CHAPTER XX – GUARDIAN OF CHILDREN AND PROPERTY OF …



LEGAL FORMS

FOR THE BOOK

“DAVENPORT’S NEW YORK WILLS AND

ESTATE PLANNING LEGAL FORMS”

Second Edition – 2018

written by Alexander W. Russell

and Ernest Charles Hope

Published by Davenport Press

© COPYRIGHT 2018 – ALEX RUSSELL

GO TO

WWW . DAVENPOR T PRESS . ORG

TO DOWNLOAD FORMS

AND BOOKS

OVERVIEW OF FORMS

BOOK HAS 10 LEGAL FORMS BUT MOST PEOPLE ONLY USE A FEW FORMS

In this book about 10 legal forms are provided, but most people only use a few forms. People can read the New York book at for more information.

Form 1. Last Will And Testament (Standard) – can control things after death like gifts of property and money, picking executor to do things after death, says less costly legal procedures can be used, and has page of legal language to avoid common legal problems

Form 2. Last Will And Testament (Guardians) – this is a Will with a Guardians paragraph to use if a person has a child under 18 or if giving major things to minors

Form 3. Self-Proving Affidavit – optional form to do with Will to make later work easier

Form 4. Informal Gift List – although rarely done and not legally binding this lets people write on simple lists outside a Will wanted gifts of tangible property like household items

Form 5. Codicil – form can change an existing Will but it may be better to just re-do Will

Form 6. Health Care Proxy (Living Will) – just in case needed later lets person give instructions and name an Agent to control health care, and many call this a “Living Will”

Form 7. Do-Not-Resuscitate –And– Medical-Orders-For-Life-Sustaining-Treatment – these 2 forms are rarely used and by law a doctor must sign and can help explain them,

and these forms may be done by those very near end-of-life or in very terminal condition to say CPR to restart heart / breathing and some other life-sustaining care should not be given

Form 8. New York Statutory Short Form Power Of Attorney – lets person share with person like spouse or friend power to do things like with money, property, debt, and records

Form 9. Designation Of Person In Parental Relationship – lets parent or similar share power over a child or an incapacitated person with someone like friend, family or nanny

Form 10. Appointment Of Agent To Control Disposition Of Remains – lets person give orders about funeral and related things, and maybe pick person to control these things

PHOTOCOPY OR DOWNLOAD BOOK FORMS AND USE PEN

To get usable forms people can 1) photocopy book pages or 2) download forms free from . When filling out forms a computer can be used, or pen

or marker can be used to add words, but signatures and most dates should always be handwritten in pen or marker. For forms that need it a notary can be found at banks, courthouses, businesses, or (often best) by hiring one from the phonebook. The person doing a Will is called “Testator” who must sign before 2 persons not getting Will gifts.

FORM 1:

LAST WILL AND TESTAMENT (STANDARD)

LAST WILL AND TESTAMENT

I, ___________________________ , of _____________ County, New York, hereby make, publish, and declare this as my Last Will and Testament (called here "Will"), and

I hereby revoke any Wills and Codicils earlier made by me.

1. GIFTS. I give in this section gifts, including specific gifts and general gifts including of money, to the beneficiaries getting particular gifts below but only if they survive me.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

2. RESIDUE. I give all my property and estate not given, distributed, or used by preceding Will provisions or other ways, whether now owned or later acquired, wherever located, and of any kind and nature including real property, personal property, and other property (all of which is called in this Will the “residue”), as follows:

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

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

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

3. ADMINISTRATION. I name and appoint ______________________________ as executor of my Will and my estate.

4. MISCELLANEOUS. The following applies to all parts of this Will and generally.

Priority of Will gifts of the same type is based on order they appear in this Will.

The words give or gift also mean to devise, bequest, grant, legacy or similar.

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

For a gift to multiple beneficiaries the share of a non-surviving beneficiary passes to the other beneficiaries in proportion to their share of the gift, including a gift of the residue, subject to other Will terms or if alternate beneficiaries are written in the gift.

My executor may sell property in a gift to give cash if the beneficiaries disagree on a use.

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

Plural, singular, or gender meanings do not limit words, this Will, or any Will part.

