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Wyoming 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 WyomingWyoming ________________________________ 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 WyomingWyoming 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 WyomingWyoming ____________ as identification, this _______ day of __________________, 20____. __________________________________________ Notary public [SEAL] Self-proved Will Affidavit y known to me or who has produced ______________________ as identification, and by ____________________________________________, a witness, who is personally known to me or who has produced _________________________, a witness, who is personally known to me or who has produced ______________________ as identification, and by ____________________________________________, a witness, who is personall to before me by _____________________________________, the testator, who is personally known to me or who has produced _____________________ as identification, and by ___________________________________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ______________________________________ Subscribed and sworn___________________________ Address: ______________________________________ _____________________________________________ (Witness) Print Name: ___________________________________ Address: ___________witness was and is competent and of proper age to witness a will. _____________________________________________ (Testator) _____________________________________________ (Witness) Print Name: ________ss, the testator was, at the time of signing, of the age of majority (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each the witnesses; 3) the witnesses signed the will upon the request of the testator, in the presence and hearing of the testator and in the presence of each other; 4) to the best knowledge of each witnethen declared to me that: 1) the attached or foregoing instrument is the last will of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presence of_______________, the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, each that _______________________________________________________________, the testator and _______________________________________, and __________________________________, and ______________________________ Witness Page 7 of ______ Self-Proved Will Affidavit STATE OF __________________________ COUNTY OF ________________________ I, the undersigned, an officer authorized to administer oaths, certify ___________ ___________________________________ ___________________________________ ___________________________________ Initials: __________ Testator __________ Witness __________ Witness _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ _______________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ____. Dated: ____________________, ______ Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: ____________________rocured 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 after his or her nameer, 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 this Will was not pr's sight Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 6 of ______ and presence and at Testator's request, and in the sight and presence of each othned in our sight and presence by _____________________________ (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testatoder penalty of perjury under the laws of the State of ____________________ that the above instrument, which consists of _____ pages, including the page(s) which contain the witness signatures, was sig adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) We, the undersigned, hereby certify and declare un Witnesses named below to witness my signature. Testator's Signature: _______________________________________________ Name: _________________________________________ (Notice to Witnesses: Three (3)______. 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 influence and ask thenforceability should affect only that provision and all other provision should remain effective. IN WITNESS WHEREOF, I have signed my name below to this Will, this _____ day of ____________________, nder, 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 unearing 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 hereu 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 she 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 if's good faith actions or non-actions 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 thfaith, 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 fiduciaryme 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 bad ___ Witness Page 5 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 survived only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. Initials: __________ Testator __________ Witness __________ Witness _______all 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, butthis 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 shpplemented 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 review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE VII MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be sunance 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 oran 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 mainteority and discretion granted herein in what Executor deems to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not such exercise may have the effect of conferring ed to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor shall exercise the powers, authon with administering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor shall be fully protected in exercising any discretion grantditions as the Executor may deem advisable and to refer to arbitration all such claims if the Executor deem same advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connecti0. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and conon or exercise of discretion, entered into by the Executor in good faith. 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. 