CHAPTER XX – GUARDIAN OF CHILDREN AND PROPERTY OF …



LEGAL FORMS DOWNLOAD

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“DAVENPORT ’ S FLORIDA WILLS AND ESTATE PLANNING

LEGAL FORMS”

Alexander William Russell

Ernest Charles Hope

Third Edition – 2018

Published by Davenport Press

Copyright © 2018 by Alex W. Russell

All rights reserved. No part of this publication and material may be reproduced, distributed, or transmitted in any form or by any means without prior written permission of the publisher or author (including photocopying or any electronic or mechanical methods). Purchasers may reproduce forms for their personal use. Notwithstanding the above, publisher and author may by other means indicate copying or use free of charge is allowed in certain circumstances.

No claim is made to copyright or ownership of government materials

LIST OF FORMS IN BOOK

IN THE BOOK ARE 11 FORMS BUT MOST PEOPLE ONLY USE A FEW

In this book 11 forms are provided but most people only use a few. Please read the book for more information including about how to use and fill out forms. The forms are:

Form 1. Last Will And Testament (Standard) (this controls things after death like property and money, picks an executor to handle things, and say less costly options can be used);

Form 2. Last Will And Testament (Guardians) (this is a Will to control things after death with a Guardians paragraph for those with minor child or giving things to persons under 18);

Form 3. Self-Proving Affidavit (often done to later help show a Will was signed correctly);

Form 4. Tangible Personal Property List (lets a person easily write down outside a Will

wanted gifts of “tangible personal property” like clothes, furniture, tools, cars, and jewelry);

Form 5. Living Will (lets person say if ever in extreme bad health that treatment of little

help should not be given, and if wanted lets a person be named “surrogate” to control this);

Form 6. Health Care Surrogate (lets person be named “surrogate” to control if needed health care (in general not just extreme situations), and also lets instructions be given);

Form 7. Do Not Resuscitate Order (often called a D.N.R. this shows paramedics and others not to try restarting the heart or breathing (cardiopulmonary resuscitation/CPR);

Form 8. Final Wishes (lets orders about funeral, burial, and related matters be given);

Form 9. Codicil (lets one make changes to an existing Will, but most just do a new Will);

Form 10. Durable Power Of Attorney (also called “Financial Power Of Attorney” lets

power over money, property, and more be shared with someone so they can do things);

Form 11. Power Of Attorney Of Parent (lets parent give power to someone over a child such as school, medical care, school, and home matters to help if parents are not near).

FORM 1:

LAST WILL AND TESTAMENT (STANDARD)

LAST WILL AND TESTAMENT.

I, ______________________ of _____________ County, Florida, hereby make, publish, and declare this as my Last Will and Testament (called here my "Will"), and I hereby revoke any Wills and Codicils earlier made by me.

1. GIFTS. I give in this section these specific gifts and general gifts including of money to the following beneficiaries but only for those who survive to get the gifts to them.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

2. GIFT LISTS. I may leave a list or other writing giving tangible personal property as allowed by Florida or other law, and I authorize any such list and make the gifts described. Gifts in a writing not found by 60 days after my death shall abate and be of no effect.

3. RESIDUE. I give the residue and remainder of my property and estate not already transferred by the preceding provisions of this Will, of any kind and nature and wherever located, whether now owned or later acquired, as follows:

a) to _____________________________________________ only if they survive me with those of these persons who survive taking the share of non-surviving persons, and

b) if none of these just named persons do survive I give this to

_______________________________________________ or their lineal descendants which descendants shall take the share of their non-surviving relative.

4. ADMINISTRATION. I name and appoint ________________________ as

Personal Representative of my Will and my estate and as my executor.

5. MISCELLANEOUS. The following applies to this Will, my estate, and generally.

Survival. For Will gifts a beneficiary must survive to get a gift and survival is an absolute condition and anti-lapse laws or similar have no effect, but a named alternative beneficiary may take a gift for non-surviving persons (including “lineal descendants”).

Survivors Take Joint Gift. For gifts to several beneficiaries if any are dead their part goes to living beneficiaries in proportion to their shares, including for the residue, but not

if there is a named alternate beneficiary to take the decedent’s share.

Gift Order. Priority of Will gifts of the same type is based on order they written.

Gift. Words “give” and “gift” also mean devise, bequest, grant, legacy or similar.