No incomplete, blank, or unfilled area is a mistake or not intentional including any part of the residue clause being undone or blank in which case other parts of the clause should be followed, and this Will and any of its parts shall be given effect if possible.

Any failure to gift in this Will to any family including child or spouse is not a mistake.

My executor has power to pay debts in time and manner and using estate property or money they find best, including they may select some debts to not pay.

Unless this Will specifically says otherwise, I do direct and request no debt related to

an encumbrance like mortgage or lien be paid and if paid for any reason then contribution is owed my estate and others (including that any potential gift recipients may be asked by my executor to assume encumbrances and such is a condition to get a gift).

No gift or other transfer made during life reduces or offsets any Will gift or part of this Will, unless during my life it was expressly usually called a “loan” or “advancement”.

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

The residue includes lapsed or failed gifts and also includes property the testator has or had any power of appointment or testamentary disposition over.

Any executor and guardian of any type is given as much power, authority, and discretion that may be given by law with no need for act of a court at any time or need for any filing or inventory or other thing (including to with no liability for change in value sell, lease, assign, mortgage, invest, exchange, and transfer in any way any property, settle claims for and against the estate or any person, and have power of sale over real or other property). The word executor shall also mean personal representative.

Any executor and guardians of any type under this Will or otherwise shall not have to give a bond, surety, security, or similar, to qualify and serve or perform any duty.

For Will gifts or other transfers going to a minor my executor without act of any court has discretion and power to transfer property to either: the minor, a guardian of the estate named by Will or a court, or a custodian under the New York Uniform Transfers to Minors Act (the “Act”) or any similar law. For a minor getting a Will gift or other transfer the person named guardian of the estate in this Will is nominated and named custodian under the Act or similar law, or if they fail to serve any executor may name a custodian.

I request unsupervised administration of my Will and estate in as informal a manner as possible.

TESTATOR

IN WITNESS WHEREOF, I who am the Testator do make, declare, sign, and publish this as my Will which I execute willingly as Testator as a free and voluntary act for the purposes expressed in it, and that when signing this Will I am at least 18 years of age and of sound mind and under no constraint or undue influence, all on this ___ day of ______________, 20____.

______________________________

Testator Signature

WITNESSES

We, _________________________ and _________________________ , the witnesses signing below, declare and say on the date appearing above that:

the Testator, ________________________________, did say, declare, and publish this document as his or her Will and did sign the Will,

both us witnesses are at least 18 years of age and of sound mind and at Testator's request and in their presence and each other’s we sign our name below as witnesses, and

we believe Testator to be 18 years of age or older and of sound mind and memory and willingly signing this Will while under no constraint or undue influence,

____________________________ _________________________________________

Witness Signature Address

____________________________ _________________________________________

Witness Signature Address

FORM 2:

LAST WILL AND TESTAMENT (GUARDIANS)

LAST WILL AND TESTAMENT

I, ___________________________ , of _____________ County, New York, hereby make, publish, and declare this as my Last Will and Testament (called here "Will"), and

I hereby revoke any Wills and Codicils earlier made by me.

1. GIFTS. I give in this section gifts, including specific gifts and general gifts including of money, to the beneficiaries getting particular gifts below but only if they survive me.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

I give ____________________________________ to _________________________.

2. RESIDUE. I give all my property and estate not given, distributed, or used by preceding Will provisions or other ways, whether now owned or later acquired, wherever located, and of any kind and nature including real property, personal property, and other property (all of which is called in this Will the “residue”), as follows:

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

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

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

3. ADMINISTRATION. I name and appoint ______________________________ as executor of my Will and my estate.

4. GUARDIANS. If any child of mine has not reached age 18 then I name and appoint __________________________________ to be guardian of the person of such child.

I also name and appoint _________________________________ as guardian of the estate and over property of such children or any other persons under age 18.

5. MISCELLANEOUS. The following applies to all parts of this Will and generally.

Priority of Will gifts of the same type is based on order they appear in this Will.

The words give or gift also mean to devise, bequest, grant, legacy or similar.

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

For a gift to multiple beneficiaries the share of a non-surviving beneficiary passes to the other beneficiaries in proportion to their share of the gift, including a gift of the residue, subject to other Will terms or if alternate beneficiaries are written in the gift.