1ed by Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 4 of ______ any such person or by my estate resulting from any election, determination, designatibe conclusive and binding upon all the beneficiaries hereof. The Executor shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experiencmerica, by the legislature or government of any state, or by any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall frain from making, in Executor's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States of Aany bond or security and without liability for any loss or damage. The Executor shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or rectually 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 paying any rent, without giving ssets 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 possession and no such interest not an property. 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's absolute discretion without responsibility for loss to the intent that investments or aibution 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 fractional share is 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 division or distrcall 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 and part credit a concerned, notwithstanding any fluctuation in market value and notwithstanding that one or more of the Executor may be beneficially interested in the property or any part thereof so valued. 5. Sell, retion 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 shall be final and binding upon all persons part in the assets forming my estate at the time of my death or at the time of such division, setting aside or payment, and I expressly will and declare that the Executor shall in their absolute disce or mortgages which may be in existence at any time forming part of my estate. 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly or intgage 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 any mortgage or mortgages and to pay off any mortgag and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor shall also have the right to renew and keep renewed any mor_____ Witness __________ Witness __________ Witness Page 3 of ______ condition and repair, in the manner and to the extent that the Executor shall deem advisable. 3. To accept surrenders of leasesiod as the Executor shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate Initials: __________ Testator _____, 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 for such per court and without notice to anyone. I also give to the Executor power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a salel 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 ofer administration of my estate, the Executor 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 reaerving hereunder. ARTICLE VI POWERS OF EXECUTOR In addition to the existing authority of the Executor and in addition to other powers and authority granted by law or necessary or appropriate for proppervised", or "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 sthe extent permitted 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", "unsu 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 original or substituted and whether one or more. To point ___________________________________, , to be the Executor of this my Will in the place and stead of the first aforementioned Executor. References to "Executor" in this my Will shall include each___________________________________, ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or is unable to serve or continue to serve as Executor for any reason, I ap 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 V NOMINATION OF EXECUTOR I appoint 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 the time of the distribution or to anyability, I authorize the Executor to nevertheless make any Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 2 of ______ distribution for any such personbe specifically otherwise provided herein or directed otherwise by law, if any person should become entitled to any share in my estate before attaining the age of majority or while under any other distive shares to be determined under the laws of the State of ________________________, then in effect, as if I had died intestate at the time fixed for distribution under this provision. Except as may ___, ____________________________________________________________, If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-law, their identities and respecares per stirpes. If none of the named child(ren) survive me, I direct that my residuary estate be distributed in equal shares per stirpes to: _________________________________________________________uted, bequeathed and given to my child(ren) _____________________________________________________________________ (name(s)). If more than one child is named, then the distribution shall be in equal she than one child is named, then the distribution shall be in equal shares per stirpes. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distribed with my residuary estate. Primary Residence All my interest in my primary residence or homestead, if any, shall be distributed to my child(ren) ___________________________________ (name(s)). If mormy residuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributuary estate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with ate. _____________________________________________ shall be distributed to ___________________________________. If this beneficiary does not survive me, this bequest shall be distributed with my resid upon or after my death pursuant to any agreement with respect to such property. ARTICLE IV DISPOSITION OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estThis direction shall not extend to or include any such taxes that may be payable by a purchaser or transferee in connection with any property transferred to or acquired by such purchaser or transfereee Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: __________ Testator __________ Witness __________ Witness __________ Witness Page 1 of ______ or benefit given or conferred by me either during my lifetime or by survivorship. The payment of the taxes shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. The taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift ue of my estate. The Executor shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of thand charged to the capital of my general estate. All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residtatute or rule of court and without order of any court. ARTICLE III PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses of last illness be first paid out of n or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by s_____________________________ Born on _________________ ARTICLE II FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper for my funeral, crematio I have the following adult child(ren): Name: _______________________________________ Born on _________________ Name: _______________________________________ Born on _________________ Name: __________d Codicils and publish and declare this to be my Last Will and Testament. ARTICLE I MARRIAGE & CHILDREN I am divorced from _____________________________________ (name of ex-spouse). I am not married.nal. Last Will And Testament Of ______________________ I, _____________________________________ (name), of _______________________ (county), _______________________ (state), revoke my former Wills anation. 