediately upon execution of this instrument. The rights, powers, and -3- authority of this, as may be appropriate. However, Agent may not disclaim assets, to which I would be entitled, if the result is that the disclaimed assets pass directly or indirectly to my Agent or my Agent's estate.ime of such transfer. 17. To disclaim any interest (subject to other provisions of this document), which might be transferred or distributed to me from any other person, estate, trust, or other entity my Agent may owe to others, excluding those whom I am legally obligated to support. 16. To transfer any of my assets to the trustee of any revocable trust created by me, if such trust exists at the tmy Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, or (c) use any of my assets to discharge any of my Agent's legal obligations, including any obligations of support whichor rights, directly or indirectly, to my Agent, my Agent's estate, my Agent's creditors, or the creditors of my Agent's estate, (b) exercise any powers of appointment I may hold in favor of my Agent, lative and shall lapse at the end of each calendar year. However, my Agent may not, unless specifically authorized by this document, (a) gift, appoint, assign or designate any of my assets, interests o gifts that qualify for the federal gift tax annual exclusion, shall not exceed in value the federal gift tax annual exclusion amount in any one calendar year, and this annual right shall be non-cumu be made to the minor directly or parent, guardian or close friend of the minor or pursuant to the Uniform Gifts to Minors Act or the Uniform Transfers To Minors Act. Any gifts made shall be limited tor organizations without regard to whether such gifts are a part of my estate planning or otherwise, and if necessary, to file any state and federal gift tax returns and documents. Gifts to minors mayo tax matters and to negotiate, compromise or settle any matter with such agency. 15. To make gifts and charitable contributions of my real, personal, tangible or intangible property, to such persons d to, federal, state, local or other income and tax returns and necessary and/or related documents; to obtain or provide information to and from any agency, including governmental agencies, relating tessionals, brokers and real estate agents. 14. To prepare, or cause to be prepared, sign, and/or file any documents with any federal, state, local or other governmental body, including, but not limiteor may own or have an interest in, in the future. 13. To employ any professional and/or business assistance as may be appropriate, including but not limited to, attorneys, accountants, investment profg proxy rights, with respect to stocks, bonds, debentures, commodities, options or any other investments. -2- 12. To maintain and/or operate any business that I currently own or have an interest in by me alone or in conjunction with any other person, including access to their contents, and to examine, remove, keep or otherwise dispose of the contents. 11. To exercise any and all rights, includinl or transfer any note, security, or draft of the United States of America, including U.S. Treasury Securities. 10. To have access to any safe deposit box, vault or other storage area owned or leased afts, warrants, money orders, certificates, cashier checks, cash or vouchers payable to me by any person, firm, corporation or political entity; to perform any act necessary to deposit, negotiate, seln with respect to any of my accounts, including, but not limited to, making deposits and withdrawals, negotiating or endorsing any checks or other instruments, obtaining bank statements, passbooks, dr of deposit, investment accounts, brokerage accounts, retirement plan accounts, and other similar accounts with financial institutions; to conduct any business with any banking or financial institutioentative Payee" for the purpose of receiving Social Security benefits. 9. To open, maintain and/or close bank accounts, including, but not limited to, checking accounts, savings accounts, certificatesor its agencies in connection with governmental benefits (including but not limited to, medical, military and social security benefits), and to appoint anyone, including my Agent, to act as my "Represe benefits and government program including, but not limited to, Social Security and Medicare; to prepare applications, provide information, and perform any other reasonable request by any government disclaimers under such policies. 8. To receive, deposit, hold, demand, deal with and/or sue to recover all payments I receive from any annuity, pension, retirement benefits, retirement plans, insurancurchase, maintain and/or deal with insurance and annuity contracts, insurance policies, including life insurance upon my life or the life of any other appropriate person and to make any elections and nts and to recover possession; and the right to ask for, demand, sue for, collect, recover and receive all monies which may become due and owing to me by reason of such transaction. 7. To apply for, pto execute any necessary document, instrument or deed for such transactions. This includes the right to sell or encumber any homestead that I now own or may own in the future; the right to remove tenat prices my Agent may deem proper) deal with all, any part or any interest in any real or personal property or asset whatsoever, tangible or intangible (now owned or acquired in the future by me) and y hereafter acquire any interest, to have, or use. 6. To maintain, manage, insure, lease, rent, sell, mortgage, improve, repair, exchange, invest, reinvest and in any other manner (on such terms and ait, any and all documents of title and demands whatsoever, whether agreed to or disputed, now due or due -1- in the future, owned by, due, owing payable, or belonging to, me or in which I have or mald, possess and/or invest any and all sums of money, accounts, debts, bonds, commercial papers, checks, drafts, causes of action, bequests, deposits, notes, interests, dividends, certificates of deposnecessary to recover and collect any amount or debt owed to me. 4. To adjust, compromise and settle any claim, against me or asserted on my behalf against any other person or entity. 5. To receive, hoents, security agreements and other debts and obligations and such other instruments in writing of whatever kind and nature as may be. 3. To request, ask, demand, sue and take any and all legal steps , or investments with or through banks, savings and loan, brokers, mutual fund companies or other institutions, proofs of loss, evidences of debts, releases, and satisfaction of mortgages, lien, judgmes, insurance policies, receipts, title documents, checks, drafts, letters of credit, stock certificates, proxies, warrants, commercial papers, withdrawal and deposit slips, certificates of deposit ofent, including but not limited to applications, assignments, bills of sale or lading, bonds, contracts, covenants, conveyances, deeds, options, trust deeds, security agreements, leases, mortgages, noton my behalf and in my name. 2. To enter into binding contracts on my behalf and to sign, endorse and execute any written agreement and document necessary to enter into any such contract and/or agreemney and the rights hereby granted. My Agent's powers and authority shall include, but not be limited to: 1. To conduct, engage in, and transact any and all lawful business of whatever kind or nature, as I could do if personally present. I hereby ratify and confirm all acts that my Agent, or my Agent's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attortsoever that I now have or may later acquire in connection with or relating to any person, item, transaction, thing, business, property, real or personal, tangible or intangible, or matter whatsoever _______________ my true and lawful attorney-in-fact for me and in my name, and in my behalf. My Agent shall have full power and authority to perform any act, power, duty, legal right or obligation whadress at _______________________________________________ do hereby make and appoint ________________________________________ ("Agent") maintaining an address at: ______________________________________ the fiduciary and other legal responsibilities of an agent. -3- GENERAL POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: I, ____________________________________ ("Principal") maintaining an adnyone to make medical and other health-care decisions for you. You may revoke this power of attorney if you later wish to do so. AGENT: By accepting or acting under the appointment, the agent assumesagent, within the scope of this power of attorney document, is legally binding upon you. If you have any questions about these powers, obtain competent legal advice. This document does not authorize ading another person ("agent") with the power to handle business and legal matters on your behalf, including the power to sell, mortgage or dispose of your property. Any such action undertaken by your structions. -2- CAUTION! PRINCIPAL: The Powers granted by this power of attorney document are broad and sweeping. Before signing this document, consider its consequences. You ("principal") are provirmore, this information is general information that is not state specific. Whenever appropriate, the instructions included with the forms packages offered for sale, generally include state specific inalforms.com as well), stays in effect even if the Grantor later becomes disabled or incapacitated. Please note that this information is not intended as and is not a substitute for legal advice. Furthestates don't require that a General Power of Attorney be witnessed, it is always a very good idea to do so. Another type of Power of Attorney, called a Durable Power of Attorneys (available at findlege it more difficult for any third party to challenge the validity of the Power of Attorney and will allow the General Power of Attorney to be recorded as a public record, if necessary. Although, some orney at any time. A General Power of Attorney should always be notarized, even if your state does not require it, especially if the Agent will be dealing with any real property. Notarization will makld be granted with care. Any action undertaken by the Agent, within the scope of the Power of Attorney document, will be legally binding upon the Grantor. The Grantor can revoke a General Power of Att does not need to be a lawyer. Almost anyone can be appointed an Attorney-In-Fact by a power of attorney. The Agent should be a competent adult. A Power of Attorney is a "powerful" instrument and shoueath of the Grantor or until the Grantor becomes disabled or incapacitated. Note that the word "attorney" is not used here to mean "lawyer". The person acting as the Attorney-In-Fact for the Principalpal" or "Grantor") to authorize someone else (called the "Agent" or "Attorney-InFact") to act on his or her behalf. This particular Form becomes effective immediately and remains effective until the dto the Disclaimers and Terms of Use found at findlegalforms.com -1- Information General Power of Attorney A General Power of Attorney allows a natural "mentally" competent person (called the "Princind should not be used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject power to handle business and legal matters on the Principal's behalf. [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you a as to the tasks the Agent should complete. The Grantor should also be very careful in the selection of the Agent. The powers granted by this document are very broad and sweeping, as the Agent has thehould keep the original document, as well as a copy. The Agent should have access to the original document as needed. [_] The Principal should be careful in instructing the Agent (or attorney-in-fact)g with any real estate in Florida. The witnesses should be adults. Generally, anyone related by blood or marriage to the Principal, the Agent or the Notary should not be a witness. [_] The Principal sa public record, if necessary. [_] Although not always required, it is always a good idea to also have two witnesses sign the Power of Attorney. Two witnesses are necessary if the Agent will be dealinncipal (i.e. the person granting the Power of Attorney; sometimes called the Grantor) should sign the document before a Notary. Notarization will allow the General Power of Attorney to be recorded as er of Attorney [_] This General Power of Attorney becomes effective immediately and remains effective until the death of the Grantor or until the Grantor becomes disabled or incapacitated. [_] The PriInstructions & Checklist General Power of Attorney [_] This package contains (1) Instructions & Checklist for General Power of Attorney; (2) Information for General Power of Attorney; (3) General Pow WisconsinWisconsin -proved Will Affidavit __________________________ , and ___________________________________ witnesses, this _______ day of __________________, 20____. __________________________________________ Notary public [SEAL] Self____________ Address: ______________________________________ Subscribed and sworn to before me by _________________________________________, the testatrix, and by ___________________________________ ,__ (Witness) Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: _______________________rix) _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ ___________________________________________ of each witness, the testatrix was, at the time of execution, 18 years of age or older, of sound mind and under no constraint or undue influence. _____________________________________________ (Testatr her. 3. The testatrix executed the will as a free and voluntary act. 4. Each of the witnesses, in the conscious presence of the testatrix, signed the will as witness. 