My executor may sell property in a gift to give cash if the beneficiaries disagree on a use.

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

Plural, singular, or gender meanings do not limit words, this Will, or any Will part.

No incomplete, blank, or unfilled area is a mistake or not intentional including any part of the residue clause being undone or blank in which case other parts of the clause should be followed, and this Will and any of its parts shall be given effect if possible.

Any failure to gift in this Will to any family including child or spouse is not a mistake.

My executor has power to pay debts in time and manner and using estate property or money they find best, including they may select some debts to not pay.

Unless this Will specifically says otherwise, I do direct and request no debt related to

an encumbrance like mortgage or lien be paid and if paid for any reason then contribution is owed my estate and others (including that any potential gift recipients may be asked by my executor to assume encumbrances and such is a condition to get a gift).

No gift or other transfer made during life reduces or offsets any Will gift or part of this Will, unless during my life it was expressly usually called a “loan” or “advancement”.

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

The residue includes lapsed or failed gifts and also includes property the testator has or had any power of appointment or testamentary disposition over.

Any executor and guardian of any type is given as much power, authority, and discretion that may be given by law with no need for act of a court at any time or need for any filing or inventory or other thing (including to with no liability for change in value sell, lease, assign, mortgage, invest, exchange, and transfer in any way any property, settle claims for and against the estate or any person, and have power of sale over real or other property). The word executor shall also mean personal representative.

Any executor and guardians of any type under this Will or otherwise shall not have to give a bond, surety, security, or similar, to qualify and serve or perform any duty.

For Will gifts or other transfers going to a minor my executor without act of any court has discretion and power to transfer property to either: the minor, a guardian of the estate named by Will or a court, or a custodian under the New York Uniform Transfers to Minors Act (the “Act”) or any similar law. For a minor getting a Will gift or other transfer the person named guardian of the estate in this Will is nominated and named custodian under the Act or similar law, or if they fail to serve any executor may name a custodian.

I request unsupervised administration of my Will and estate in as informal a manner as possible.

TESTATOR

IN WITNESS WHEREOF, I who am the Testator do make, declare, sign, and publish this as my Will which I execute willingly as Testator as a free and voluntary act for the purposes expressed in it, and that when signing this Will I am at least 18 years of age and of sound mind and under no constraint or undue influence, all on this ___ day of ______________, 20____.

______________________________

Testator Signature

WITNESSES

We, _________________________ and _________________________ , the witnesses signing below, declare and say on the date appearing above that:

the Testator, ________________________________, did say, declare, and publish this document as his or her Will and did sign the Will,

both us witnesses are at least 18 years of age and of sound mind and at Testator's request and in their presence and each other’s we sign our name below as witnesses, and

we believe Testator to be 18 years of age or older and of sound mind and memory and willingly signing this Will while under no constraint or undue influence,

____________________________ _________________________________________

Witness Signature Address

____________________________ _________________________________________

Witness Signature Address

FORM 3

SELF-PROVING AFFIDAVIT

SELF-PROVING AFFIDAVIT

We, ___________________________ and ________________________________, the witnesses, whose names are signed to the attached instrument, now personally appear before the undersigned authority and being first duly sworn, declare to the undersigned authority under penalty of perjury that:

a) testator in the presence of both witnesses signed the attached instrument as testator,

b) testator declared, published, made, signed and executed the instrument as his or her Will;

c) testator executed the instrument willingly, and as his or her free and voluntary act for the purposes expressed therein;

d) each of the witnesses in the presence of each other, at the request of the testator in his or her hearing and presence, signed the Will as witnesses; and

e) that to the best of each witness’s knowledge the testator was at the time of execution of the Will over 18 years of age, of sound mind, and under no constraint or undue influence.

Signature of Witness: ________________________

Address of Witness: ________________________________________________________

Signature of Witness: ________________________

Address of Witness: ________________________________________________________

Notary Public:

Subscribed, sworn and acknowledged before me by ________________________ and ___________________________, witnesses, this ____ day of _________________, 20 ___.

__________________________________

Notary Public

FORM 4:

INFORMAL GIFT LIST

INFORMAL GIFT LIST..

I request but do not require family and other people follow the gifts I write below.

A gift written below has no effect if a Will specifically gives the same property.