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 professioime 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 situouse is not a U.S. citizen, the deduction is limited (it was $100,000 in 1999). This information and these forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from tIn addition, each individual may leave an unlimited amount to his or her spouse upon death without any federal estate tax liability. This is referred to as the "Marital Deduction". If the recipient spss) interests; [] individual retirement accounts and qualified employee benefit plans; [] the face value of any life insurance policy; [] property you are holding in trust; any joint property you own following: [] real estate; [] stocks and bonds; [] bank accounts; [] tangible personal property (household furnishings and furniture, jewelry, art, and other personal effects); [] partnership (busine't use this will and should consult with tax professionals and an attorney. Before using this Will, it may be helpful to determine the value of all of the assets in your estate. Assets may include then value and exceeds that amount, the greater your need for professional estate tax planning advice. If your assets come near the $2,000,000 level, Information about Wills ­ Page 2 you really shouldnedit is $2,000,000. The credit is available to each individual and his or her spouse. Estates totaling $2,000,000 or more could be subject to federal estate tax. As your estate approaches $2,000,000 iw provides that upon the death of an individual, there is a credit against the estate tax otherwise due on a portion of the value of an individual's estate. For a person dying in 2006 to 2008, that crrincipal estate planning document. If you have a large estate, you may need more complicated planning to reduce or limit death taxes. Testators should have an understanding of tax laws. Federal tax laermits self proving, but requires the affidavit to be in a specific format similar to the one included in our wills. The Will is for anyone in any life situation where this Will is to be used as the pCalifornia and the District of Columbia, the courts have some latitude to accept a will as self proved, to require an affidavit of the witnesses or to require the witnesses to testify. New Hampshire pe affidavit in those states will not invalidate the Will (since it is a separate document from the Will). In those states it will have to be "proven" in court, like any other will. In Ohio, Maryland, ocation. A few states like Louisiana, Maryland, Ohio and Vermont (as of 2003) do not have statutes permitting self proving wills. The affidavit will be of no use in those states. However, including thsses are not available when they are needed.. However, even with the Affidavit, the Will may still be subject to contest on such grounds as undue influence, lack of testamentary capacity, or prior revties for signing a Will were followed. The Affidavit may eliminate the need to have witnesses testify, that the formalities in signing the Will were followed. The Affidavit can also be useful if witnern laws, all wills were proved by having one or more of the witnesses come into court and testify under oath, or through sworn affidavits, that each saw the Testator sign the will and that the formalined. The Affidavit does not affect the validity or legality of the Will. However, it can speed up the admission of the Will to probate after the death of the Testator. Before the adoption of more modenclosed self-proving affidavit, which contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary, that all required formalities were observed when the Will was sigficiary designations (such as life insurance or employee benefit plans), and assets held in trust generally will not be required to be probated and will not be governed by this Will. The Will has an e probate for the Testator's estate. It merely directs how the assets which are individually owned by the Testator will be distributed. Assets held jointly with rights of survivorship, assets with beneTerms of Use found at findlegalforms.com Information about Wills This Will distributes the assets of the person making the Will (the "Testator") as specified by the Testator. This Will does not avoidate planning matters. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and t 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 with estt or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting poinlocal requirements. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legal effecplace. All wills should be reviewed by a lawyer before they are signed. If the Testator moves to another state, the current will should be checked by a lawyer in their new state to make sure it meets that the total of all of the beneficiary's percentage's equal 100%. Check the totals before signing the Will. State and federal laws which affect estate planning can vary over time and from place to 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 distribution in percentages, make surery or one of the Executors dies. Checklist & Instructions ­ Page 4 Most state laws guarantee a minimum share of an estate to a spouse when the other spouse dies. The Will may be invalid if a spouse ed and an entirely new Will should be written and signed. New wills are commonly necessary when, for example, the Testator's marital status changes, if the Testator has a child or if a named beneficiae the Will, do not modify it by adding, deleting, or changing words on the face of the Will. Such changes are usually disregarded. If changes are desired, the original and all copies should be destroyare 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 competent tax advisor. If it becomes necessary to changplan benefits, life insurance proceeds and survivor benefits arising in other contracts and plans are not normally governed by a will. This