Informal. I request informal and unsupervised administration of my Will and estate.

Descendants. A gift including the residue to “lineal descendants” is “per stirpes”.

Unfilled Will. No unfilled or blank part is a mistake including in the residue clause.

Residue. The residue includes lapsed or failed gifts, inheritances owned, insurance paid to estate, and property with power of appointment or testamentary disposition.

Paying Debts. My executor has power to pay debts in time and manner and with property or money they find best, including not paying some debts if practicable.

Mortgage or Lien. I direct no debt with an encumbrance such as mortgage or lien should be paid, and if paid for some reason contribution is owed my estate and others.

Events During Life. No gift or other transfer made during life reduces or offsets any gift or part of this Will, unless expressly called a “loan” or “advancement”.

Items No Longer Held. A gift of property including real property that is no longer owned has no effect and a Will gift of such lapses without ademption or replacement.

Powers. Any personal representative or guardian of any type is given as much power,

authority, and discretion that may be given by law, including without liability for change in value to sell, lease, assign, mortgage, invest, exchange, or transfer in any way property, settle claims for and against the estate or any person, and have power of sale over real property, with no need for any filing or inventory or act of court. If beneficiaries getting the same property disagree on use for property it may be sold and cash given.

No Bond. Any personal representative, executor, or guardian of any type serving under this Will or otherwise shall qualify and serve with no bond, surety, or other security.

Minors Gifts. For gifts to a minor my personal representative has discretion and power without court action to transfer property to a: minor, guardian of property for a minor named by Will or a court, adult a minor lives with, or custodian under the Florida Uniform Transfers to Minors Act or similar law. The person named to be guardian of property or the estate is hereby named as custodian under such Act or any similar law.

Meaning. Plural, singular, or gender meanings do not limit this Will.

Omitted Persons. A failure to gift to any family including a child is not a mistake.

TESTATOR

I, _________________________, the Testator of this document, do sign, publish, and declare that I sign and execute this instrument as my Last Will and Testament, that I sign it willingly as a free and voluntary act for the purposes expressed therein, and that I am at least 18 years of age and of sound mind and under no constraint or undue influence,

this __ day of ________________, 20___.

________________________

Testator

WITNESSES

We, __________________ and ____________________, the Witnesses signing below, do declare in our presence the foregoing instrument was willingly published, declared, and signed by the above-named Testator as his or her Last Will and Testament, that to the best of our knowledge the Testator is at least 18 years of age and of sound mind and under no constraint or undue influence, that each of us is at least 18 years old, and that in the presence and hearing of Testator and each other we hereby sign our names as Witnesses.

__________________________ ________________________________________

Witness Address

_________________________ ________________________________________

Witness Address

FORM 2:

LAST WILL AND TESTAMENT (GUARDIANS)

LAST WILL AND TESTAMENT

I, ______________________ of _____________ County, Florida, hereby make, publish, and declare this as my Last Will and Testament (called here my "Will"), and I hereby revoke any Wills and Codicils earlier made by me.

1. GIFTS. I give in this section these specific gifts and general gifts including of money to the following beneficiaries but only for those who survive to get the gifts to them.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

I give ____________________________________ to __________________________.

2. GIFT LISTS. I may leave a list or other writing giving tangible personal property as allowed by Florida or other law, and I authorize any such list and make the gifts described. Gifts in a writing not found by 60 days after my death shall abate and be of no effect.

3. RESIDUE. I give the residue and remainder of my property and estate not already transferred by the preceding provisions of this Will, of any kind and nature and wherever located, whether now owned or later acquired, as follows:

a) to _____________________________________________ only if they survive me with those of these persons who survive taking the share of non-surviving persons, and

b) if none of these just named persons do survive I give this to

_______________________________________________ or their lineal descendants which descendants shall take the share of their non-surviving relative.

4. ADMINISTRATION. I name and appoint ________________________ as

Personal Representative of my Will and my estate and as my executor.

5. GUARDIANS. If any child of mine has not reached age 18 then I name and appoint _______________________________ to be Guardian Of The Person of any such child.

I also name and appoint ____________________________ as Guardian Of The Property and estate of any such child or any persons under age 18 who receive or possess property.