If I make multiple gift lists all should be followed and if there are conflicts the more recent list controls. This gift list has no effect if not found by 60 days from my death.

I direct only “tangible personal property” can be given here, so not land or buildings, not money, and not accounts or most investments.

PROPERTY ITEMS GIFTED NAMES OF 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:

CODICIL

C O D I C I L

I, _________________________, of ___________ County, New York, do hereby

make, publish, and declare this as my Codicil to my Will dated _______________.

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

__________________________________________________________________

__________________________________________________________________ _________________________________________________________________ .

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

__________________________________________________________________

__________________________________________________________________ _________________________________________________________________.

THIRD: In all other respects at this time I hereby do confirm and republish the

above-described Will.

TESTATOR..

IN WITNESS WHEREOF, I say, publish, and declare that this is a Codicil to my Will described above, and I now execute this Codicil instrument willingly as a free and voluntary act for the purposes expressed in this Codicil and in such Will, 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 undersigned witnesses,

declare and say in the presence of both of us this Codicil instrument was willingly signed, published, and declared by _____________________ the Testator as his or her Codicil,

that to the best of our knowledge the Testator when signing was at least 18 years of age and of sound mind and under no constraint or undue influence, and

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 6

HEALTH CARE PROXY (LIVING WILL)

HEALTH CARE PROXY

( Also called “Living Will”, see New York’s Public Health Law section 2981 )

(1) I , ________________________________________ hereby appoint

_________________________________________________________ (name, home address and telephone number)

as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise. This proxy shall take effect only when and if I become unable to make my own health care decisions.

(2) Optional: Alternate Agent

If the person I appoint is unable, unwilling or unavailable to act as my health care agent, I hereby appoint

_________________________________________________________

(name, home address and telephone number)

as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise.

(3) (Timing) Unless I revoke it or state an expiration date or circumstances under which it will expire, this proxy shall remain in effect indefinitely. (Optional: If you want this proxy to expire, state the date or conditions here.) This proxy shall expire (specify date or conditions):

_________________________________________________________

(4) Optional (Instructions): I direct my health care agent to make health care decisions according to my wishes and limitations, as he or she knows or as stated below. (If you want to limit your agent’s authority to make health care decisions for you or to give specific instructions, you may state your wishes or limitations here.) I direct my health care agent to make health care decisions in accordance with the following limitations and/or instructions (attach additional pages as necessary):

_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________

In order for your agent to make health care decisions for you about artificial nutrition and hydration (nourishment and water provided by feeding tube and intravenous line), your agent must reasonably know your wishes. You can either tell your agent what your wishes are or include them in this section. See instructions for sample language that you could use if you choose to include your wishes on this form, including your wishes about artificial nutrition and hydration.

(5) Your Identification (please print)

Your Name ___________________ Your Signature __________________

Date __________ Your Address _________________________________

(6) Optional: Organ and/or Tissue Donation

I hereby make an anatomical gift, to be effective upon my death, of: (check any that apply)

[ ] Any needed organs and/or tissues

[ ] The following organs and/or tissues ____________________

[ ] Limitations ___________________________________________

If you do not state your wishes or instructions about organ and/or tissue donation on this form, it will not be taken to mean that you do not wish to make a donation or prevent a person, who is otherwise authorized by law, to consent to a donation on your behalf.

Your Signature ________________________ Date _______________

(7) Statement by Witnesses (Witnesses must be 18 years of age or older and cannot be the health care agent or alternate.)

I declare that the person who signed this document is personally known to me

and appears to be of sound mind and acting of his or her own free will. He or she

signed (or asked another to sign for him or her) this document in my presence.

Witness 1

Date _______________

Name (print) ____________________ Signature _____________________

Address ______________________________________________________

Witness 2

Date _______________

Name (print) ____________________ Signature _____________________

Address ______________________________________________________

FORM 7

DO-NOT-RESUSCITATE

– AND –

MEDICAL-ORDERS-FOR-LIFE-SUSTAINING-TREATMENT

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BLANK PAGE

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FORM 8

POWER OF ATTORNEY NEW YORK

STATUTORY SHORT FORM

POWER OF ATTORNEY

NEW YORK STATUTORY SHORT FORM

(a) CAUTION TO THE PRINCIPAL: Your Power of Attorney is an important document. As the “principal,” you give the person whom you choose (your “agent”) authority to spend your money and sell or dispose of your property during your lifetime without telling you. You do not lose your authority to act even though you have given your agent similar authority.