5. To the best of the knowledgey sworn, do declare to the undersigned authority all of the following: 1. The testatrix executed the instrument as her will. 2. The testatrix signed willingly, or willingly directed another to sign fo________________________, and ________________________________ and ________________________________, the testatrix and the witnesses whose names are signed to the foregoing instrument, being first dul______ __________ Witness Witness Page 9 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ We, ________________________________, and ____________________________________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testatrix/Wife __________ Witness _________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ______________________ter his or her name. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: __this Will was not procured by duress, menace, fraud or undue influence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth afresence of each other, do hereby subscribe our names as witnesses on the date shown above. We understand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that tator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence and at testator's request, and in the sight and p__ 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 _____________________________ (the "Tes __________ Witness __________ __________ Witness Witness Page 8 of ______ We, the undersigned, hereby certify and declare under penalty of perjury under the laws of the State of __________________es: Three (3) adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) Initials: __________ Testatrix/Wife ence and ask the Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witness______________, ______. at ____________________ (city), that I declare this to be my Last Will and Testament, that I am of legal age and sound mind, that I make this under no constraint or undue influ shall then take precedence over the terms of this Will or it's Codicils, except where otherwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ______ermine the order of deaths or to determine who survived the death of the other Spouse or who died first, I direct that it be determined that my Husband survived me. In that case, the terms of his Willnenforceability should affect only that provision and all other provision should remain effective. 7. Survival If my Husband and I die under circumstances whereby it is difficult or impractical to deteunder, free from all matrimonial rights or controls by his or her spouse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or usharing or division of property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary herif not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall be assigned or anticipated, or fall into any community of property, partnership or other form of the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and ary's good faith actions or nonactions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that ad faith, be liable individually to any beneficiary of my estate, and my estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiducied me unless the beneficiary is living on the thirtieth day after the date of my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bitness Witness Page 7 of ______ 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survivnly if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. Initials: __________ Testatrix/Wife __________ Witness __________ __________ Wl be taken to refer to the person or persons intended regardless of gender or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, but ois Will in interpreting its provisions. Throughout this Will the use of any gender shall be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronouns shallemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of thr review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE X MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be suppenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question o an advantage on any one or more of the beneficiaries or would otherwise, but for the foregoing, be considered as being other than an impartial exercise of their duties hereunder or as not being maintdiscretion granted herein in what Executor or Trustee deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have the effect of conferring and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor or Trustee shall exercise the powers, authority and , including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor or Trustee shall be fully protected in exercising any discretion granted to them in my Will and to refer to arbitration all such claims if the Executor or Trustee deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connection with administering my estatems at any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and conditions as the Executor or Trustee may deem advisableustee in good faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or clai any loss, claim, tax or other cost experienced by any such person or by my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor or Tr_ Witness Witness Page 6 of ______ conclusive and binding upon all the beneficiaries hereof. The Executor or Trustee shall not be liable to any person, whether beneficiary or otherwise, by reason ofe or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall be Initials: __________ Testatrix/Wife __________ Witness __________ _________ns, 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 legislativiable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or refrain from making, in Executor's or Trustee's absolute discretion, any elections, determinatioo use any tangible personal property or real property, without paying any rent, without giving any bond or security and without liability for any loss or damage. The Executor or Trustee shall not be lry 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 beneficiaries of my estate tustee's absolute discretion without responsibility for loss to the intent that investments or assets so retained shall be deemed to be authorized investments for all purposes of my Will. No reversiona cause any share to be composed of money, property or undivided fractional share in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's or Trthereof for such length of time as they may think best. Make any division or distribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and upon such terms, and either for cash or credit or for part cash and part credit as they may in their absolute discretion decide upon, or to postpone such conversion of my estate or any part or parts e beneficially interested in the property or any part thereof so valued. 5. Sell, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and of the Executor or Trustee shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor or Trustee may bre that the Executor or Trustee shall in their absolute discretion fix the value of my estate or any part thereof for the purpose of making any such division, setting aside or payment and the decisionany share or interest therein either wholly or in part in the assets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and decla mortgage or mortgages and to pay off any mortgage or mortgages which may be in existence at any time forming part of my estate. 4. Make any division of my real or personal estate or set aside or pay have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my estate or any part thereof, to borrow money on any such real estate upon the security of anyble. 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor or Trustee shall alsoom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the manner and to the extent that the Executor or Trustee shall deem advisaor such period as the Executor or Trustee shall determine; collect any income Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 5 of ______ therefrsuch a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate administration of my estate f court and without notice to anyone. I also give to the Executor or Trustee power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect l or personal property that may be included in my estate in such manner and for such purposes, for such prices, and upon such terms, credits and conditions as may be deemed advisable, without order of and the Trust, the Executor and the Trustee shall have the right and power to: 1. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of any reaee with regards to the administration of any Trust created by this Will, and in addition to other powers and authority granted by law or necessary or appropriate for proper administration of my estatey or surety shall be required of any Executor serving hereunder. ARTICLE IX POWERS OF EXECUTOR & TRUSTEE In addition to the existing authority of the Executor with regards to the Will and of any Trustdiction over my estate, using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, securitnal or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to administer my estate without adjudication, order or direction of the court having juriso "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my Will, my estate or any portion thereof who may be acting as such from time to time whether origiis unable to serve or continue to serve as Executor for any reason, I appoint ___________________________________, to be the Executor of this my Will in the place and stead of my Husband. References tt to the provisions of applicable law. ARTICLE VIII NOMINATION OF EXECUTOR I appoint my Husband ___________________________________, as the Executor of this my Will. If my Husband cannot, does not or s my wish that before the expiration of ___ days from the date of my death the appointed Guardian apply to have custody of such child(ren) and act as the guardian of the property of such child pursuanor continue to serve as Guardian for any reason, I appoint ___________________________________, as the Guardian of my minor child(ren) in the place and stead of the first aforementioned Guardian. It iardian of my minor child(ren). If such Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 4 of ______ person cannot, does not or is unable to serve sband predeceases me or if it becomes otherwise necessary to appoint a Guardian for any of my minor child(ren) under the age of eighteen years, I appoint ___________________________________, as the Guer the Trust once a year. If a beneficiary is a minor or has a disability, the Trustee may provide such accounting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE VII GUARDIAN If my Hue place and stead of the first aforementioned Executor. No bond, security or surety shall be required of any Trustee serving hereunder. The Trustee shall provide an accounting to the beneficiaries undIf such person or entity cannot, does not or is unable to serve or continue to serve as Trustee for any reason, I appoint ___________________________________, , to be the Trustee under this Will in th judgment, feels that the `proceeds' may be subject to any type of seizure or other legal proceeding. ARTICLE VI TRUSTEE I appoint ___________________________________, as the Trustee under this Will. ry has not accepted any of the benefits so renounced. The Trustee may withhold the distribution of any income or principal to any beneficiaries under the Trust if Trustee, in Trustee's own opinion and by a beneficiary, the trust shall be construed as though such beneficiary predeceased me if the beneficiary's renunciation occurred within nine months following the date of my death and the beneficiaeneficiary to renounce, in whole or in part, any provisions of the trust for the benefit of such beneficiary, or upon any power of appointment herein granted. As to any interest in the trust renouncedll not be subject to any assignment, anticipation, creditor's claim, seizure, attachment or other manner of legal process. this provision shall not be deemed to be a limitation upon the right of any brequired to distribute it had I died intestate, unmarried, and a resident of the state of ___________________ at such time and owning such property. 5. The interest of any beneficiary in the Trust shar when the trust is ended, none of the intended beneficiaries of the trust is living, the Trustee shall distribute the property to whomever and in the same proportions as, my Executor would have been ong any of my other children, who shall be living at the time of the death of such child, in equal shares per stirpes. 4. If at any time prior to the termination of the Trust created under this Will oe whole of his or her share under the Trust created by this Will, and if such child leaves no descendants surviving him or her, then such share or the amount thereof then remaining shall be divided amstee shall administer such shares for any descendants under the age of _____________ years as directed by this Will for any of my minor children. If any of my child(ren) should die before receiving thof his or her share under the Trust created by this Will, then such share or the amount thereof then remaining shall be divided among the descendants of such child in equal shares per stirpes. The Trurincipal of the Trust. If any of my child(ren) should die before Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 3 of ______ receiving the whole Trust, including any share of undistributed income. When my youngest child reaches the age of _______ years, this Trust will terminate and the Trustee shall give that child any remaining income and p shall be added to the principal. 