6. MISCELLANEOUS. The following applies to this Will, my estate, and generally.

Survival. For Will gifts a beneficiary must survive to get a gift and survival is an absolute condition and anti-lapse laws or similar have no effect, but a named alternative beneficiary may take a gift for non-surviving persons (including “lineal descendants”).

Survivors Take Joint Gift. For gifts to several beneficiaries if any are dead their part goes to living beneficiaries in proportion to their shares, including for the residue, but not

if there is a named alternate beneficiary to take the decedent’s share.

Gift Order. Priority of Will gifts of the same type is based on order they written.

Gift. Words “give” and “gift” also mean devise, bequest, grant, legacy or similar.

Informal. I request informal and unsupervised administration of my Will and estate.

Descendants. A gift including the residue to “lineal descendants” is “per stirpes”.

Unfilled Will. No unfilled or blank part is a mistake including in the residue clause.

Residue. The residue includes lapsed or failed gifts, inheritances owned, insurance paid to estate, and property with power of appointment or testamentary disposition.

Paying Debts. My executor has power to pay debts in time and manner and with property or money they find best, including not paying some debts if practicable.

Mortgage or Lien. I direct no debt with an encumbrance such as mortgage or lien should be paid, and if paid for some reason contribution is owed my estate and others.

Events During Life. No gift or other transfer made during life reduces or offsets any gift or part of this Will, unless expressly called a “loan” or “advancement”.

Items No Longer Held. A gift of property including real property that is no longer owned has no effect and a Will gift of such lapses without ademption or replacement.

Powers. Any personal representative or guardian of any type is given as much power,

authority, and discretion that may be given by law, including without liability for change in value to sell, lease, assign, mortgage, invest, exchange, or transfer in any way property, settle claims for and against the estate or any person, and have power of sale over real property, with no need for any filing or inventory or act of court. If beneficiaries getting the same property disagree on use for property it may be sold and cash given.

No Bond. Any personal representative, executor, or guardian of any type serving under this Will or otherwise shall qualify and serve with no bond, surety, or other security.

Minors Gifts. For gifts to a minor my personal representative has discretion and power without court action to transfer property to a: minor, guardian of property for a minor named by Will or a court, adult a minor lives with, or custodian under the Florida Uniform Transfers to Minors Act or similar law. The person named to be guardian of property or the estate is hereby named as custodian under such Act or any similar law.

Meaning. Plural, singular, or gender meanings do not limit this Will.

Omitted Persons. A failure to gift to any family including a child is not a mistake.

TESTATOR

I, _________________________, the Testator of this document, do sign, publish, and declare that I sign and execute this instrument as my Last Will and Testament, that I sign it willingly as a free and voluntary act for the purposes expressed therein, and that I am at least 18 years of age and of sound mind and under no constraint or undue influence,

this __ day of ________________, 20__.

________________________

Testator

WITNESSES

We, __________________ and ____________________, the Witnesses signing below, do declare in our presence the foregoing instrument was willingly published, declared, and signed by the above-named Testator as his or her Last Will and Testament, that to the best of our knowledge the Testator is at least 18 years of age and of sound mind and under no constraint or undue influence, that each of us is at least 18 years old, and that in the presence and hearing of Testator and each other we hereby sign our names as Witnesses.

__________________________ ________________________________________

Witness Address

_________________________ ________________________________________

Witness Address

FORM 3:

SELF-PROVING AFFIDAVIT

SELF-PROVING AFFIDAVIT

(Florida Statutes Section 732.503)

STATE OF FLORIDA

COUNTY OF ____________

I, ___________________________, declare to the officer taking my acknowledgment of this instrument, and to the subscribing witnesses, that I signed this instrument as my will.

_________________________

Testator

We, ________________________ and __________________________, have been sworn by the officer signing below, and declare to that officer on our oaths that the testator declared the instrument to be the testator’s will and signed it in our presence and that we each signed the instrument as a witness in the presence of the testator and of each other.

___________________________ ________________________________

Witness Witness

Acknowledged and subscribed before me by the testator, ______________________, who has produced _______________________ as identification,

and sworn to and subscribed before me by the witnesses,

________________________ who has produced ______________ as identification and ________________________ who has produced ______________ as identification, and subscribed by me in the presence of the testator and the subscribing witnesses, all on __________________, 20__.

________________________

(Signature of Officer)

____________________________________

(Print, type, or stamp commissioned name and affix official seal)

FORM 4:

TANGIBLE PERSONAL PROPERTY GIFT LIST

TANGIBLE PERSONAL PROPERTY GIFT LIST..