When your agent exercises this authority, he or she must act according to any instructions you have provided or, where there are no specific instructions, in your best interest. “Important Information for the Agent” at the end of this document describes your agent’s responsibilities.

Your agent can act on your behalf only after signing the Power of Attorney before a notary public.

You can request information from your agent at any time. If you are revoking a prior Power of Attorney, you should provide written notice of the revocation to your prior agent(s) and to any third parties who may have acted upon it, including the financial institutions where your accounts are located.

You can revoke or terminate your Power of Attorney at any time for any reason as long as you are of sound mind. If you are no longer of sound mind, a court can remove an agent for acting improperly.

Your agent cannot make health care decisions for you. You may execute a “Health Care Proxy” to do this.

The law governing Powers of Attorney is contained in the New York General Obligations Law, Article 5, Title 15. This law is available at a law library, or online through the New York State Senate or Assembly websites, senate.state.ny.us or assembly.state.ny.us.

If there is anything about this document that you do not understand, you should ask a lawyer of your own choosing to explain it to you.

(b) DESIGNATION OF AGENT(S):

I, ______________________________________________________________, hereby appoint:

[name and address of principal]

_______________________________________________________________ as my agent(s)

[name(s) and address(es) of agent(s)]

If you designate more than 1 agent above, they must act together unless you initial the statement below.

(______) My agents may act SEPARATELY.

(c) DESIGNATION OF SUCCESSOR AGENT(S): (OPTIONAL)

If every agent designated above is unable or unwilling to serve, I appoint as my successor agent(s):

_______________________________________________________________________________

[name(s) and address(es) of successor agent(s)]

Successor agents designated above must act together unless you initial the statement below.

(_______) My successor agents may act SEPARATELY.

You may provide for specific succession rules in this section. Insert specific succession provisions here: ____________________________________________________________________ _________________________________________________________________________________

(d) This POWER OF ATTORNEY shall not be affected by my subsequent incapacity unless I have stated otherwise below, under ‘Modifications”.

(e) This POWER OF ATTORNEY does not revoke any Powers of Attorney previously executed by me unless I have stated otherwise below, under “Modifications.”

If you do not intend to revoke your prior Powers of Attorney, and if you have granted the same authority in this Power of Attorney as you granted to another agent in a prior Power of Attorney, each agent can act separately unless you indicate under “Modifications” that the agents with the same authority are to act together.

(f) GRANT OF AUTHORITY:

To grant your agent some or all of the authority below, either

(1) Initial the bracket at each authority you grant, or

(2) Write or type the letters for each authority you grant on the blank line at (P), and initial the bracket at (P). If you initial (P), you do not need to initial the other lines.

I grant authority to my agent(s) with respect to the following subjects as defined in sections 5¬

1502A through 5-l502N of the New York General Obligations Law:

(_____) (A) real estate transactions;

(_____) (B) chattel and goods transactions;

(_____) (C) bond, share, and commodity transactions;

(_____) (D) banking transactions;

(_____) (E) business operating transactions;

(_____) (F) insurance transactions;

(_____) (G) estate transactions;

(_____) (H) claims and litigation;

(_____) (I) personal and family maintenance. If you grant your agent this authority, it will allow the agent to make gifts that you customarily have made to individuals, including the agent, and charitable organizations. The total amount of all such gifts in any one calendar year cannot exceed five hundred dollars;

(_____) (J) benefits from governmental programs or civil or military service;

(_____) (K) health care billing and payment matters; records, reports, and statements;

(_____) (L) retirement benefit transactions;

(_____) (M) tax matters;

(_____) (N) all other matters;

(_____) (O) full and unqualified authority to my agent(s) to delegate any or all of the foregoing powers to any person or persons whom my agent(s) select;

(_____) (P) EACH of the matters identified by the following letters __________________________. You need not initial the other lines if you initial line (P).