3. As each minor child reaches the age of _______ years, the Trust will terminate as to that child alone and the Trustee shall give that child his or her share of thebution at the termination of the trust. If during any year that the Trust is in effect any portion of the income from the trust is not paid to or applied for the benefit of the child(ren) such portione based on the individual need(s) of my child(ren) and on the availability of assets in the trust. Any such payments shall not be deducted from or charged to the child(ren)'s share of the final distriducation) until such time as each child is no longer a minor as defined herein. If deemed necessary by the Trustee, such amounts paid to my child(ren) need not be equal among my children, but should ben) or their descendants such sums from the income or principal of the Trust as the Trustee deems appropriate for their maintenance, support, health and education (including college and professional est assets. In Trustee's discretion, the Trust assets may be converted into cash or other instruments in order to make the administration of the Trust easier. 2. The Trustee shall pay any minor child(re of the proceeds of any life insurance policy on my life, any pension plan, contract or other policy passing to any minor children shall be held in trust by the Trustee and treated as part of the Truinvested, administered and distributed by the Trustee, under the provisions of this Will, in order to provide for the care, health, support, maintenance and education of any minor child(ren). The sharhis Will, to invest and to hold in trust, as a private trust, (herein referred to as "Trust" or "Trust assets") for the benefit of my child(ren). 1. The Trust assets shall be retained, held, managed, nor child(ren)" for purposes of this Will and the Trust created thereby. I direct the Executor to transfer all assets that have passed under this Will to any minor child(ren) to the Trustee named in t TRUST FOR MINOR CHILDREN If my Husband predeceases me and, at the time of my death, any of my child(ren) are under the age of ____________ years, those children shall be deemed and referred to as "mi time of the distribution or to any other person the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE Vny 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 at theherwise 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 make atate 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 directed ot-law, their identities and respective shares to be determined under Initials: __________ Testatrix/Wife __________ Witness __________ __________ Witness Witness Page 2 of ______ the laws of the Se beneficiary is named, then the distribution shall be in equal shares per stirpes. If any such above mentioned beneficiary does not survive me, my residuary estate shall be distributed to my heirs-atl be distributed to: ______________________________________________________________ _____________________________________________________________________ (name(s) of beneficiary(ies)). If more than onviving child(ren) or their descendants per stirpes. If none of my children or their descendants survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shaldistributed to the then living descendants of the deceased child, per stirpes. If any child predeceases me and leaves no descendants, then that child's share shall be distributed equally among any sur___________________________(name(s)), while trying to maintain regard for each child's preference. Each share created for a deceased child of mine who has one or more descendants then living shall be sposed of by this Will, shall be distributed in equal shares per stirpes to my child(ren) ___________________________________________________________________ __________________________________________operty and personal property, be distributed, and given to my Husband. ____________________________. If my Husband does not survive me, then my residuary estate and any other property not otherwise di______________________________. If my Husband does not survive me, this bequest shall be distributed with my residuary estate. Residuary Estate I direct that my residuary estate, including any real prry does not survive me, this bequest shall be distributed with my residuary estate. Primary Residence My interest in my primary residence or homestead, if any, shall be distributed to my Husband _____not survive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiaive me, this bequest shall be distributed with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does hat the following specific bequests be made from my estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survansferred to or acquired by such purchaser or transferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct t_________ __________ Witness Witness Page 1 of ______ This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property tr are owed by my estate or by any beneficiary. The Executor shall not be seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testatrix/Wife __________ Witness _ction with any insurance on my life or any gift or benefit given or conferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxesto pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connecause of my death shall be paid out of the residue of my estate. The Executor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary d expenses of last illness be first paid out of and charged to the capital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed be markers, regardless of any limitation fixed by statute or rule of court and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses anhe Executor deems proper for my funeral, cremation or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and__ Born on _________________ Name: ____________________________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as t______________________ (name of husband). I have the following child(ren): Name: ____________________________________________ Born on _________________ Name: __________________________________________be my Last Will and Testament. ARTICLE I SPOUSE & CHILDREN I am married to __________________________________________________ (name of husband). All references to "my Husband" refer to __________________________ I, _________________________________________ (name), of ____________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to ________________________________________ (Signature) ________________________________________ (Official capacity of officer) [SEAL] Self-proved Will Affidavit Last Will And Testament Of _______________________, the testator, and by ___________________________________ , __________________________ , and ___________________________________ witnesses, this _______ day of __________________, 20____.___________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed and sworn to before me by __________________________________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ __________________ or undue influence. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ___________________________________ Address: _________f the testator, signed the will as witness. 5. To the best of the knowledge of each witness, the testator was, at the time of execution, 18 years of age or older, of sound mind and under no constraintl. 2. The testator signed willingly, or willingly directed another to sign for him. 3. The testator executed the will as a free and voluntary act. 4. Each of the witnesses, in the conscious presence oe witnesses whose names are signed to the foregoing instrument, being first duly sworn, do declare to the undersigned authority all of the following: 1. The testator executed the instrument as his wilTY OF ________________________ We, ________________________________, and _______________________________, and ________________________________ and ________________________________, the testator and th____ ___________________________________ Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 9 of ______ Self-Proved Will Affidavit STATE OF WISCONSIN COUN________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ___________________________________ ___________________________________ ___________________________der. 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: Address: City: erstand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue influence; The maker is age 18 or olor's request and in the Testator's sight and presence and at testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. We undthe witness signatures, was signed in our sight and presence by _____________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testat, hereby certify and declare under penalty of perjury under the laws of the State of ____________________ that the above instrument, which consists of _____ pages, including the page(s) which contain fore signing. The witnesses should not receive assets under this Will.) Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 8 of ______ We, the undersigned__________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the following clause beill 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 Signature: _____rwise directed by law. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, ______. at ____________________ (city), that I declare this to be my Last Wpouse 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, except where otheuld 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 of the other S 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 provision shois 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 spouse. 6.om, 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 beneficiary and hecific 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 therefrons 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, the spte 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 nonactions as the fiduciary, except for such acti my death. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate, and my esta purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date ofdate of the court order granting such adoption. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 7 of ______ 2. Thirty Day Survival Requirement. For theder 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 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 regardless of geniven 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 ofver or whomsoever. ARTICLE X 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 g 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 tribunal whatsoee, 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 exercise ofest 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 otherwisl representatives by reason of the exercise of such discretion. The Executor or Trustee shall exercise the powers, authority and discretion granted herein in what Executor or Trustee deems to be the bother professional fees. The Executor or Trustee shall be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or persona 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, accountant, agent, broker and thers for such consideration or no consideration and upon such terms and conditions as the Executor or Trustee may deem advisable and to refer to arbitration all such claims if the Executor or Trusteership or business in which I may have an interest at the time of my death. 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against oy my estate resulting from any election, determination, designation or exercise of discretion, entered into by the Executor or Trustee in good faith. 9. Windup, dissolve, settle or continue any partnee beneficiaries hereof. The Executor or Trustee shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or band such exercise of discretion by the Executor shall be Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 6 of ______ conclusive and binding upon all thed by the federal government of the United States of America, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, any such property so used. 8. Make or refrain from making, in Executor's or Trustee's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enactying any rent, without giving any bond or security and without liability for any loss or damage. The Executor or Trustee shall not be liable or responsible for any injury to, consumption of or loss ofion and no such interest not actually producing income shall be treated as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property or real property, without pae intent that investments or assets so retained shall be deemed to be authorized investments for all purposes of my Will. No reversionary or future interest shall be sold prior to falling into possessractional share in property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's or Trustee's absolute discretion without responsibility for loss to thdivision or distribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and cause any share to be composed of money, property or undivided fand part credit as they may in their absolute discretion decide upon, or to postpone such conversion of my estate or any part or parts thereof for such length of time as they may think best. Make any valued. 5. Sell, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cash or credit or for part cash ersons concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor or Trustee may be beneficially interested in the property or any part thereof so n fix the value of my estate or any part thereof for the purpose of making any such division, setting aside or payment and the decision of the Executor or Trustee shall be final and binding upon all pets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and declare that the Executor or Trustee shall in their absolute discretiohich may be in existence at any time forming part of my estate. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly or in part in the asses upon any real estate forming part of my 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 woney in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor or Trustee shall also have the right to renew and keep renewed any mortgage or mortgag keeping such property in adequate condition and repair, in the manner and to the extent that the Executor or Trustee shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend mcollect any income Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 5 of ______ therefrom; and pay the taxes and expenses thereof, including the cost ofr of sale 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 or Trustee shall determine; cutor or Trustee 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 powe 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 Exe 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 inby this Will, and in addition to other powers and authority granted by law or necessary or appropriate for proper administration of my estate and the Trust, the Executor and the Trustee shall have thender. ARTICLE IX POWERS OF EXECUTOR & TRUSTEE In addition to the existing authority of the Executor with regards to the Will and of any Trustee with regards to the administration of any Trust created r "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any Executor serving hereuermitted by law, the Executor shall have the right to administer my estate without adjudication, order or direction of the court having jurisdiction over my estate, using "informal", "unsupervised", oxecutrix, and Personal Representatives of my 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 pppoint __________________________________________________, 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, E EXECUTOR I appoint my Wife ___________________________________, 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 a my death the appointed Guardian apply to have custody of such child(ren) and act as the guardian of the property of such child pursuant to the provisions of applicable law. ARTICLE VIII NOMINATION OF_____________________________, as the Guardian of my minor child(ren) in the place and stead of the first aforementioned Guardian. It is my wish that before the expiration of ___ days from the date of_ Testator __________ Witness __________ __________ Witness Witness Page 4 of ______ person cannot, does not or is unable to serve or continue to serve as Guardian for any reason, I appoint ______o appoint a Guardian for any of my minor child(ren) under the age of eighteen years, I appoint ___________________________________, as the Guardian of my minor child(ren). If such Initials: _________ has a disability, the Trustee may provide such accounting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE VII GUARDIAN If my Wife predeceases me or if it becomes otherwise necessary tNo bond, security or surety shall be required of any Trustee serving hereunder. The Trustee shall provide an accounting to the beneficiaries under the Trust once a year. If a beneficiary is a minor oro serve or continue to serve as Trustee for any reason, I appoint ___________________________________, , to be the Trustee under this Will in the place and stead of the first aforementioned Executor. ny type of seizure or other legal proceeding. ARTICLE VI TRUSTEE I appoint ___________________________________, as the Trustee under this Will. If such person or entity cannot, does not or is unable te Trustee may withhold the distribution of any income or principal to any beneficiaries under the Trust if Trustee, in Trustee's own opinion and judgment, feels that the `proceeds' may be subject to ah such beneficiary predeceased me if the beneficiary's renunciation occurred within nine months following the date of my death and the beneficiary has not accepted any of the benefits so renounced. Thons of the trust for the benefit of such beneficiary, or upon any power of appointment herein granted. As to any interest in the trust renounced by a beneficiary, the trust shall be construed as thougtor's claim, seizure, attachment or other manner of legal process. this provision shall not be deemed to be a limitation upon the right of any beneficiary to renounce, in whole or in part, any provisid, and a resident of the state of ___________________ at such time and owning such property. 5. The interest of any beneficiary in the Trust shall not be subject to any assignment, anticipation, crediaries of the trust is living, the Trustee shall distribute the property to whomever and in the same proportions as, my Executor would have been required to distribute it had I died intestate, unmarrie time of the death of such child, in equal shares per stirpes. 4. If at any time prior to the termination of the Trust created under this Will or when the trust is ended, none of the intended beneficihis Will, and if such child leaves no descendants surviving him or her, then such share or the amount thereof then remaining shall be divided among any of my other children, who shall be living at theder the age of _____________ years as directed by this Will for any of my minor children. If any of my child(ren) should die before receiving the whole of his or her share under the Trust created by t, then such share or the amount thereof then remaining shall be divided among the descendants of such child in equal shares per stirpes. The Trustee shall administer such shares for any descendants unuld die before Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 3 of ______ receiving the whole of his or her share under the Trust created by this Wille. When my youngest child reaches the age of _______ years, this Trust will terminate and the Trustee shall give that child any remaining income and principal of the Trust. If any of my child(ren) sho child reaches the age of _______ years, the Trust will terminate as to that child alone and the Trustee shall give that child his or her share of the Trust, including any share of undistributed incomany year that the Trust is in effect any portion of the income from the trust is not paid to or applied for the benefit of the child(ren) such portion shall be added to the principal. 3. As each minor and on the availability of assets in the trust. Any such payments shall not be deducted from or charged to the child(ren)'s share of the final distribution at the termination of the trust. If during er a minor as defined herein. If deemed necessary by the Trustee, such amounts paid to my child(ren) need not be equal among my children, but should be based on the individual need(s) of my child(ren) or principal of the Trust as the Trustee deems appropriate for their maintenance, support, health and education (including college and professional education) until such time as each child is no longts may be converted into cash or other instruments in order to make the administration of the Trust easier. 2. The Trustee shall pay any minor child(ren) or their descendants such sums from the incomemy life, any pension plan, contract or other policy passing to any minor children shall be held in trust by the Trustee and treated as part of the Trust assets. In Trustee's discretion, the Trust assetee, under the provisions of this Will, in order to provide for the care, health, support, maintenance and education of any minor child(ren). The share of the proceeds of any life insurance policy on vate trust, (herein referred to as "Trust" or "Trust assets") for the benefit of my child(ren). 1. The Trust assets shall be retained, held, managed, invested, administered and distributed by the TrusTrust created thereby. I direct the Executor to transfer all assets that have passed under this Will to any minor child(ren) to the Trustee named in this Will, to invest and to hold in trust, as a pris me and, at the time of my death, any of my child(ren) are under the age of ____________ years, those children shall be deemed and referred to as "minor child(ren)" for purposes of this Will and the n the Executor may consider to be a proper recipient thereof. Receipt of any such distribution shall be a sufficient discharge to the Executor. ARTICLE V TRUST FOR MINOR CHILDREN If my Wife predecease the beneficiary or to a parent, guardian, conservator, committee of such person, trustee of such person, person with whom the beneficiary resides at the time of the distribution or to any other persoitled to any share in my estate before attaining the age of majority or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person directly tos if I had died intestate at the time fixed for distribution under this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, if any person should become entres to be determined under Initials: __________ Testator __________ Witness __________ __________ Witness Witness Page 2 of ______ the laws of the State of ____________________, then in effect, ation shall be in equal shares per stirpes. If any such above mentioned beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respective sha__________________________________________ _____________________________________________________________________ (name(s) of beneficiary(ies)). If more than one beneficiary is named, then the distribur stirpes. If none of my children or their descendants survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed to: ____________________s of the deceased child, per stirpes. If any child predeceases me and leaves no descendants, then that child's share shall be distributed equally among any surviving child(ren) or their descendants pele trying to maintain regard for each child's preference. Each share created for a deceased child of mine who has one or more descendants then living shall be distributed to the then living descendantal shares per stirpes to my child(ren) _____________________________________________________________________________ _____________________________________________________________________(name(s)), whid given to my Wife. _______________________________. If my Wife does not survive me, then my residuary estate and any other property not otherwise disposed of by this Will, shall be distributed in equoes not survive me, this bequest shall be distributed with my residuary estate. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed anl be distributed with my residuary estate. Primary Residence My interest in my primary residence or homestead, if any, shall be distributed to my Wife ___________________________________. If my Wife dtributed with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shal with my residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be disde from my estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributedr or transferee upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be mae 1 of ______ This direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchase beneficiary. The Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ __________ Witness Witness Pagife or any gift or benefit given or conferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by anyhe payment of the taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my lout of the residue of my estate. The Executor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. Trst paid out of and charged to the capital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid tation fixed by statute or rule of court and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be fifuneral, cremation or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limie: ____________________________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my of wife). I have the following child(ren): Name: ____________________________________________ Born on _________________ Name: ____________________________________________ Born on _________________ Namt. ARTICLE I SPOUSE & CHILDREN I am married to __________________________________________________ (name of wife). All references to "my Wife" refer to __________________________________________ (name ____________________________ (name), of ____________________ (county), _______________________ (state), revoke my former Wills and Codicils and publish and declare this to be my Last Will and Testamenith estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. Last Will And Testament Of ______________________ I, _____________ng point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing w 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. These forms should only be a starti spouse upon death without any federal estate tax liability. This is referred to as the "Marital Deduction". If the recipient spouse is not a U.S. citizen, the deduction is limited (it was $100,000 inbenefit plans; [] the face value of any life insurance policy; [] property you are holding in trust; any joint property you own In addition, each individual may leave an unlimited amount to his or herngible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (business) interests; [] individual retirement accounts and qualified employee ey. Before using this Will, it may be helpful to determine the value of all of the assets in your estate. Assets may include the following: [] real estate; [] stocks and bonds; [] bank accounts; [] taestate 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 with tax professionals and an attornr 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 greater your need for professional 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 available to each individual and his oth 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 otherwise due on a portion of the l 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 complicated planning to reduce or limit deavit 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 one included in our wills. The Wil 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 self proved, to require an affidaills. 