I wish this to be a separate writing with gifts of tangible personal property to be carried out after my death as allowed by Florida Statutes § 732.515 or similar laws.

I know property used in a trade or business, money or coin, real property, and non-tangible property cannot be given by this writing.

I give an item listed below only if the named recipient survives me and if no specific gift in my Will gives the item.

This writing has no effect if not found by 60 days after my death.

PROPERTY RECIPIENTS

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

_____________________________________ is given to _________________________

DATE: _____________________ SIGNED:________________________________

FORM 5:

LIVING WILL

L I V I N G W I L L

(Florida Statutes Section 765.303)

Declaration made this __ day of ___________, 20__, I ____________________________, willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and I do hereby declare that: if at any time I am incapacitated and

________ (initial) I have a terminal condition

or ________ (initial) I have an end-stage condition

or ________ (initial) I am in a persistent vegetative state

and if my attending or treating physician and another consulting physician have determined that there is no reasonable medical probability of my recovery from such condition, I direct that life-prolonging procedures be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying, and that I be permitted to die naturally with only administration of medication or the performance of any medical procedure deemed necessary to provide me with comfort care or to alleviate pain.

I do________, I do not ________ desire that nutrition and hydration (food and water) be withheld or withdrawn when the application of such procedures would serve only to prolong artificially the process of dying.

It is my intention that this declaration be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and to accept the consequences for such refusal.

In the event that I have been determined to be unable to provide express and informed consent regarding the withholding, withdrawal, or continuation of life-prolonging procedures, I wish to designate, as my surrogate to carry out the provisions of this declaration:

Name:_____________________________

Address:________________________________________ Zip Code: _________

Phone: ( ____ )____________________

I understand the full import of this declaration, and I am emotionally and mentally competent to make this declaration.

Additional Instructions (optional): _____________________________________________

_________________________________________________________________________

_________________________________________________________________________

Signed: __________________________

Witness: ____________________ Witness: ___________________

Address: ____________________________ Address: _____________________________

Phone: _____________________ Phone: ______________________

FORM 6:

DESIGNATION OF HEALTH CARE SURROGATE

DESIGNATION OF HEALTH CARE SURROGATE

(Florida Statutes Section 765.203)

Name: ____________________________ _______________________ _____

(Last) (First) (Middle Initial)

In the event that I have been determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to designate as my surrogate for health care decisions:

Name:______________________________

Address:_____________________________________________ Zip Code:___________

Phone Number (_____)___________________________

If my surrogate is unwilling or unable to perform his or her duties, I wish to designate as my alternate surrogate:

Name:______________________________

Address:_____________________________________________ Zip Code:___________

Phone Number (_____)___________________________

I fully understand that this designation will permit my designee to make health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray the cost of health care; and to authorize my admission to or transfer from a health care facility.

Additional instructions (optional):_______________________________________________

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

I further affirm that this designation is not being made as a condition of treatment or admission to a health care facility. I will notify and send a copy of this document to the following persons other than my surrogate, so they may know who my surrogate is.

Signed:________________________ Date:______________

Witness 1:_________________________ Witness 2:_________________________

FORM 7:

DO NOT RESUSCITATE ORDER

FORM 8:

FINAL WISHES

F I N A L W I S H E S

I, THE BELOW-SIGNED, HEREBY STATE THE FOLLOWING FUNERAL, BURIAL, AND OTHER INSTRUCTIONS:

1. Wanted final place and details for handling of body:_________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Wanted funeral, burial, and other services like viewing, visitation, or church: _____________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Wanted details like history and family to mention, parting words, readings, songs, foods, and other things:___________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Attorneys, accountants, friends and others to inform of death:__________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5. Other instructions:____________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SIGNED:___________________________________ DATED:___________________

PRINTED NAME:_________________________

FORM 9:

CODICIL

C O D I C I L

I, _______________________, a resident of ______________ County, Florida, declare this to be a Codicil to my Will dated _______________.

FIRST: I hereby do revoke the part of my Will that reads as follows: _______________________________________________________________

_______________________________________________________________ ____________________________________________________________ .

SECOND: I hereby do add the following part to my Will: _______________________________________________________________

_______________________________________________________________ _____________________________________________________________.

