attorney

DURABLEPOWEROFATTORNEY

StateofFlorida

Countyof____________________________

KNOWALLMENBYTHESEPRESENTS,thatI,__________________________________,of____________________,

(name)(county)

Florida,asauthorizedbyFloridalaw,doherebyappoint,_______________________________________________________

(name)

werofattorneyshallbenon-delegableexceptasotherwiprovidedinFloridaStatutes,

andshallbevalidandrablepowerofattorneyis

notaffectedbysubquentincapacityoftheprincipalexceptasprovidedinFloridaStatutes.

Thepropertysubjecttothisdurablepowerofattorneyshallincludeallrealandpersonalpropertyownedbyme,my

interestinalpropertyheldinjointtenancy,myinterestinallnon-homesteadpropertyheldintenancybytheentirety,andall

propertyoverwhichIholdpowerofappointmentandshallalsoincludeauthoritytoll,mortgageorconveymyhomestead

property.

Withoutlimitingthebroadpowersintendedtobeconferredbytheprecedingprovisions,Iexpresslyauthorizemyattorney

actinghereunderinafiduciarycapacitytodoandexecutealloranyofthefollowingacts,deeds,andthingsformybenefitandon

mybehalf.

TIONPOWERS:Toask,demand,suefor,recover,collect,receiveallsumsofmoney,bankdeposits,chattels

andotherrealorpersonalproperty,tangibleorintangible,ofwhatsoevernatureordescriptionthatmaybedue,

owing,payableorbelongingtome,andtoexecuteanddeliverreceipts,releas,cancellationsordischarges.

TPOWERS:TottleanyaccountorreckoningwhatsoeverwhereinInowamoratanytimehereaftershall

beinanywayinterestedorconcernedwithanypersonwhomsoever,andtopayorreceivethebalancethereofasthe

camayrequire.

POSITBOXES:Toenteranysafedepositorotherplaceofsafekeepingstandinginmynamewithfullauthority

toremoveanyandallthecontentsthereofandtomakeadditions,substitutionsandreplacements,specifically

includinganysafedepositboxinmynamejointlywithmyspouoranyotherperson.

GPOWERS:

(a)Toborrowanysumorsumsofmoneyonsuchtermsandwithsuchcurity,whetherrealorpersonalproperty

belongingtome,asmyattorneymaythinkfit,andtoexecuteanyandallnotes,mortgagesandother

instrumentswhichmyattorneymaydeemnecessaryordesirable.

(b)Todraw,accept,make,endororotherwidealwithanychecks,promissorynotes,billsofexchangeor

othercommercialormercantileinstruments,specificallyincludingtherighttomakewithdrawalsfromany

savingsaccountorbuildingorloandeposits.

(c)Toredeemorcashinany/orallbondsissuedbytheUnitedStatesGovernmentoranyofitsagencies,any

otherbondsandanycertificatesofdepositorothersimilarastsorcuritiesbelongingtome.

(d)Tollalloranybonds,sharesofstock,warrants,debentures,orothercuritiesbelongingtome,andto

executeallassignmentsandotherinstrumentsnecessaryorproperfortransferringthesametothepurchar

orpurcharsthereof,andtogivegoodreceiptsanddischargesforallmoniespayableinrespectthereof.

(e)Toinvesttheproceedsofanyredemptionsorsalesaforesaid,andanyotherofmymonies,insuch,bonds,

sharesofstockandothercuritiesasmyattorneyshallthinkfit,andfromtimetotimetovarythesaid

investmentsoranyofthem.

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MENTPOWERS:Tovoteatallmeetingsofstockholdersofanycompanyorcorporation,andotherwitoact

asmyattorneyorproxyinrespectofmysharesofstockorothercuritiesorinvestmentswhichnoworhereaftershall

belongtome,andtoappointsubstitutesorproxieswithrespecttoanysuchsharesofstock.

ERS:Tosignandexecuteinmybehalfanytaxreturn,stateorfederalrelatingtoincome,gift,advalorem,

intangibleorothertaxes,stateorfederal,andtoactformeinanyexaminations,audits,hearings,conferencesor

litigationrelatingtoanysuchtaxes,includingauthoritytofileandprocuterefundclaims,andtoenterintoaneffect

anyttlements.

OWERS:

(a)Toexecutearevocableorirrevocabletrustwhichprovidesthatallincomeandprincipalshallbepaidtomeor

theguardianofmyestate,orappliedformybenefitinsuchmannerasIormyattorneyhereundershall

requestorasthetrusteeshalldetermine,andthatonmydeathanyremainingasts,includingincome,shall

passaccordingtomywillorintestatesuccessionifIhavenowill.

(b)Tomakeadditionsoffundsandasts,realandpersonal,toanytrustestablishedbyme.

SSINTERESTS:

(a)Toll,rent,leaforanyterm,orexchange,anyrealestateorintereststherein,forsuchconsiderationsand

uponsuchtermsandconditionsasmyattorneymayefit;specificallyincludingthepowerandauthorityto

executeacknowledgeanddeliverdeeds,mortgages,leasandotherinstrumentsconveyingorencumbering

titletopropertyownedbymeandmyspoujointly.