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 from the Will). In those states itsuch 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 statutes permitting self proving win 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 may still be subject to contest on rn 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 witnesses testify, that the formalities 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 testify under oath, or through swo 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 speed up the admission of the Will ired 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 affidavit of the witnesses, made beforestributed. Assets held jointly with rights of survivorship, assets with beneficiary designations (such as life insurance or employee benefit plans), and assets held in trust generally will not be requWill (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 individually owned by the Testator will be di. [_] 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 the assets of the person making the on. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your particular situati as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from timewill 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 warranties have been made or are providedwhich 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/Testatrix moves to another state, the current ution in percentages, make sure that the total of all of the beneficiary's percentages equal 100%. Check the totals before signing the Will. Checklist & Instructions ­ Page 5 State and federal laws ill may be invalid if a spouse receives nothing or only a small portion of the estate. Consult an attorney if you wish to disinherit a spouse or any children. If any part of the Will calls for distribtatus changes, if the Testator has a child or if a named beneficiary or one of the Executors dies.. Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Wchanges are desired, the original and all copies should be destroyed and an entirely new Will should be signed. New wills are commonly necessary when, for example, the Testator's/Testatrix's marital scompetent tax advisor. If it becomes necessary to change the Will, do not modify it by adding, deleting, or modifying words on the face of the Will. Such changes are usually disregarded. Instead when is not designed to reduce taxes. Estate taxes, if any, are based on the size of the total taxable estate and other matters. The tax results of the choices made in this Will should be discussed with a in trust. In addition, the distribution of retirement plan benefits, life insurance proceeds and survivor benefits arising in other contracts and plans are not normally governed by a will. This Will would automatically pass to another person by operation of law or by any contract. For example, the Will does not dispose of property held in joint tenancy with rights of survivorship or property heldTestator and may also (if Testator/Testatrix so wish) be provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Testator, py" of a will should be prepared. While photocopies may used for reference purposes, only the original can be admitted to probate. Copies are rarely accepted. A copy of the Will should be kept by the nal of the Will should be kept in a secure location such as a safe deposit box at a bank or lawyer's office. Unlike other legal instruments where multiple originals are prepared, only one original "co before naming them as a Personal Representative, to make sure that they are willing and can serve. If you select a bank or trust company, be sure to check into their fees for such services. The origit to pick a person (or bank or trust company) that can be trusted to handle financial matters and to deal appropriately with family members. It is best to talk to people (and banks or trust companies)luding i.e. not counting the self-proving affidavit) should be entered by hand in the bottom right of each page. The Personal Representative / Executor, should be picked carefully. It is very importanotary or other person authorized to take acknowledgments and administer oaths. The affidavit states that all required formalities were observed when the Will was signed. The total number of pages (excdavit (called "Proof of Will" in some states) and attach it to the end of the Will. The Affidavit contains the Testator's/Testatrix's acknowledgment and the affidavit of the witnesses, made before a Nf included, should not be counted because the affidavit is not a part of the Will itself. Checklist & Instructions ­ Page 4 The Testator/Testatrix and the witnesses should sign the self-proving affies an earlier Will). The Witnesses should indicate the total number of pages in the Will, including the page(s) on which the witness signature lines appear. The page with the self-proving affidavit, iested, the date should be filled in (preferably by hand), with the date of the actual signing. This step could be crucial to determine the validity of the Will at a later date (i.e. if this Will revoktatrix and each other and of the notary public. The witnesses must be satisfied that the Testator/Testatrix is an adult of sound mind and he/she is signing the Will freely and willingly. Wherever requ Will. This can prevent subsequent substitution of pages. The witnesses should also initial the bottom of each page of the Will. All witnesses must sign their names in the presence of the Testator/Tesl and Testament. I am signing it freely and voluntarily", or similar words. Although not required in most states, it is a good idea for the Testator/Testatrix to initial the bottom of each page of theed to be the Testator's Last Will and Testament. However, the witnesses don't need to read or know the contents of the Will. For example, the v can say: "The document I am about to sign is my Last Wilr sign the Will. The notary public is needed for the self-proved affidavit. Before signing the Will, the Testator/Testatrix should orally declare that the document that is about to be signed is intendt be located. The witnesses should not be beneficiaries under the Will. For example children, spouses, heirs or executors should not be witnesses. All witnesses and the notary should watch the Testato and a notary public. The signature of a third witness can provide additional protection if the signature of one of the witnesses is deemed to be invalid for any reason or if one of the witnesses can'titled to a share of the estate. Although most states only require two witnesses, the Testator should sign the Will in the presence of three (3) qualified, competent, disinterested and adult witnesseses). Being of "sound mind" usually means that the Testator knows that he/she is signing a Will, is familiar with the property and the value thereof and knows about relatives and others who might be enitnesses and a Notary in front of each other. The Testator (i.e. the person who is writing the Will) must be of "sound mind" when signing the Will and must be of legal age (i.e. eighteen in most statffidavit (although technically not part of the Will) states that all required formalities were observed when the Will was signed. The Affidavit needs to be completed and signed, by the Testator, all Wonth year city; [] signature; []name Witnesses: Witnesses must provide and fill out: [] name of state; [] number of pages; [] name of testator; [] witness signatures and info Affidavit: The enclosed Ang a provision dealing with situations of simultaneous death of both husband and wife. · · · · · · Checklist & Instructions ­ Page 3 · · · Signature Block: Testator needs to fill out: [] day ms of Executor and Trustee empowers them to deal with matters like taxes, taking care of the property, and making distributions to the beneficiaries Article X: Contains miscellaneous provisions includitative will pay whatever is left to the beneficiaries named in the will. Testator/Testatrix must provide and fill out [] the name of executor (spouse); [] name of alternate executor. Article IX: Powerty. The Personal Representative is also responsible for paying outstanding debts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Represene an Executor to administer the estate, and an alternate in case the first choice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's properpointed as guardian of child(ren). Article VIII: Deals with the appointment of the Testator's/Testatrix's Personal Representative (i.e. Executor) and alternate; It allows the Testator/Testatrix to names the Testator/Testatrix. Testator/Testatrix must provide and fill out [] the name of Guardian; [] name of alternate Guardian; [] number of days within which Guardian has to apply to be officially approvide and fill out [] the name of Trustee; [] name of alternate Trustee. Article VII: Deals with appointment of the Guardian and an alternate for the minor children in the event the spouse predeceass the Testator/Testatrix to name a person and an alternate to act as the Trustee that will administer the assets passing under the Will for any child(ren) under a certain age. Testator/Testatrix must needs to be entered four (4) times in this section); [] state under whose laws the will is made. Article VI: Deals with appointment of Trustee and Trustee's specific duties/responsibilities. It allowy minor children if spouse predeceases Testator/Testatrix. Testator/Testatrix must provide and fill out: [] age when children should not be considered minors any longer for purposes of the Trust (thises in the event that all children predecease the Testator and there are no descendants of the children; [] state under whose laws the will is made. Article V: Deals with the creation of a trust for ans given; [] name of Spouse to whom the Residuary Estate is given to; [] name of child(ren) to whom residuary estate is given in event spouse does not survive Testator; [] name of alternate beneficiari); [] name(s) of person/entity property is given to (three blank paragraphs are provided, but you can add as many as you need). [] name of Spouse to whom Testator's interest in any primary residence iAllows Testator/Testatrix to give specific dollar amounts or other property to specific persons or charities. Testator/Testatrix must provide and fill out: [] description of property (or dollar amountrial expenses. Article III: Authorizes payments of debts and expenses. · · Checklist & Instructions ­ Page 2 · Article IV: Disposes of specific property, primary residence and residuary property. e of child(ren) and date of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and buprovide and fill out: [] name, [] county and [] state Article I: Gives the name of the spouse and any child(ren). Testator/Testatrix must provide and fill out [] name of spouse (in two places); [] namompleted. · · · Title: Enter name of Testator/Testatrix in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator/Testatrix must into various sections. The content of each section is explained below. Some sections require information to be provided and filled out in the space provided. The enclosed Affidavit also needs to be csband. The second Will and Affidavit is to be used by the Wife. The instructions for both wills are the same. It is suggested that both Wills be executes/signed at the same time. The Wills are dividedx to make specific gifts to others as well. This Will is suitable for estates worth less than $1,000,000. There are two Wills in this form package. The first Will and Affidavit is to be used by the Hus pre-deceased the Testator, the Will allows the appointment of a Guardian for any minor child(ren) and a Trustee to administer the minor children's assets. This Will also allows the Testator/Testatriath of both husband and wife. If the Spouse does not survive the Testator/Testatrix the assets will go to the children. If the children are minors at the time of the Testator's death and the spouse ha The Wills distribute the assets of the Husband to the Wife and the assets of the Wife to the Husband in the event of their death. They also have a provision dealing with situations of simultaneous deis form package contains two "Mutual Wills" and is for use by a married couple (husband and wife i.e. Testator and Testatrix) with one or more minor children. It also includes a self-proved affidavit.out Wills; (3) Husband's Mutual Will for ­ Married Couple with Minor Children with self-proved affidavit; (4) Wife's Mutual Will for ­ Married Couple with Minor Children with self-proved affidavit. ThChecklist and Instructions Mutual Will - Married Couple with Minor Children This package contains (1) Checklist and Instruction for Mutual Will ­ Married Couple with Minor Children; (2) Information ab WisconsinWisconsin ________________________ _________________________________________________ -2- health care providers to whom he or she has given copies of this document: _________________________________________________ _________________________________________________ _________________________If you know that the patient is pregnant, this document has no effect during her pregnancy. The person making this living will may use the following space to record the names of those individuals and ument, you must make a good faith attempt to transfer the patient to another physician who will comply. Refusal or failure to make a good faith attempt to do so constitutes unprofessional conduct. 