Will is not designed to reduce taxes. Estate taxes, if any, 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 held in trust. In addition, the distribution of retirement e provided to the person named as Executor / Personal Representative. This Will does not dispose of property that, on the death of the Testator, would automatically pass to another person by operations may be 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 Testator and may also (if Testator so wishes) bn 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 "copy" of a will should be prepared. While photocopieto 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 original of the Will should be kept in a secure locatio 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) before naming them as a Personal Representative, t) should be entered by hand in the bottom right of each page. The Personal Representative / Executor, should be picked carefully. It is very important to pick a person (or bank or trust company) thatgments and administer oaths. The affidavit states that all required formalities were observed when the Will was signed. The total number of pages (excluding i.e. not counting the self-proving affidavistates) and attach it to the end of the Will. The Affidavit contains the Testator's acknowledgment and the affidavit of the witnesses, made before a Notary or other person authorized to take acknowleddavit, if included, should not be counted because the affidavit is not a part of the Will itself. The Testator and the witnesses should sign the self-proving affidavit (called "Proof of Will" in some es an earlier Will). The total number of pages in the Will, including the page(s) on which the witness signature lines appear, should be indicated by the Witnesses. The page with the self-proving affiested, 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 revokof the notary public. The witnesses must be satisfied that the Testator is an adult of sound mind and he/she is signing the Will freely and willingly. Checklist & Instructions ­ Page 3 Wherever requprevent 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 and each other 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 to initial the bottom of each page of the Will. This can Testator's Last Will and Testament. However, the witnesses don't need to read or know the contents of the Will. For example, the Testator can say: "The document I am about to sign is my Last Will andign the Will. The notary public is needed for the self proved affidavit. Before signing the Will, the Testator should orally declare that the document that is about to be signed, is intended to be thee 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 Testator sd 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't b share of the estate. Although most states only require two witnesses, the Will should be signed by the Testator in the presence of three (3) qualified, competent, disinterested and adult witnesses anof "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 entitled to ad 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 states). Being though 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 Witnesses ancity; []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 Affidavit (alrs like taxes, taking care of the property, and making distributions to the beneficiaries Article VII: Contains miscellaneous provisions Signature Block: Testator needs to fill out: [] day month year ns ­ Page 2 named in the will. Testator must provide and fill out [] the name of executor; [] name of alternate executor. Article VI: Powers of Executor empowers the representative to deal with mattebts, administration expenses and taxes out of the testator's estate. After paying debts and expenses, the Personal Representative will pay whatever is left to the beneficiaries Checklist & Instructiooice cannot serve. The Executor will have the responsibility (after the testator's death) of managing the testator's property. The Personal Representative is also responsible for paying outstanding dewith the appointment of the Testator's Personal Representative (i.e. Executor) and alternate; It allows the Testator to name an Executor to administer the estate, and an alternate in case the first ch [] name(s) of person(s)/entity(s) remaining tangible property is given to; [] name(s) of person(s)/entity(s) Residuary Estate is given to; [] state under whose laws the will is made Article V: Deals r must provide and fill out: [] description of property (or dollar amount); [] name(s) of person/entity property is given to (three blank paragraphs are provided, but you can add as many as you need).e III: Authorizes payments of debts and expenses. Article IV: Disposes of specific property. Allows Testator to give specific dollar amounts or other property to specific persons or charities. Testatoate of birth for each child. Three spaces are provided for names of children. You can add or remove spaces for names as necessary. Article II: Authorizes payment of funeral and Burial expenses. Articlll out: []name, [] county and []state Article I: Gives the name of the ex-spouse and the name(s) of any child(ren). Testator must provide and fill out [] name of ex-spouse; [] name of child(ren) and deeds to be completed. Title: Enter name of Testator in blank space under title "Last Will and Testament of". Introduction: Contains preliminary information about the will. Testator must provide and fi00,000. This Will is divided into various sections. The content of each section is explained below. Some sections require information to be entered in the space provided. The enclosed Affidavit also nudes a selfproved affidavit. It distributes the assets of the Testator (i.e. person making the will) to specific beneficiaries named in the Will. This Will is suitable for estates worth less than $2,0; (2) Information about Wills; (3) Will ­ Divorced Person (not remarried) with Adult Children and self-proved affidavit. This Will is for a Divorced (not remarried) Person with Adult Children and inclChecklist and Instructions Will ­ Divorced (not remarried) Person with Adult Children This package contains (1) Checklist and Instruction for Will ­ Divorced Person (not remarried) with Adult Children WyomingWyoming ate) Advance Health Care Directive __________________ _____________________________________________________________ Advance Health Care Directive (Signature of notary public in lieu of