(g) MODIFICATIONS: (OPTIONAL) In this section, you may make additional provisions, including language to limit or supplement authority granted to your agent.

However, you cannot use this Modifications section to grant your agent authority to make gifts or changes to interests in your property. If you wish to grant your agent such authority, you MUST complete the Statutory Gifts Rider.

______________________________________________________________________________________ ______________________________________________________________________________________

______________________________________________________________________________________ ______________________________________________________________________________________

(h) CERTAIN GIFT TRANSACTIONS: STATUTORY GIFTS RIDER (OPTIONAL)

In order to authorize your agent to make gifts in excess of an annual total of $500 for all gifts described in (I) of the grant of authority section of this document (under personal and family maintenance), you must initial the statement below and execute a Statutory Gifts Rider at the same time as this instrument. Initialing the statement below by itself does not authorize your agent to make gifts. The preparation of the Statutory Gifts Rider should be supervised by a lawyer.

(______) (SGR) I grant my agent authority to make gifts in accordance with the terms and conditions of the Statutory Gifts Rider that supplements this statutory Power of Attorney.

(h) DESIGNATION OF MONITOR(S): (OPTIONAL)

IF YOU WISH TO APPOINT MONITOR(S), INITIAL AND FILL IN THE SECTION BELOW:

(_____) I wish to designate __________________________________________, whose address(es) is (are) __________________________________________________________________________ ______________________________________________________________________ as monitor(s). Upon the request of the monitor(s), my agent(s) must provide the monitor(s) with a copy of the power of attorney and a record of all transactions done or made on my behalf. Third parties holding records of such transactions shall provide the records to the monitor(s) upon request.

(j) COMPENSATION OF AGENT(S): (OPTIONAL) Your agent is entitled to be reimbursed from your assets for reasonable expenses incurred on your behalf. If you ALSO wish your agent(s) to be compensated from your assets for services rendered on your behalf, initial the statement below. If you wish to define “reasonable compensation”, you may do so above, under “Modifications.”

(______) My agent(s) shall be entitled to reasonable compensation for services rendered.

(k) ACCEPTANCE BY THIRD PARTIES: I agree to indemnify the third party for any claims that may arise against the third party because of reliance on this Power of Attorney. I understand that any termination of this Power of Attorney, whether the result of my revocation of the Power of Attorney or otherwise, is not effective as to a third party until the third party has actual notice or knowledge of the termination.

(l) TERMINATION: This Power of Attorney continues until I revoke it or it is terminated by my death or other event described in section 5-1511 of the General Obligations Law.

Section 5-1511 of the General Obligations Law describes the manner in which you may revoke your Power of Attorney, and the events which terminate the Power of Attorney.

(m) SIGNATURE AND ACKNOWLEDGMENT:

In Witness Whereof I have hereunto signed my name on _____________________, 20____.

PRINCIPAL signs here: ____________________________________________________

State of New York

County of __________________, ss.:

On the ____ day of __________________________ in the year ___________ before me, the undersigned, personally appeared ___________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

________________________________________________

Signature and Office of individual taking acknowledgment

(n) IMPORTANT INFORMATION FOR THE AGENT:

When you accept the authority granted under this Power of Attorney, a special legal relationship is created between you and the principal. This relationship imposes on you legal responsibilities that continue until you resign or the Power of Attorney is terminated or revoked. You must:

(1) act according to any instructions from the principal, or, where there are no instructions, in the principal’s best interest;

(2) avoid conflicts that would impair your ability to act in the principal’s best interest;

(3) keep the principal’s property separate and distinct from any assets you own or control, unless otherwise permitted by law;

(4) keep a record or all receipts, payments, and transactions conducted for the principal; and

(5) disclose your identity as an agent whenever you act for the principal by writing or printing the principal’s name and signing your own name as “agent” in either of the following manners:

(Principal’s Name) by (Your Signature) as Agent, or (Your Signature) as Agent for (Principal’s Name).

You may not use the principal’s assets to benefit yourself or anyone else or make gifts to yourself or anyone else unless the principal has specifically granted you that authority in this document, which is either a Statutory Gifts Rider attached to a statutory Short Form Power of Attorney or a non-statutory Power of Attorney. If you have that authority, you must act according to any instructions of the principal or, where there are no such instructions, in the principal’s best interest. You may resign by giving written notice to the principal and to any co-agent, successor agent, monitor if one has been named in this document, or the principal’s guardian if one has been appointed. If there is anything about this document or your responsibilities that you do not understand, you should seek legal advice.