THIRD: In all other respects I hereby do confirm and republish the above-described Will.

TESTATOR. .

I, the Testator, sign, publish, and declare I sign and execute this instrument as my Codicil, that I sign it willingly as a free and voluntary act for the purposes expressed therein, and that I am at least 18 years of age and of sound mind and under no constraint or undue influence, this __ day of ____________, 20__.

________________________

Testator

WITNESSES ..

We, the undersigned, declare in our presence the foregoing instrument was willingly published, declared, and signed by the above-named Testator as his or her Codicil, that to the best of our knowledge the Testator is at least 18 years of age and of sound mind and under no constraint or undue influence, that each of us is at least 18 years old, and that in the presence and hearing of Testator and each other we hereby sign our names as witnesses.

____________________ ________________________________________

Witness Address

____________________ ________________________________________

Witness Address

FORM 10:

DURABLE POWER OF ATTORNEY

DURABLE POWER OF ATTORNEY.

This Power of Attorney is not affected by subsequent incapacity of the Principal except as provided in Florida Statutes § 709.08. This power of attorney is effective immediately and will continue until it is revoked.

I, _______________________________________, as Principal, hereby appoint _________________________________ as my Attorney-in-Fact to act for me in any lawful way with respect to the following initialed subjects:

(Initial where Attorney-in-Fact shall have power and authority)

_______ 1. Personal Property. To do any action involving personal property including lease, sell, mortgage, purchase, exchange, and acquire, and to agree, bargain, and contract for the lease, sale, purchase, exchange, and acquisition of, and to accept, take, receive, and possess any personal property whatsoever, tangible or intangible, or interest thereto, on such terms and conditions, and under such covenants, as my Attorney-in-Fact shall deem proper; to have access to safe deposit boxes and remove all con- tents and relinquish or surrender the safe deposit box; and to maintain, repair, improve, manage, insure, rent, lease, sell, convey, subject to liens or mortgages, or to take any other security interests in said property which are recognized under the Uniform Commercial Code as adopted at that time under the laws of the State of Florida or any applicable state, or otherwise pledge and in any way or manner deal with all or any part of any real or personal property whatsoever, tangible or intangible, or any interest therein, that I own at the time of execution or may thereafter acquire, under such terms and conditions, and under such covenants, as my Attorney-in-Fact shall deem proper.

_______ 2. Real Property. To do any action involving real estate and fixtures including lease, sell, mortgage, purchase, exchange, and acquire, and to agree, bargain, and contract for the lease, sale, purchase, exchange, and acquisition of, and to accept, take, receive, and possess any interest in real property whatsoever, now owned or hereafter acquired, including my Homestead Property, on such terms and conditions, and under such covenants, as my Attorney-in-Fact shall deem proper; and to maintain, repair, tear down, alter, rebuild, improve, manage, insure, move, rent, lease, sell, convey, subject to liens, mortgages, and security deeds, and in any way or manner deal with all or any part of any interest in real property whatsoever, including specifically, but without limitation, real property lying and being situated in the State of Florida, under such terms and conditions, and under such covenants, as my Attorney-in-Fact shall deem proper and may for all deferred payments accept purchase money notes payable to me and secured by mortgages or deeds to secure debt, and may from time to time collect and cancel any of said notes, mortgages, security interests, or deeds to secure debt.

_______ 3. Transacting of Business. To conduct, engage in, and otherwise transact the affairs of any and all lawful business ventures of whatever nature or kind that I may now or hereafter be involved in. To organize or continue and conduct any business which term includes, without limitation, any farming, manufacturing, service, mining, retailing or other type of business operation in any form, whether as a proprietorship, joint venture, partnership, corporation, trust or other legal entity; operate, buy, sell, expand, contract, terminate or liquidate any business; direct, control, supervise, manage or participate in the operation of any business and engage, compensate and discharge business managers, employees, agents, attorneys, accountants and consultants; and, in general, exercise all powers with respect to business interests and operations which the principal could if present and under no disability.

_______ 4. Banking Transactions. To conduct banking transactions as provided in Section 709.2208(1) of the Florida Statues, including all the actions mentioned in this Statute.

_______ 5. Investment Transactions. To conduct investment transactions as provided in Section 709.2208(2) of the Florida Statutes, including all the actions mentioned in this Statute.