witnesses) ___________________________________ (d___ Date: _______________ Print Name: ___________________________________________________ Telephone Number: _____________________________________________ Residence Address: ___________________________n operator of a community care facility, the operator of a residential care facility, nor an employee of an operator of a residential care facility. Witness #2: Signature: ____________________________ted as attorney-in-fact by this document, and that I am not a treating health care provider, an employee of a treating health care provider, the operator of a community care facility, an employee of al, that the principal signed or acknowledged this document in my presence, that the principal appears to be of sound mind and under no duress, fraud or undue influence, that I am not the person appoin_____________________________________ I declare under penalty of perjury under the laws of Wyoming that the person who signed or acknowledged this document is personally known to me to be the principa______________________________________________ Telephone Number: _____________________________________________ Residence Address: _____________________________________________ ________________________e operator of a residential care facility, nor an employee of an operator of a residential care facility. Witness #1: Signature: _______________________________ Date: _______________ Print Name: _____nd that I am not a treating health care provider, an employee of a treating health care provider, the operator of a community care facility, an employee of an operator of a community care facility, thd this document in my presence, that the principal appears to be of sound mind and under no duress, fraud or undue influence, that I am not the person appointed as attorney-in-fact by this document, alare under penalty of perjury under the laws of Wyoming that the person who signed or acknowledged this document is personally known to me to be the principal, that the principal signed or acknowledge______________________________ Residence Address: _____________________________________________ _____________________________________________________________ (Optional) SIGNATURES OF WITNESSES: I decNATURES: Sign and date the form here: Signature: _______________________________ Date: _______________ Print Name: ___________________________________________________ Telephone Number: _______________ code) _____________________________________________ (phone) Advance Health Care Directive ******************** (12) EFFECT OF COPY: A copy of this form has the same effect as the original. (13) SIGy physician: _____________________________________________ (name of physician) _____________________________________________ (address) _____________________________________________ (city) (state) (zip___________________________________ (phone) If the physician I have designated above is not willing, able or reasonably available to act as my primary physician, I designate the following as my primar_________________________________________ (name of physician) _____________________________________________ (address) _____________________________________________ (city) (state) (zip code) __________: (i) Any purpose authorized by law; (ii) Transplantation; (iii) Therapy; (iv) Research; (v) Medical education. PART 4 (OPTIONAL) (11) I designate the following physician as my primary physician: _____________________________________________ ______________________________________________________________________ (d) My gift is for the following purposes (strike any of the following you do not want)pon my death (initial applicable box): (a) I give my body, or (b) I give any needed organs, tissues or parts, or (c) I give the following organs, tissues or parts only: _________________________________ ______________________________________________________________________________ (Add additional sheets if needed.) Advance Health Care Directive PART 3 DONATION OF ORGANS AT DEATH (OPTIONAL) (10) U____________________________________________ ______________________________________________________________________________ ___________________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ __________________________________uctions you have given above, you may do so here.) I direct that:_______________________________________________________________ _________________________________________________________________________________________________________________________________ (9) OTHER WISHES: (If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instr_____________________ ______________________________________________________________________________ ______________________________________________________________________________ ____________________F FROM PAIN: Except as I state in the following space, I direct that treatment for alleviation of pain or discomfort be provided at all times: _________________________________________________________f the choice I have made in paragraph (6). If I initial this box , artificial hydration must be provided regardless of my condition and regardless of the choice I have made in paragraph (6). (8) RELIEin accordance with the choice I have made in paragraph (6) unless I initial the following box. If I initial this box , artificial nutrition must be provided regardless of my condition and regardless od as long as possible within the limits of generally accepted health care standards. (7) ARTIFICIAL NUTRITION AND HYDRATION: Artificial nutrition and hydration must be provided, withheld or withdrawn medical certainty, I will not regain consciousness, or (iii) the likely risks and burdens of treatment would outweigh the expected benefits, OR (b) Choice To Prolong Life I want my life to be prolongeant my life to be prolonged if (i) I have an incurable and irreversible condition that will result in my death within a relatively short time, (ii) I become unconscious and, to a reasonable degree of ect that my health care providers and others involved in my care provide, withhold or withdraw treatment in accordance with the choice I have initialed below: (a) Choice Not To Prolong Life I do not w__________ I do not nominate anyone to be guardian. Advance Health Care Directive PART 2 INSTRUCTIONS FOR HEALTH CARE Please strike any wording that you do not want. (6) END-OF-LIFE DECISIONS: I dirin the order designated: _____________________________________________________________ _____________________________________________________________ ___________________________________________________on needs to be appointed for me by a court, (please initial one): I nominate the agent(s) whom I named in this form in the order designated to act as guardian. I nominate the following to be guardian determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent. (5) NOMINATION OF GUARDIAN: If a guardian of my persgive in Part 2 of this form, and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent care decisions for me takes effect immediately. (4) AGENT'S OBLIGATION: My agent shall make health care decisions for me in accordance with this power of attorney for health care, any instructions I supervising health care provider determines that I lack the capacity to make my own health care decisions unless I initial the following box. If I initial this box my agent's authority to make health________________________________________________________________________ (Add additional sheets if needed.) (3) WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE: My agent's authority becomes effective when my___________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________________________________________________________________ ______________________________________________________________________________ ___________________________________________ for me, including decisions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive, except as I state here:_________________________ _(city) (state) (zip code) __________________ (home phone) __________________ (work phone) Advance Health Care Directive (2) AGENT'S AUTHORITY: My agent is authorized to make all health care decisionss my second alternate agent: _________________________________ (name of individual you choose as second alternate agent) _________________________________ (address) _________________________________ ____ (work phone) OPTIONAL: If I revoke the authority of my agent and first alternate agent or if neither is willing, able or reasonably available to make a health care decision for me, I designate af individual you choose as first alternate agent) _________________________________ (address) _________________________________ (city) (state) (zip code) __________________ (home phone) ______________agent's authority or if my agent is not willing, able or reasonably available to make a health care decision for me, I designate as my first alternate agent: _________________________________ (name oagent) _________________________________ (address) _________________________________ (city) (state) (zip code) __________________ (home phone) __________________ (work phone) OPTIONAL: If I revoke my EY FOR HEALTH CARE (1) DESIGNATION OF AGENT: I designate the following individual as my agent to make health care decisions for me: _________________________________ (name of individual you choose as be discussed with a tax professional. The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at www.findlegalforms.com Advance Health Care Directive POWER OF ATTORNsure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should d/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 first to make rranties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. These forms are not intended and are not a substitute for legal and is willing to take the responsibility. You have the right to revoke this advance health care directive or replace this form at any time. These forms are provided "as is" and no implied or express wa institution at which you are receiving care, and to any health care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes anry public or, in the alternative, be witnessed by two (2) witnesses. Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health careate a supervising health care provider to have primary responsibility for your health care. After completing this form, sign and date the form at the end. This form must either be signed before a nota additional wishes. Advance Health Care Directive Part 3 of this form lets you express an intention to donate your bodily organs and tissues following your death. Part 4 of this form lets you design, including the provision of artificial nutrition and hydration, as well as the provision of pain relief. Space is also provided for you to add to the choices you have made or for you to write out anyu give specific instructions about any aspect of your health care. Choices are provided for you to express your wishes regarding the provision, withholding or withdrawal of treatment to keep you alive medication and orders not to resuscitate; and (d) Direct the provision, withholding or withdrawal of artificial nutrition and hydration and all other forms of health care. Part 2 of this form lets yoiagnose or otherwise affect a physical or mental condition; (b) Select or discharge health care providers and institutions; (c) Approve or disapprove diagnostic tests, surgical procedures, programs ofay have to be made. If you choose not to limit the authority of your agent, your agent will have the right to: (a) Consent or refuse consent to any care, treatment, service or procedure to maintain, dsions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that m operator or employee of a residential or community care facility at which you are receiving care. Unless the form you sign limits the authority of your agent, your agent may make all health care deci You may also name an alternate agent to act for you if your first choice is not willing, able or reasonably available to make decisions for you. Unless related to you, your agent may not be an owner,l as agent to make health care decisions for you if you become incapable of making your own decisions or if you want someone else to make those decisions for you now even though you are still capable.se this form, you may complete or modify all or any part of it. You are free to use a different form. Part 1 of this form is a power of attorney for health care. Part 1 lets you name another individua for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your supervising health care provider. If you uctive Instructions Wyoming Advance Health Care Directive You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisionsor health care. (e) An advance health care directive that conflicts with an earlier advance health care directive revokes the earlier directive to the extent of the conflict. Advance Health