Liability of agent:

The meaning of the authority given to you is defined in New York’s General Obligations Law, Article 5, Title 15. If it is found that you have violated the law or acted outside the authority granted to you in the Power of Attorney, you may be liable under the law for your violation.

(o) AGENT’S SIGNATURE AND ACKNOWLEDGMENT OF APPOINTMENT:

It is not required that the principal and the agent(s) sign at the same time, nor that multiple agents sign at the same time.

I/we, ___________________________________________________________________ (Agent(s)), have read the foregoing Power of Attorney. I am/we are the person(s) identified therein as agent(s) for the principal named therein. I/we acknowledge my/our legal responsibilities.

Agent(s) sign(s) here: __________________________________________________________

State of New York

County of _______________________, ss.:

On the ___ day of _____________ in the year 20___ before me, the undersigned, personally appeared

_________________________________________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

_____________________________________________

Signature and Office of individual taking acknowledgment

(o) SUCCESSOR AGENT’S SIGNATURE AND ACKNOWLEDGEMENT OF APPOINTMENT (OPTIONAL):

It is not required that the principal and the successor agent(s), if any, sign at the same time, nor that multiple successor agents sign at the same time. Furthermore, successor agents cannot use this Power of Attorney unless the agent(s) designated above is/are unable or unwilling to serve.

I/we, _________________________________________, have read the foregoing Power of Attorney, I am/we are the person(s) identified therein as successor agent(s) for the principal named therein.

I/we acknowledge my/our legal responsibilities.

Agent(s) sign(s) here: __________________________________________________________

State of New York

County of ____________________ ss.:

On the ___ day of ______________ in the year 20__ before me, the undersigned, personally appeared _________________________________________________________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

_____________________________________________

Signature and Office of individual taking acknowledgment

NEW YORK STATUTORY POWER OF ATTORNEY

AFFIDAVIT AS TO POWER OF ATTORNEY

[OPTIONAL AND USUALLY DONE LATER]

STATE OF NEW YORK

COUNTY OF ____________________, ss:

____________________, being duly sworn, deposes and says as follows:

1. This affidavit is made in connection with the (transfer) (mortgage) of property known as ________________________________________________________________________, in ____________________, New York to___________________________________.

2. I am (the) (an) agent named in the Power of Attorney (hereafter "Power of Attorney") made by _____________________, as principal (the "Principal"), dated_______________.

3. I do not have actual notice that the Power of Attorney has been modified in any way that would affect my ability to authorize or engage in the present transaction for which the Power of Attorney is being used, or notice of any facts indicating that the Power of Attorney has been so modified.

4. I do not have actual notice of the termination or revocation of the Power of Attorney, or notice of any facts indicating that the Power of Attorney has been terminated or revoked, and the Power of Attorney remains in full force and effect.

5. If the Principal has been my spouse, we are not divorced and our marriage has not been annulled.

6. If I am a successor agent, the prior agent is no longer able or willing to serve.

NOTE: If multiple agents are appointed, an affidavit is to be executed by each agent.

Signature

Sworn to before me this ___ day

of ____________________, 20____.

____________________________

Notary Public

FORM 9

DESIGNATION OF PERSON IN

PARENTAL RELATIONSHIP

DESIGNATION OF PERSON IN PARENTAL RELATIONSHIP

(New York State General Obligations Law section 5-1551)

I, __________________________________________, hereby state that I am the parent of the child/children/incapacitated person(s) named below and there are no Court Orders now in effect in any jurisdiction that would prohibit me from exercising the power that I now seek to authorize.

The address and telephone number(s) where I can be reached while this designation is in effect is: Address: ____________________________________________________ Telephone: __________________________________________________

.