_______ 6. Safe Deposit Boxes. To enter, access, remove items including money and documents, place items, open new boxes in my or other name, terminate any box and related lease, and to also do all these things with boxes held jointly with another or over any box I myself somehow have access or rights.

_______ 7. Claims, Litigation, and Settlement. To commence, prosecute, discontinue, or defend all actions or other legal proceedings touching my property, real or personal, or any part thereof, or touching any matter in which I or my property, real or personal, may be in any way concerned. To defend, settle, adjust, make allowances, compound, submit to arbitration or mediation, and compromise all accounts, reckonings, claims, and demands whatsoever that now are, or hereafter shall be, pending between me and any person, firm, corporation, or other legal entity, as my Attorney-in-Fact shall deem proper. To take legal action to enforce this document or concerning the Attorney-in-Fact’s power to act for me.

_______ 8. Borrowing of Funds. To borrow for me and on my behalf any sum or sums of money on such terms and with such security as my Attorney-in-Fact may deem appropriate, and for that purpose to execute all promissory notes, bonds, mortgages and other instruments which may be necessary or proper.

_______ 9. Vehicles. To do any action involving any vehicle I now own or shall at any time hereafter acquire, including at any time to execute vehicle transfers, and also to buy, sell, lease, repair, store, or take other action with said vehicles.

_______ 10. Insurance Policies. To act as my attorney-in-fact or proxy in respect to any policy of insurance on my life or health, or any other type of insurance, and in such capacity to exercise any rights, privileges or options which I may have thereunder or pertaining thereto, and additional insurance of any type may be obtained as my attorney-in-fact deems proper.

My Attorney-in-Fact will NOT under any circumstances have any power or incident of ownership whatsoever with respect to any life insurance policy owned by me under which my Attorney-in-Fact is the insured.

_______ 11. Retirement Plans. To contribute to, withdraw from and deposit funds in any type of retirement plan (which term includes, without limitation, any tax qualified or nonqualified pension, profit sharing, stock bonus, employee savings and other retirement plan, individual retirement account, deferred compensation plan and any other type of employee benefit plan); select and change payment options for the principal under any retirement plan; make rollover contributions from any retirement plan to other retirement plans or individual retirement accounts; exercise all investment powers available under any type of self-directed retirement plan; and, in general, exercise all powers with respect to retirement plans and retirement plan account balances which the principal could if present and under no disability.

_______ 12. Government and Private Benefits. To make such applications as may be required from time to time with Social Security, Medicare or Medicaid Administrators, and with all private insurance companies with whom I have insurance coverage; and to complete such forms and file such claims as may be required to obtain benefits which may be due or available to me.

_______ 13. Planning with Care Givers. To change my state of domicile and residency, to redirect my mail, to provide and pay for care givers to permit me to remain in my own home, even if this care is more expensive than care provided in a facility, to make necessary arrangement for my care at any hospital, nursing home, or assisted living facility and to pay for such care, and to make advance arrangements for my funeral and burial expenses.

_______ 14. Tax Returns. To file, amend, withdraw, exercise elections, allocate exemptions or give consent with respect to any federal, state and local tax returns (and any schedules, notices, powers of attorney, or other forms or documents related there to) for any type of tax for any period before or after the grant of this power, and otherwise to deal in any respect whatsoever with regard to such tax returns. Notices and correspondence relating to such matters may be sent directly to my Attorney-in-Fact.

_______ 15. Employ Attorneys, Accountants, Advisors, Contractors, and Employees.

To engage, appoint, employ, pay, and to remove or dismiss in my name, any agents, advisors, counsel, contractors, and employees who may be or have been doing services of any kind.

_______ 16. Health Care Insurance, Benefits, and Financial Choices. To make decisions which relate to my healthcare including financial, insurance, and benefit choices, and in all ways without limit my Attorney-in-Fact shall be treated as my personal representative for all purposes related to my Protected Health Information as such term is defined in the Health Insurance Portability and Accountability Act of 1996, set forth in 45 CFR § 164 and other applicable federal, state, and/or local laws and regulations.

_______ 17. Records and Information. To access, request, view, inspect, copy, release, and any other thing concerning records, reports, statements, and data of any kind concerning my financial, health care, property, or other matters, and any confidentiality, right of privacy, privilege, or any other limitation is hereby waived and ordered removed.