4. pain relief measures. If the patient's stated desires are that life-sustaining procedures or feeding tubes be used, this directive must be followed. 3. If you feel that you cannot comply with this docss you believe that withholding or withdrawing life-sustaining procedures or feeding tubes would cause the patient pain or reduced comfort and that the pain or discomfort cannot be alleviated through tient has a terminal condition or is in a persistent vegetative state. 2. The choices in this document were made by a competent adult. Under the law, the patient's stated desires must be followed unlethe withholding or withdrawal of life-sustaining procedures or of feeding tubes when 2 physicians, one of whom is the attending physician, have personally examined and certified in writing that the paignature: ______________________________________ Print Name: ____________________________________________ Date Signed _________________ DIRECTIVES TO ATTENDING PHYSICIAN 1. This document authorizes se restricted by law from being a witness. Witness Signature: ______________________________________ Print Name: ____________________________________________ Date Signed _________________ Witness Sam an adult and am not related to the person signing this document by blood, marriage or adoption. I am not entitled to and do not have a claim on any portion of the person's estate and am not otherwi_____________ Address _______________________________________________ Date Signed _________________ Date of Birth ________________ I believe that the person signing this document is of sound mind. I 1 of the Wisconsin Statutes or the information accompanying this document. -1- ATTENTION : You and the 2 witnesses must sign the document at the same time. Signed ___________________________________stent vegetative state. If you have not checked either box, feeding tubes will be used. If you are interested in more information about the significant terms used in this document, see section 154.0e following are my directions regarding the use of feeding tubes: o o YES, I want feeding tubes used if I am in a persistent vegetative state. NO, I do not want feeding tubes used if I am in a persiive state. If you have not checked either box, life-sustaining procedures will be used. 3. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2 physicians who have personally examined me, thife-sustaining procedures: o o YES, I want life-sustaining procedures used if I am in a persistent vegetative state. NO, I do not want life-sustaining procedures used if I am in a persistent vegetather box, feeding tubes will be used. 2. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2 physicians who have personally examined me, the following are my directions regarding the use of lgarding the use of feeding tubes: o o YES, I want feeding tubes used if I have a terminal condition. NO, I do not want feeding tubes used if I have a terminal condition. If you have not checked eitphysicians who have personally examined me, I do not want my dying to be artificially prolonged and I do not want life-sustaining procedures to be used. In addition, the following are my directions rees, I intend that my family and physician honor this document as the final expression of my legal right to refuse medical or surgical treatment. 1. If I have a TERMINAL CONDITION, as determined by 2 s specified in this document. Under those circumstances, I direct that I be permitted to die naturally. If I am unable to give directions regarding the use of life-sustaining procedures or feeding tubn to Physicians (Living Will) I,________________________________________________________________, being of sound mind, voluntarily state my desire that my dying not be prolonged under the circumstanceith a tax professional. Living Will Information & Instructions ­ Page 4 [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Declaratioour 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 discussed we. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits yn made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advicd place of the revocation and the time, date and place, if different, that he or she was notified of the revocation. [_] These forms are provided "as is" and no implied or express warranties have beee attending physician of the revocation. (d) By executing a subsequent declaration. (2) Recording the revocation. The attending physician shall record in the patient's medical record the time, date anbal expression by the declarant of his or her intent to revoke the declaration. This revocation becomes effective only if the declarant or a person who is acting on behalf of the declarant notifies ths directed by the declarant and who acts in the presence of the declarant. (b) By a written revocation of the declarant expressing the intent to revoke, signed and dated by the declarant. (c) By a vern may be revoked at any time by the declarant by any of the following methods: (a) By being canceled, defaced, obliterated, burned, torn or otherwise destroyed by the declarant or by some person who i employee, other than a chaplain or a social worker, of an inpatient health care facility in which the declarant is a patient. 154.05 Revocation of declaration. (1) Method of revocation. A declaratio is a health care provider, as defined in s. 155.01 (7), who is serving the declarant at the time of execution, an employee, other than a chaplain or a social worker, of the health care provider or an3 (b) Have knowledge that he or she is entitled to or has a claim on any portion of the declarant's estate. (c) Directly financially responsible for the declarant's health care. (d) An individual whohe execution of the declaration may, at the time of the execution, be any of the following: (a) Related to the declarant by blood, marriage or adoption. Living Will Information & Instructions ­ Page ying his or her attending physician of the existence of the declaration. An attending physician who is so notified shall make the declaration a part of the declarant's medical records. No witness to t's express direction and in his or her presence; such a proxy signing shall either take place or be acknowledged by the declarant in the presence of 2 witnesses. The declarant is responsible for notifesence of 2 witnesses. If the declarant is physically unable to sign a declaration, the declaration must be signed in the declarant's name by one of the witnesses or some other person at the declarante unless the declarant's attending physician advises that, in his or her professional judgment, the administration is medically contraindicated. A declaration must be signed by the declarant in the prelief measures. A declarant may not authorize the withholding or withdrawal of nutrition or hydration that is administered or otherwise received by the declarant through means other than a feeding tub that, in his or her professional judgment, the withholding or withdrawal will cause the declarant pain or reduce the declarant's comfort and the pain or discomfort cannot be alleviated through pain rn a persistent vegetative state. A declarant may not authorize the withholding or withdrawal of any medication, life-sustaining procedure or feeding tube if the declarant's attending physician advisesration, which shall take effect on the date of execution, authorizing the withholding or withdrawal of life-sustaining procedures or of feeding tubes when the person is in a terminal condition or is ittending physician, who have personally examined the declarant. 154.03 Declaration to physicians. (1) Any person of sound mind and 18 years of age or older may at any time voluntarily execute a declaied patient" means a declarant who has been diagnosed and certified in writing to be afflicted with a terminal condition or to be in a persistent vegetative state by 2 physicians, one of whom is the a. 154.03 (2). (2) "Feeding tube" means a medical tube through which nutrition or hydration is administered into the vein, stomach, nose, mouth or other body opening of a qualified patient. (3) "Qualifions. In this subchapter: (1) "Declaration" means a written, witnessed document voluntarily executed by the declarant under s. 154.03 (1), but is not limited in form or substance to that provided in snjury or illness that reasonable medical judgment finds would cause death imminently, so that the application of life-sustaining procedures serves only to postpone the moment of death. 154.02 Definitesponses that indicate cognitive functioning, although autonomic functions continue. Living Will Information & Instructions ­ Page 2 (8) "Terminal condition" means an incurable condition caused by ible loss of all of the functions of the cerebral cortex and results in a complete, chronic and irreversible cessation of all cognitive functioning and consciousness and a complete lack of behavioral rming any medical procedure. (b) The provision of nutrition or hydratio n. (5m) "Persistent vegetative state" means a condition that reasonable medical judgment finds constitutes complete and irreversiaintenance of blood pressure and heart rate, blood transfusion, kidney dialysis and other similar procedures, but does not include: (a) The alleviation of pain by administering medication or by perforattending physician, would serve only to prolong the dying process but not avert death when applied to a qualified patient. "Life-sustaining procedure" includes assistance in respiration, artificial m. 50.135 (1) and includes community-based residential facilities, as defined in s. 50.01 (1g). (5) "Life-sustaining procedure" means any medical procedure or intervention that, in the judgment of the th and family services. (3) "Health care professional" means a person licensed, certified or registered under ch. 441, 448 or 455. (4) "Inpatient health care facility" has the meaning provided under shis chapter: (1) "Attending physician" means a physician licensed under ch. 448 who has primary responsibility for the treatment and care of the patient. (2g) "Department" means the department of healonsin Living Will) is based on the Wisconsin Statutes Chapter 154. For your convenience, we have included useful excerpts from the Wisconsin Statutes relating to Living Wills. 154.01 Definitions. In trmation and Instruction for Wisconsin Declaration to Physicians (Wisconsin Living Will); (2) Wisconsin Declaration to Physicians (Wisconsin Living Will). This Wisconsin Declaration to Physicians (Wisc. Signature ___________________________________ Date ______________________ 7 Information and Instructions Wisconsin Declaration to Physicians (Wisconsin Living Will) This package contains (1) Infompt to notify the Donee to which or to whom I agreed to donate.) Failing to check any of the lines immediately above creates no presumption about my desire to make or refuse to make an anatomical giftdonate my body for anatomical study if needed. o I refuse to make an anatomical gift. (If this revokes a prior commitment that I have made to make an anatomical gift to a designated Donee, I will atteo donate only the following organs or parts: ____________________________________________ ____________________. (specify the organs or parts). o I wish to donate any needed organ or part. o I wish to o his or her health care decisions. 6 This power of attorney for health care is executed as provided in chapter 155 of the Wisconsin Statutes. ANATOMICAL GIFTS (optional) Upon my death: o I wish t____________________ Failure to execute a power of attorney for health care document under chapter 155 of the Wisconsin Statutes creates no presumption about the intent of any individual with regard tress ________________________________________________________________ Alternate's signature ______________________________________________________ Address ______________________________________________________________________ (name of principal) has discussed his or her desires regarding health care decisions with me. Agent's signature _________________________________________________________ Addesignated me to be his or her health care agent or alternate health care agent if he or she is ever found to have incapacity and unable to make health care decisions himself or herself. ______________(Witness Signature) Date: _______________ STATEMENT OF HEALTH CARE AGENT AND ALTERNATE HEALTH CARE AGENT I understand that __________________________________________________ (name of principal) has d(Witness Signature) Date: _______________ Witness No. 2: Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ t have a claim on the principal's estate. Witness No. 1: Print Name: ___________________________________ Address: ______________________________________ _____________________________________________ in or a social worker, of an inpatient health care facility in which the declarant is a patient. I am not the principal's health care agent. To the best of my knowledge, I am not entitled to and do no care. I am not a health care provider who is serving the principal at this time, an employee of the health care provider, other than a chaplain or a social worker, or an employee, other than a chaplay for health care is voluntary. I am at least 18 years of age, am not related to the principal by blood, marriage or adoption and am not directly financially responsible for the principal's health 5 uments.) STATEMENT OF WITNESSES I know the principal personally and I believe him or her to be of sound mind and at least 18 years of age. I believe that his or her execution of this power of attorne_________________________________________________ Date _____________________________________ (The signing of this document by the principal revokes all previous powers of attorney for health care docure of this information. (The