..I am temporarily entrusting __________________________, a person over the age of eighteen who resides at ____________________________ ___________________, telephone number ( ) __________, the full care, control, and power over the following child/children/incapacitated person(s) including schooling, activities, medical and mental health care, access to records, travel, home and discipline, and money or property owned by them:

_________________________ (NAME) date of birth _____________

_________________________ (NAME) date of birth _____________

_________________________ (NAME) date of birth _____________

_________________________ (NAME) date of birth _____________

_________________________ (NAME) date of birth _____________

Any authority granted to the person in parental relationship pursuant to this form shall be valid from ________________________ (date) until and including _________________________ (date), or until date of revocation whichever occurs first (limited to maximum 6 months, and if over 30 days must include all parties addresses and telephone numbers and be signed by parent(s) and person designated in presence of a notary public)

Dated: ____________ Signed: __________________________ . (Parent signature)

Sworn to before me this ___ day of ___________________, 20___.

___________________________

Notary Public

SIGNATURE OF DESIGNEE

I, __________________________________, the person designated in parental relationship for the child/children/incapacitated person(s) named herein, hereby consent to this designation by my signature below.

Dated: ____________ Signed: __________________________

Sworn to before me this ___ day of ___________________, 20___. ___________________________ Notary Public

SIGNATURE OF SECOND PARENT [OPTIONAL]

I, ________________________________, am also the parent of the child/children/incapacitated person(s) named herein, there is a Court Order directing that both parents must agree on education and/or health decisions concerning such child/children/incapacitated person(s), and I hereby consent to this designation by my signature below. . The address and telephone number(s) where I can be reached while this designation is in effect is: Address: ____________________________________________________ Telephone: __________________________________________________

Dated: ____________ Signed: __________________________ . (Parent signature)

Sworn to before me this ___ day of ___________________, 20___.

___________________________

Notary Public

.

FORM 10

APPOINTMENT OF AGENT TO CONTROL

DISPOSITION OF REMAINS

APPOINTMENT OF AGENT TO CONTROL DISPOSITION OF REMAINS

(New York Public Health Law § 4201)

I, __________________________________________________________

(Your name and address)

being of sound mind, willfully and voluntarily make known my desire that, upon my death, the disposition of my remains shall be controlled by ___________________________________________________________.

(name of agent)

With respect to that subject only, I hereby appoint such person as my

agent with respect to the disposition of my remains.

SPECIAL DIRECTIONS: Set forth below are any special directions limiting the power granted to my agent as well as any instructions or wishes desired to be followed in the disposition of my remains:

____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________

Indicate below if you have entered into a pre-funded pre-need agreement subject to section four hundred fifty-three of the general business law for funeral merchandise or service in advance of need:

[ ] No, I have not entered into a pre-funded pre-need agreement subject

to section four hundred fifty-three of the general business law.

[ ] Yes, I have entered into a pre-funded pre-need agreement subject to section four hundred fifty-three of the general business law.

____________________________________________________________

(Name of funeral firm with which you entered into a pre-funded

pre-need funeral agreement to provide merchandise and/or services)

AGENT:

Name: ______________________________________________________

Address: ____________________________________________________

Telephone Number: ____________________________________________

SUCCESSORS: If my agent dies, resigns, or is unable to act, I hereby appoint the following persons (each to act alone and successively, in the order named) to serve as my agent to control the disposition of my remains as authorized by this document:

1. First Successor

Name: ________________________________

Address: ____________________________________________________

Telephone Number: __________________________________

2. Second Successor

Name: ________________________________

Address: ____________________________________________________

Telephone Number: __________________________________

DURATION: This appointment becomes effective upon my death.

PRIOR APPOINTMENT REVOKED: I hereby revoke any prior appointment of any person to control the disposition of my remains.

Signed this ___ day of _____________________, 20____.

_______________________________________________

(Signature of person making the appointment)

Statement by witness (must be 18 or older) I declare that the person who executed this document is personally know to me and appears to be of sound mind and acting of his or her free will. He or she signed (or asked another to sign for him or her) this document in my presence.

Witness 1: ________________________________

(signature)

Address: ___________________________________________________

Witness 2: ________________________________

(signature)

Address: ___________________________________________________

ACCEPTANCE AND ASSUMPTION BY AGENT:

1. I have no reason to believe there has been a revocation of this

appointment to control disposition of remains.

2. I hereby accept this appointment.

Signed this ___ day of _____________________, 20____.

_______________________________________________

(Signature of agent)

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