Care Dire(d) A decree of annulment, divorce, dissolution of marriage or legal separation revokes a previous designation of a spouse as agent unless otherwise specified in the decree or in a power of attorney fho is informed of a revocation shall promptly communicate the fact of the revocation to the supervising health care provider and to any health care institution at which the patient is receiving care. hall, as soon as possible after the revocation, be documented in a writing signed and dated by the individual or a witness to the revocation. (c) A health care provider, agent, guardian or surrogate wpacity may revoke all or part of an advance health care directive, other than the designation of an agent, at any time and in any manner that communicates an intention to revoke. Any oral revocation s Revocation of advance health care directive. (a) An individual with capacity may revoke the designation of an agent only by a signed writing. Advance Health Care Directive (b) An individual with caination of a guardian of the person. (j) An advance health care directive is valid for purposes of this act if it complied with the applicable law at the time of execution or communication. 35-22-404.ent known to the agent. (g) A health care decision made by an agent for a principal is effective without judicial approval. (h) A written advance health care directive may include the individual's nomecision in accordance with the agent's determination of the principal's best interest. In determining the principal's best interest, the agent shall consider the principal's personal values to the ext(f) An agent shall make a health care decision in accordance with the principal's advance health care directive and other wishes to the extent known to the agent. Otherwise, the agent shall make the dan individual instruction or the authority of an agent, shall be made by the primary physician, but the supervising health care provider may make the decision if the primary physician is unavailable. capacity. (e) Unless otherwise specified in a written advance health care directive, a determination that an individual lacks or has recovered capacity, or that another condition exists that affects r health care, the authority of an agent becomes effective only upon a determination that the principal lacks capacity, and ceases to be effective upon a determination that the principal has recoveredare facility or employee of the operator or facility; (iv) The operator of a residential care facility or employee of the operator or facility. (d) Unless otherwise specified in a power of attorney foitness for a power of attorney for health care: (i) A treating health care provider or employee of the provider; (ii) The attorney-in-fact nominated in the writing; (iii) The operator of a community c of an operator of a community care facility, the operator of a residential care facility, nor an employee of an operator of a residential care facility. (c) None of the following shall be used as a wppointed as attorney-in-fact by this document, and that I am not a treating health care provider, an employee of a treating health care provider, the operator of a community care facility, an employeed or acknowledged this document in my presence, that the principal appears to be of sound mind and under no duress, Advance Health Care Directive fraud or undue influence, that I am not the person asubstance: I declare under penalty of perjury under the laws of Wyoming that the person who signed or acknowledged this document is personally known to me to be the principal, that the principal signeeach of whom witnessed either the signing of the instrument by the principal or the principal's acknowledgement of the signature or of the instrument, each witness making the following declaration in ity care facility at which the principal is receiving care. The durable power of attorney must either be sworn and acknowledged before a notary public or must be signed by at least two (2) witnesses, later incapacity and may include individual instructions. Unless related to the principal by blood, marriage or adoption, an agent may not be an owner, operator or employee of a residential or commun must be in writing and signed by the principal or by another person in the principal's presence and at the principal's expressed direction. The power remains in effect notwithstanding the principal'sdult or emancipated minor may execute a power of attorney for health care, which may authorize the agent to make any health care decision the principal could have made while having capacity. The power) An adult or emancipated minor may give an individual instruction. The instruction may be oral or written. The instruction may be limited to take effect only if a specified condition arises. (b) An ath this act as the person or persons who are to make those decisions in accordance with this act. (xxi) "This act" means W.S. 35-22-401 through 35-22-416. 35-22-403. Advance health care directives. (ae to initiate, continue or discontinue the use of a life sustaining procedure on behalf of a patient who lacks capacity; and (D) Are identified by the supervising health care provider in accordance wie; (xx) "Surrogate" means an adult individual or individuals who: (A) Have capacity; (B) Are reasonably available; (C) Are willing to make health care decisions, including decisions to initiate, refusbject to the jurisdiction of the United States; (xix) "Supervising health care provider" means the primary health care provider who has undertaken primary responsibility for an individual's health caric mental illness; Advance Health Care Directive (xviii) "State" means a state of the United States, the District of Columbia, the Commonwealth of Puerto Rico or a territory or insular possession suient's health care needs; (xvii) "Residential care facility" means a public or private facility providing for the residential and health care needs of the elderly or persons with disabilities or chron to be contacted with a level of diligence appropriate to the seriousness and urgency of a patient's health care needs and willing and able to act in a timely manner considering the urgency of the patual's health care or, in the absence of a designation or if the designated physician is not reasonably available, a physician who undertakes the responsibility; (xvi) "Reasonably available" means ableanced practice registered nurse; (xv) "Primary physician" means a physician designated