Any Special Instructions:_______________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I hereby grant unto my Attorney-in-Fact named below full power and authority to execute all instruments, and to do everything appropriate and necessary to be done for me and in my name, as set forth herein.

This instrument shall be governed by the laws of Florida, however it is my intention that it shall be valid and exercisable in any other state or jurisdiction including where I or my family have property.

I agree any party or person 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 they learn 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.

SIGNATURE

Signed:___________________________________ Date:__________________

WITNESSES

On the date written above, the Principal declared to me in my presence that this document is his or her power of attorney and that he or she had willingly signed as his or her free and voluntary act for the purposes expressed.

Witness #1 Signature Witness #2 Signature

________________________________ ________________________________

Witness #1 printed name Witness #2 printed name

________________________________ ________________________________

NOTARY

Sworn to and subscribed before me on ________________, 20___, by ______________________, who produced the following identification:__________________.

____________________________ (Notary or official)

AFFIDAVIT

(Affidavit of Attorney-in-Fact; Florida Statutes Section 709.2119)

STATE OF ________________

COUNTY OF _________________

Before me, the undersigned authority, personally appeared _________________________ (“Affiant”), who swore or affirmed that:

1. Affiant is the agent named in the Power of Attorney executed by ________________________ (“Principal”) on ____________________________ .

2. This Power of Attorney is currently exercisable by Affiant. The principal is domiciled in _____________________________________________________.

3. To the best of Affiant’s knowledge after diligent search and inquiry:

a. The Principal is not deceased;

b. Affiant’s authority has not been suspended by initiation of proceedings to determine incapacity or to appoint a guardian or a guardian advocate;

c. Affiant’s authority has not been terminated by the filing of an action for dissolution or annulment of Affiant’s marriage to the principal, or their legal separation; and

d. There has been no revocation, or partial or complete termination, of the power of attorney or of Affiant’s authority.

4. Affiant is acting within the scope of authority granted in the power of attorney.

5. Affiant agrees not to exercise any powers granted by the Power of Attorney if Affiant attains knowledge that the power of attorney has been revoked, has been partially or completely terminated or suspended, or is no longer valid because of the death or adjudication of incapacity of the Principal.

_____________________________________ (Affiant) __________________________

Signature Print Name

Sworn to and subscribed before me this __ day of ______________________, 20___, by

______________________________.

______________________________ (Signature of Notary Public-State of Florida)

____________________________ (Print, Type, or Stamp Commissioned Name of Notary Public)

Personally Known OR Produced Identification

________________________________________________

(Type of Identification Produced)

FORM 11:

POWER OF ATTORNEY OF PARENT

POWER OF ATTORNEY OF PARENT

I, __________________________, appoint __________________________, who resides at ____________________________________________, as my true and lawful Attorney-in-Fact, for me and in my name and place for my child, ___________________________ (the “Child”) whose date of birth is ________________ and social security number is _________________. I do hereby give my Attorney-in-Fact full power and authority over the Child and all matters and things involving the Child, including without limitation all power and authority over:

1) Education of any kind including choice of schools and classes;

2) Money or property owned by or involving the Child in any way;

3) Custody and care including housing, control of events and schedule, and discipline; and

4) Medical treatment including permission and consent to medical and/or dental care without delay and without contacting anyone, access and review of medical and personal records, transport including an ambulance, admission to any hospital or other facility, use of drugs and medications including anesthesia, surgery, and any other minor or major care.

I hereby grant my Attorney-in-Fact full power and authority to execute all instruments, and power and authority to do every act and thing necessary or helpful in exercising any of the powers given under this Power of Attorney, but no power over marriage or adoption is given.

The Power of Attorney shall commence and be effective immediately and continue until I revoke it in a writing delivered to the Attorney-in-Fact.

I agree any party who receives a copy of this document may act under it, and revocation of the power of attorney is not effective as to a third party until they learn 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.

IN WITNESS WHEREOF, the undersigned has executed this Power of Attorney on this ___ day of ________________, 20____.

Signed: _____________________________

WITNESSES

____________________________ ____________________________

Print Name _________________________ Print Name ____________________________

STATE OF FLORIDA

COUNTY OF _______________

The foregoing instrument was acknowledged before me this __day of ___________, 20__, by ____________________, who is personally known or has provided ___________________ as identification.

____________________ Notary

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