principal and the witnesses all must sign the document at the same time.) SIGNATURE OF PRINCIPAL (person creating the power of attorney for health care) Signature.. ___arding my physical or mental health, including medical and hospital records. (b) Execute on my behalf any documents that may be required in order to obtain this information. (c) Consent to the disclosny limitations in this document, my health care agent has the authority to do all of the following (pursuant to Section 155.30(3): (a) Request, review and receive any information, oral or written, reg__________________________________ _____________________________________________________________________ INSPECTION AND DISCLOSURE OF INFORMATION RELATING TO MY PHYSICAL OR MENTAL HEALTH Subject to a______________________ 2) ___________________________________________________________________ _____________________________________________________________________ 3) _________________________________s, provisions or limitations that I wish to state (add more items if needed): 1) ___________________________________________________________________ 4 _______________________________________________ocument, my health care agent shall act consistently with my following stated desires, if any, and is subject to any special provisions or limitations that I specify. The following are specific desirey health care agent may not make health care decisions for me if my health care agent knows I am pregnant. STATEMENT OF DESIRES, SPECIAL PROVISIONS OR LIMITATIONS In exercising authority under this dmay not make health care decisions for me if my health care agent knows I am pregnant. Health care decision if I am pregnant Yes o. No o If I have not checked either "Yes" or "No" immediately above, mf I have checked "Yes" to the following, my health care agent may make health care decisions for me even if my agent knows I am pregnant. If I have checked "No" to the following, my health care agent a feeding tube Yes o. No o If I have not checked either "Yes" or "No" immediately above, my health care agent may not have a feeding tube withdrawn from me. HEALTH CARE DECISIONS FOR PREGNANT WOMEN Iy health care agent may not have orally ingested nutrition or hydration withheld or withdrawn from me unless provision of the nutrition or hydration is medically contraindicated. Withhold or withdraw her professional judgment, this will cause me pain or will reduce my comfort. If I have checked "No" to the following, my health care agent may not have a feeding tube withheld or withdrawn from me. Mare. PROVISION OF A FEEDING TUBE If I have checked "Yes" to the following, my health care agent may have a feeding tube withheld or withdrawn from me, unless my physician has advised that, in his or -based residential facility Yes o. No o 3 If I have not checked either "Yes" or "No" immediately above, my health care agent may admit me only for short-term stays for recuperative care or respite cadmit me for a purpose other than recuperative care or respite care, but if I have checked "No" to the following, my health care agent may not so admit me: 1. A nursing home Yes o. No o 2. A communityt may admit me to a nursing home or community-based residential facility for short-term stays for recuperative care or respite care. If I have checked "Yes" to the following, my health care agent may h research or psychosurgery, electroconvulsive treatment or drastic mental health treatment procedures for me. ADMISSION TO NURSING HOMES OR COMMUNITY-BASED RESIDENTIAL FACILITIES My health care agention for mental diseases, an intermediate care facility for the mentally retarded, a state treatment facility or a treatment facility. My health care agent may not consent to experimental mental healtr health care decision on what he or she believes to be in my best interest. LIMITATIONS ON MENTAL HEALTH TREATMENT My health care agent may not admit or commit me on an inpatient basis to an institu expressed prior to the time of the decision. If I have not expressed a health care choice about the health care in question and communication cannot be made, my health care agent shall base his or he I am able to communicate in any manner, including by blinking my eyes. If this communication cannot be made, my health care agent shall base his or her decision on any health care choices that I have to make a health care decision, my health care agent is instructed to make the health care decision for me, but my health care agent should try to discuss with me any specific proposed health care ifhealth care decisions I would make if I were able. I desire that my wishes be carried out through the authority given to my health care agent under this document. If I am unable, due to my incapacity,gent, if I need treatment, for all of my health care and treatment. I have discussed my desires thoroughly with my health care agent and believe that he or she understands my philosophy regarding the L STATEMENT OF AUTHORITY GRANTED Unless I have specified otherwise in this document, if I ever have incapacity I instruct my health care provider to obtain the health care decision of my health care anformation effectively or to communicate decisions to such an extent that I lack the capacity to manage my health care decisions. A copy of that statement must be attached to this document. 2 GENERA a physician and a psychologist who have personally examined me sign a statement that specifically expresses their opinion that I have a condition that means that I am unable to receive and evaluate iloyee of a health care facility in which I am a patient or a spouse of any of those persons, unless he or she is also my relative. For purposes of this document, "incapacity" exists if 2 physicians orng health care decisions on my behalf. Neither my health care agent nor my alternate health care agent whom I have designated is my health care provider, an employee of my health care provider, an emp___________________________________ ____________________________________________________________ (print name, address and telephone number) to be my alternate health care agent for the purpose of makind telephone number) to be my health care agent for the purpose of making health care decisions on my behalf. If he or she is ever unable or unwilling to do so, I hereby designate ____________________isions for myself, due to my incapacity, I hereby designate. _______________________________________________________ ____________________________________________________________ (print name, address aition. In addition, I may, by this document, specify my wishes with respect to making an anatomical gift upon my death. DESIGNATION OF HEALTH CARE AGENT If I am no longer able to make health care deccument, "health care decision" means an informed decision to accept, maintain, discontinue or refuse any care, treatment, service or procedure to maintain, diagnose or treat my physical or mental cond of this power of attorney for health care, I expect to be fully informed about and allowed to participate in any health care decision for me, to the extent that I am able. For the purposes of this dos and date of birth), being of sound mind, intend by this document to create a power of attorney for health care. My executing this power of attorney for health care is voluntary. Despite the creation this ____________________ day of _________ (month), _________ (year). CREATION OF POWER OF ATTORNEY FOR HEALTH CARE I, ___________________________________________________________ (print name, addres NOT SIGN THIS DOCUMENT UNLESS YOU CLEARLY UNDERSTAND IT. IT IS SUGGESTED THAT YOU KEEP THE ORIGINAL OF THIS DOCUM ENT ON FILE WITH YOUR PHYSICIAN." 1 Power Of Attorney for Health Care Document madeVOKES ANY PRIOR DOCUMENT OF GIFT THAT YOU MAY HAVE MADE. YOU MAY REVOKE OR CHANGE ANY ANATOMICAL GIFT THAT YOU MAKE BY THIS DOCUMENT BY CROSSING OUT THE ANATOMICAL GIFTS PROVISION IN THIS DOCUMENT. DOOCUMENT IS INVALID. YOU MAY ALSO USE THIS DOCUMENT TO MAKE OR REFUSE TO MAKE AN ANATOMICAL GIFT UPON YOUR DEATH. IF YOU USE THIS DOCUMENT TO MAKE OR REFUSE TO MAKE AN ANATOMICAL GIFT, THIS DOCUMENT RE AGENT, YOUR HEALTH CARE PROVIDERS AND ANY OTHER PERSON TO WHOM YOU HAVE GIVEN A COPY. IF YOUR AGENT IS YOUR SPOUSE AND YOUR MARRIAGE IS ANNULLED OR YOU ARE DIVORCED AFTER SIGNING THIS DOCUMENT, THE DRECTING ANOTHER PERSON TO DESTROY IT IN YOUR PRESENCE, BY SIGNING A WRITTEN AND DATED STATEMENT OR BY STATING THAT IT IS REVOKED IN THE PRESENCE OF TWO WITNESSES. IF YOU REVOKE, YOU SHOULD NOTIFY YOURVOKES ANY PRIOR POWER OF ATTORNEY FOR HEALTH CARE THAT YOU MAY HAVE MADE. IF YOU WISH TO CHANGE YOUR POWER OF ATTORNEY FOR HEALTH CARE, YOU MAY REVOKE THIS DOCUMENT AT ANY TIME BY DESTROYING IT, BY DIIS REQUIRED TO DETERMINE WHAT WOULD BE IN YOUR BEST INTERESTS IN MAKING THE DECISION. THIS IS AN IMPORTANT LEGAL DOCUMENT. IT GIVES YOUR AGENT BROAD POWERS TO MAKE HEALTH CARE DECISIONS FOR YOU. IT RET YOU DO OR DO NOT DESIRE, AND YOU MAY LIMIT THE AUTHORITY OF YOUR HEALTH CARE AGENT. IF YOUR HEALTH CARE AGENT IS UNAWARE OF YOUR DESIRES WITH RESPECT TO A PARTICULAR HEALTH CARE DECISION, HE OR SHE . YOU SHOULD TAKE SOME TIME TO DISCUSS YOUR THOUGHTS AND BELIEFS ABOUT MEDICAL TREATMENT WITH THE PERSON OR PERSONS WHOM YOU HAVE SPECIFIED. YOU MAY STATE IN THIS DOCUMENT ANY TYPES OF HEALTH CARE THA SIGN THIS LEGAL DOCUMENT TO SPECIFY THE PERSON WHOM YOU WANT TO MAKE HEALTH CARE DECISIONS FOR YOU IF YOU ARE UNABLE TO MAKE THOSE DECISIONS PERSONALLY. THAT PERSON IS KNOWN AS YOUR HEALTH CARE AGENT VALUES AND THE DETAILS OF YOUR FAMILY RELATIONSHIPS. THIS POSES A PROBLEM IF YOU BECOME PHYSICALLY OR MENTALLY UNABLE TO MAKE DECISIONS ABOUT YOUR HEALTH CARE. IN ORDER TO AVOID THIS PROBLEM, YOU MAYITHHELD IF YOU OBJECT. BECAUSE YOUR HEALTH CARE PROVIDERS IN SOME CASES MAY NOT HAVE HAD THE OPPORTUNITY TO ESTABLISH A LONG-TERM RELATIONSHIP WITH YOU, THEY ARE OFTEN UNFAMILIAR WITH YOUR BELIEFS ANDPOWER OF ATTORNEY FOR HEALTH CARE YOU HAVE THE RIGHT TO MAKE DECISIONS ABOUT YOUR HEALTH CARE. NO HEALTH CARE MAY BE GIVEN TO YOU OVER YOUR OBJECTION, AND NECESSARY HEALTH CARE MAY NOT BE STOPPED OR Wcument should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com 6 NOTICE TO PERSON MAKING THIS first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this doe for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitut health care instrument under sub. (1) creates no presumption about the intent of an individual with regard to his or her health care decisions. [_] These forms are provided "as is" and no implied or commitment under s. 51.20, or for protective placement or protective services under ch. 55. (d) Any person under the order of a court for good cause shown. (3) Failure to file a power of attorney forr who is providing care to the principal. (c) The court and all parties involved in proceedings for guardianship of the principal under ch. 880, for emergency detention under s. 51.15, for involuntarypecified in sub. (1), the following persons may have access to the instrument without first obtaining consent from the principal: (a) The health care agent for the principal. (b) A health care provideekeeping, with the register in probate of the county in which the principal resides. (2) If a principal or health care agent has filed the principal's power of attorney for health care instrument as sevocation. 5 155.65 Filing power of attorney instrument. (1) A principal or a principal's health care agent may, for a fee, file the principal's power of attorney for health care instrument, for safare instrument, record in the principal's medical record the time, date and place of the revocation and the time, date and place, if different, of the notification to the health care provider of the r knows has a copy of the power of attorney for health care instrument. (4) The principal's health care provider shall, upon notification of revocation of the principal's power of attorney for health cat the power of attorney for health care that named him or her as health care agent has been revoked, he or she shall communicate this fact to any health care provider for the principal that he or sheiage is annulled or divorce from the spouse is obtained, the power of attorney for health care is revoked and the power of attorney for health care instrument is invalid. (3) If an individual knows thequent power of attorney for health care instrument. (2) If the health care agent is the principal's spouse and, subsequent to the execution of a power of attorney for health care instrument, the marrnt to revoke the power of attorney for health care. (c) Verbally expressing the principal's intent to revoke the power of attorney for health care, in the presence of 2 witnesses. (d) Executing a subssence of the principal to so destroy the power of attorney for health care instrument. (b) Executing a statement, in writing, that is signed and dated by the principal, expressing the principal's inteany time by doing any of the following: (a) Canceling, defacing, obliterating, burning, tearing or otherwise destroying the power of attorney for health care instrument or directing another in the preft. 155.40 Revocation of power of attorney for health care. (1) A principal may revoke his or her power of attorney for health care and invalidate the power of attorney for health care instrument at nt may make an anatomical gift under s. 157.06 (3) (a) 7. of all or a part of the principal's body after the principal's death unless the principal made an unrevoked refusal to make that anatomical giaccordance with the desires of the principal, the health care agent may sign or otherwise execute any documents, waivers or releases related to the principal's care or treatment. (8) A health care ageehalf of the principal that the power of attorney for health care instrument authorizes. 