by an individual or the individual's agent, guardian or surrogate, to have primary responsibility for the individ "Primary health care provider" means any person licensed under the Wyoming statutes practicing within the scope of that license as a licensed physician, licensed physician's assistant or licensed advmedicine under the Wyoming Medical Practice Act; (xiii) "Power of attorney for health care" means the designation of an agent to make health care decisions for the individual granting the power; (xiv)ry course of business; (xi) "Individual instruction" means an individual's direction concerning a health care decision for the individual; (xii) "Physician" means an individual authorized to practice other forms of health care. (x) "Health care institution" means an institution, facility or agency licensed, certified or otherwise authorized or permitted by law to provide health care in the ordinasapproval of diagnostic tests, surgical procedures, programs of medication and orders not to resuscitate; and (C) Directions to provide, withhold or withdraw artificial nutrition and hydration and alldividual or the individual's agent, guardian, or surrogate, regarding the individual's health care, including: (A) Selection and discharge of health care providers and institutions; (B) Approval or dicare" means any care, treatment, service or procedure to maintain, diagnose or otherwise affect an individual's physical or mental condition; (ix) "Health care decision" means a decision made by an inrough 14-1-206; (vii) "Guardian" means a judicially appointed guardian or conservator having authority to make a health care decision for an individual; Advance Health Care Directive (viii) "Health " means a public or private facility responsible for the day-to-day care of persons with disabilities; (vi) "Emancipated minor" means a minor who has become emancipated as provided in W.S. 14-1-201 thy" means an individual's ability to understand the significant benefits, risks and alternatives to proposed health care and to make and communicate a health care decision; (v) "Community care facilityited to, nasogastric tubes, gastrostomies, jejunostomies and intravenous infusions. Artificial nutrition and hydration does not include assisted feeding, such as spoon or bottle feeding; (iv) "Capacitrition and hydration" means supplying food and water through a conduit, such as a tube or an intravenous line where the recipient is not required to chew or swallow voluntarily, including, but not limfor health care, or both; (ii) "Agent" means an individual designated in a power of attorney for health care to make a health care decision for the individual granting the power; (iii) "Artificial nutyoming Statutes relating to Advance Health Care Directives. 35-22-402. Definitions. (a) As used in this act: (i) "Advance health care directive" means an individual instruction or a power of attorney ive. This Wyoming Advance Health Care Directive is based on Title 35 Chapter 22 Article 4 (35-22401) et. Seq. of the Wyoming Statutes. For your convenience, we have included useful excerpts from the Wrective; and 3) the Wyoming Advance Health Care Directive. This form includes a power of attorney for health care and instructions for health care, usually referred to as an advance health care directInformation Wyoming Advance Health Care Directive This packet includes: 1) Information regarding the Wyoming Advance Health Care Directive; 2) Instructions regarding the Wyoming Advance Health Care Di WyomingWyoming Printed Name of Notary My commission expires: Quitclaim Deed - 2 _, this _________________ day of ___________________, 20__. WITNESS my hand and official seal. NOTARY SEAL _______________________________ Signature of Notary Public _______________________________ __________________________________________ Type or Print Name of Grantor State of Wyoming County of ______________ } ss. The foregoing instrument was acknowledged before me by______________________ appurtenances and improvements thereon. Quitclaim Deed - 1 IN WITNESS WHEREOF, Grantor has executed this Quitclaim Deed on __________________, 20 __. ____________________________________________ __s and/or assigns forever; so that neither Grantor nor Grantor's heirs, successors and/or assigns shall have claim or demand any right or title to the property described above, or any of the buildings,nts, conditions, reservations and restrictions of record. TO HAVE AND TO HOLD all of Grantor's right, title and interest in and to the above described property unto Grantee, Grantee's heirs, successor_________________________, County of ________________________________, State of Wyoming described as follows: [Insert legal description] SUBJECT TO all, if any, valid easements, rights of way, covena, AND FOREVER QUITCLAIMS to Grantee, all right, title, interest and claim to the plot, piece or parcel of land, with all the buildings, appurtenances and improvements thereon, if any, in the City of _in the amount of _______________________ DOLLARS ($___________) and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Grantor hereby REMISES, RELEASES_____ __________________________________________ and ________________________________ ("Grantee") whose address is _____________________________________________________. FOR A VALUABLE CONSIDERATION, AIM DEED KNOW ALL MEN BY THESE PRESENTS THAT: THIS QUITCLAIM DEED, made and entered into on ___________________, 20_____, between ____________________________ ("Grantor") whose address is ____________ and Terms of Use found at findlegalforms.com Recording requested by: and when recorded, please return this deed and tax statements to: Escrow No.: For recorder's use only Title Order No.: QUITCLsed 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 Disclaimerseturned 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 be uwith 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 rhird parties. [_] Documents referencing land should include a legal description of the land. Verify that the legal description is correct. [_] A Quitclaim Deed may require other documents to be filed 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 against tInstructions & Checklist for Quitclaim Deed Wyoming (Individual) [_] This package contains (1) Instructions and Checklist for Quitclaim Deed and (2) Quitclaim Deed [_] The Grantor should date and sign WyomingWyoming _____________ 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 Wyoming