4 (7) If necessary to implement the health care decisions that a health care agent is authorized to make, in , in good faith, act in the best interests of the principal in exercising his or her authority. (6) If the principal is known to be pregnant, the health care agent may make a health care decision on ba valid declaration executed by the principal under subch. II of ch. 154. In the absence of a specific directive by the principal or if the principal's desires are unknown, the health care agent shall executed by the principal under subch. II of ch. 154, except that the provisions of a principal's valid power of attorney for health care instrume nt supersede any directly conflicting provisions of ealth care instrument or as otherwise specifically directed by the principal to the health care agent at any time. The health care agent shall act in good faith consistently with any valid declarationof the nutrition or hydration is medically contraindicated. (5) The health care agent shall act in good faith consistently with the desires of the principal as expressed in the power of attorney for hdrawal will cause the principal pain or reduce the principal's comfort. A health care agent may not consent to the withholding or withdrawal of orally ingested nutrition or hydration unless provision r the principal if the power of attorney for health care instrument so authorizes, unless the principal's attending physician advises that, in his or her professional judgment, the withholding or withto psychosurgery, electroconvulsive treatment or drastic mental health treatment procedures for the principal. (4) A health care agent may consent to the withholding or withdrawal of a feeding tube fopal is not diagnosed as developmentally disabled or as having a mental illness at the time of the proposed admission. (3) A health care agent may not consent to experimental mental health research or a community-based residential facility, for purposes other than those specified in subd. 2. a. and b., if the power of attorney for health care instrument specifically so authorizes and if the princis a temporary placement not to exceed 30 days, in order to provide the health care agent with a vacation or to release temporarily the health care agent for a family emergency. c. To a nursing home orital inpatient unit, unless the hospital admission was for psychiatric care. b. If the principal lives with his or her health care agent, to a nursing home or a community-based residential facility, arincipal to the following facilities, under the following conditions: a. To a nursing home, for recuperative care for a period not to exceed 3 months, if the principal is admitted directly from a hosp. "Community-based residential facility" has the meaning given in s. 50.01 (1g). 3 b. "Nursing home" has the meaning given in s. 50.01 (3). 2. A health care agent may consent to the admission of a p19). (b) A principal may be admitted or committed on an inpatient basis to a facility specified in par. (a) 1. to 4. only under the applicable requirements of ch. 51 or 55. (c) 1. In this paragraph: an intermediate care facility for the mentally retarded, as defined in s. 46.278 (1m) (am). 3. A state treatment facility, as defined in s. 51.01 (15). 4. A treatment facility, as defined in s. 51.01 (ions. (2) (a) A health care agent may not consent to admission of the principal on an inpatient basis to any of the following: 1. An institution for mental diseases, as defined in s. 49.43 (6m). 2. Aagent who is known to the health care provider to be available to make health care decisions for the principal has priority over any individual other than the principal to make these health care decist; powers; limitations. (1) Unless the power of attorney for health care instrument otherwise provides and except as specified in subs. (2) (a) and (b), (3) and (4) and s. 155.60 (2), the health care vidual who has attained age 18, at the express direction and in the presence of the principal. (c) Signed in the presence of 2 witnesses who meet the requirements of sub. (2). 155.20 Health care agenealth care instrument; execution; witnesses. (1) A valid power of attorney for health care instrument shall be all of the following: (a) In writing. (b) Dated and signed by the principal or by an indi designate an alternate individual to serve as his or her health care agent in the event that the health care agent first designated is unable or unwilling to do so. 2 155.10 Power of attorney for hoyee is a relative of the individual. (4) The desires of a principal who does not have incapacity supersede the effect of his or her power of attorney for health care at all times. (5) A principal mayt or resides, or a spouse of any of those providers or employees, may be designated by the individual as a health care agent unless the health care provider, employee or spouse of the provider or empler of attorney for health care instrument. (3) No health care provider for an individual, employee of that health care provider or employee of a health care facility in which an individual is a patieny be a relative of the principal or have knowledge that he or she is entitled to or has a claim on any portion of the principal's estate. A copy of the statement, if made, shall be appended to the powcapacity. Mere old age, eccentricity or physical disability, either singly or together, are insufficient to make a finding of incapacity. Neither of the individuals who make a finding of incapacity maas defined in s. 448.01 (5), or one physician and one licensed psychologist, as defined in s. 455.01 (4), who personally examine the principal and sign a statement specifying that the principal has inction. (2) Unless otherwise specified in the power of attorney for health care instrument, an individual's power of attorney for health care takes effect upon a finding of incapacity by 2 physicians, ealth care. An individual for whom an adjudication of incompetence and appointment of a guardian of the person is in effect under ch. 880 is presumed not to be of sound mind for purposes of this subseve" has the meaning given in s. 242.01 (11). 155.05 Power of attorney for health care. (1) An individual who is of sound mind and has attained age 18 may voluntarily execute a power of attorney for hse of making health care decisions on his or her behalf if the individual cannot, due to incapacity. (11) "Principal" means an individual who executes a power of attorney for health care. (12) "Relati60 or older for purposes of the state plan under 42 USC 3027. (10) "Power of attorney for health care" means the designation, by an individual, of another as his or her health care agent for the purpoacks the capacity to manage his or her health care decisions. (9) "Multipurpose senior center" means a facility that is the focal point for the delivery of services in a community to individuals aged lth agency, as defined in s. 50.49 (1) (a). 1 (8) "Incapacity" means the inability to receive and evaluate information effectively or to communicate decisions to such an extent that the individual lhealth care services, an operational cooperative sickness care plan organized under ss. 185.981 to 185.985 that directly provides services through salaried employees in its own facility, or a home heacing Christian Science treatment, an optometrist licensed under ch. 449, a psychologist licensed under ch. 455, a partnership thereof, a corporation or limited liability company thereof that provides icensed under ch. 447, a physician, physician assistant, perfusionist, podiatrist, physical therapist, occupational therapist, or occupational therapy assistant licensed under ch. 448, a person practicility under s. 45.365, 51.05, 51.06, 233.40, 233.41, 233.42 or 252.10. (7) "Health care provider" means a nurse licensed or permitted under ch. 441, a chiropractor licensed under ch. 446, a dentist lnty home, county infirmary, county hospital, county mental health center or other place licensed or approved by the department under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.35, 51.08 or 51.09 or a fa accept, maintain, discontinue or refuse health care. (6) "Health care facility" means a facility, as defined in s. 647.01 (4), or any hospital, nursing home, community-based residential facility, coudual is unable or unwilling to make those decisions, an alternate individual designated by the principal to do so. (5) "Health care decision" means an informed decision in the exercise of the right toor treat an individual's physical or mental condition. (4) "Health care agent" means an individual designated by a principal to make health care decisions on behalf of the principal or, if that indiviutrition or hydration is administered into the vein, stomach, nose, mouth or other body opening of a declarant. (3) "Health care" means any care, treatment, service or procedure to maintain, diagnose wer Of Attorney For Health Care Form. 155.01 Definitions. In this chapter: (1) "Department" means the department of health and family services. (2) "Feeding tube" means a medical tube through which n. This Wisconsin Power Of Attorney For Health Care is based on the Wisconsin Statutes Chapter 154. For your convenience, we have included useful excerpts from the Wisconsin Statutes relating to the Po Wisconsin Power Of Attorney For Health Care This package contains (1) Information and Instruction for Wisconsin Power Of Attorney For Health Care; (2) Wisconsin Power Of Attorney For Health Care Forms document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information and Instructionsney first to make sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of thiitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attord or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substsometimes known as an Advance Health Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implieWisconsin Advance Health Care Directive This package contains both a Wisconsin Power of Attorney for Health Care and a Wisconsin Declaration to Physician (Living Will). Together these forms are also WisconsinWisconsin ______________________________ Signature of Notary Public _______________________________ Printed Name of Notary My commission expires: Quitclaim Deed - 2 ___________________, 20___ the above named___________________________ to me known to be the person _____________________ who executed the foregoing instrument and acknowledged the same. NOTARY SEAL _________________________ ____________________________________________ Type or Print Name of Grantor STATE OF WISCONSIN County of ______________ } ss. Personally came before me this _______ day of _e, or any of the buildings, appurtenances and improvements thereon. Quitclaim Deed - 1 IN WITNESS WHEREOF, Grantor has executed this Quitclaim Deed on __________________, 20 __. ____________________ Grantee's heirs, successors and/or assigns forever; so that neither Grantor nor Grantor's heirs, successors and/or assigns shall have claim or demand any right or title to the property described abovents, rights of way, covenants, conditions, reservations and restrictions of record. TO HAVE AND TO HOLD all of Grantor's right, title and interest in and to the above described property unto Grantee, if any, in the City of __________________________, County of ________________________________, State of Wisconsin described as follows: [Insert legal description] SUBJECT TO all, if any, valid easem hereby REMISES, RELEASES, AND FOREVER QUITCLAIMS to Grantee, all right, title, interest and claim to the plot, piece or parcel of land, with all the buildings, appurtenances and improvements thereon, VALUABLE CONSIDERATION, in the amount of _______________________ DOLLARS ($___________) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Grantore address is _________________ __________________________________________ and ________________________________ ("Grantee") whose address is _____________________________________________________. FOR Acorder's use only QUITCLAIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: THIS QUITCLAIM DEED, made and entered into on ___________________, 20_____, between ____________________________ ("Grantor") whosrs and Terms of Use found at findlegalforms.com Recording requested by: and when recorded, please return this deed and tax statements to: Parcel Identification No.: Escrow No.: Document No.: For re used without consulting with an attorney first. An Attorney should be consulted before negotiating any document with another party. [_] The purchase and use of these forms is subject to the Disclaime returned unrecorded or may be charged additional fees [_] These forms are not intended and are not a substitute for legal advice. These forms should only be a starting point for you and should not bed with it. Please check your local requirements with your local Recorder's (or similar) office. [_] Depending on the type of document, additional requirements may apply. Nonconforming documents may be third parties. [_] Documents referencing land should include a legal description of the land. Verify that the legal description is correct. [_] A Quitclaim Deed may require other documents to be filegn the Quitclaim Deed before a Notary. Among other things, Notarization will allow the Quitclaim Deed to be recorded as a public record. Without filing, the Quitclaim Deed may not be effective againstInstructions & Checklist for Quitclaim Deed Wisconsin (Individual) [_] This package contains (1) Instructions and Checklist for Quitclaim Deed and (2) Quitclaim Deed [_] The Grantor should date and si WisconsinWisconsin _____________ 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 Wisconsin