(b)Tocommence,procute,discontinueordefendallactionsorotherlegalproceedingstouchingmyestateor

anypartthereof,ortouchinganymatterinwhichIormyestatemaybeinanywayconcerned.

(c)Thepowershereinconferreduponmyattorneyshallextendtoandincludeallofmyright,titleandinterestin

andtoanyrealandpersonalproperty,tangibleorintangible,inwhichImayhaveanestatebytheentirety,

jointtenancy,tenancyincommon,astrusteeorbeneficiaryofanytrust,orinanyothermanner.

ALINTERESTS:

(a)Tomakegifts,outrightorintrust,inanamountnotgreaterthan$10,000.00perdoneeperyearorthe

amountsallowedwithoutgifttaxconquencesundertheappropriateInternalRevenuecodeprovisions

(includingmyattorneyhereunderappointed).

(b)Toarrangeformyentrancetoandcareatanyhospital,nursinghome,healthcenter,convalescenthome,

retirementhomeorsimilarinstitution.

(c)Torenounceordisclaimanyinterestacquiredbytestateorintestatesuccessionorbyintervivostransfer.

CAREPOWERS:

(a)Toauthorize,arrangefor,conntto,waiveandterminateanyandallmedicalandsurgicalproceduresonmy

behalf(includinganyelectionorelectionandagreementundertheLife-ProlongingProceduresActofFlorida

withrequesttoproviding,withholdingorwithdrawinglife-prolongingproceduresshouldIfailtomakea

declarationhereunder)andtopayorarrangecompensationformycare.

(b)TomakehealthcaredecisionsformeandtoprovideinformedconntifIamincapableofmakinghealthcare

decisionsorprovidinginformedconnt.

(i)Tobethefinalauthoritytoactformeandtomakehealthcaredecisionsformeinmatters

regardingmyhealthcareduringanyperiodinwhichIhavetheincapacitytoconnt.

(ii)Toexpeditiouslyconsultwithappropriatehealthcareproviderstoprovideinformedconntin

mybestinterestandmakehealthcaredecisionsformewhichmysaidSurrogatebelievesIwould

havemadeunderthecircumstancesifIwerecapableofmakingsuchdecisions.

(iii)Togiveanyconntinwritingusingtheappropriateconntform.

(iv)Tohaveaccesstoappropriateclinicalrecordsregardingmeandhaveauthoritytoauthorizethe

releaofinformationandclinicalrecordstoappropriatepersonstoinsurethecontinuityofmy

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(v)Toapplyforpublicbenefits,wherenecessary,suchasMedicareandMedicaid,formeandhave

accesstoinformationregardingmyincomeandaststotheextentrequiredtomakesuch

applicationifnecessary.

(vi)TomakeallhealthcaredecisionsonmybehalfincludingbutnotlimitedtothotforthinF.S.

Chapter765.

LPOWERS:

(a)Ingeneraltodoallotheracts,deeds,mattersandthingswhatsoeverinoraboutmyestate,propertyand

affairs,ortoconcurwithpersonsjointlyinterestedwithmethereinindoingallacts,deeds,mattersandthings

hereinparticularlyorgenerallydescribed,asfullyandeffectuallytoallintentsandpurposasIcoulddo

mylf.

(b)ThisinstrumentixecutedbymeintheStateofFloridabutitismyintentionthatthepowersandauthority

hereinconferreduponmyattorneyasauthorizedbythelawsofFloridanoworhereafterinforceandeffect

shallbeexercisableinanyotherstateorjurisdictionwhereImayhaveanypropertyorasts.

Iherebyratifyandconfirm,andpromiatalltimestoratifyandconfirmallandwhatsoevermydulyauthorizedattorney

hereundershalllawfullydoorcautobedonebyvirtueoftheprents,includinganythingwhichshallbedone

betweentherevocationofthisinstrumentbymydeathorinanyothermannerandnoticeofsuchrevocationreachingmy

attorney;andIherebydeclarethatasagainstmeandallpersonsclaimingundermeeverythingwhichmysaidattorney

shalldoorcautobedoneinpursuancehereofaftersuchrevocationasaforesaidshallbevalidandeffectualinfavorof

anypersonsclaimingthebenefitthereofwho,beforethedoingthereof,shallnothavehadnoticeofsuchrevocation.

INWITNESSWHEREOF,IhaveexecutedthisDurablePowerofAttorney.

_______________________________________________________________________________

WitnessSignatureDateSignatureDate

_______________________________________________________________________________

WitnessSignatureDatePrintName

StateofFlorida

Countyof___________________________

Beforeme,theundersignedauthority,dulyauthorizedtotakeacknowledgementsandadministeroaths,personally

appeared________________________________,personallyknowntometobethepersondescribedabove,whobeingby

mefirstdulyswornstatesthat(HisorHer)isthepersonwhoexecutedtheforegoinginstrumentforthereasonxpresd

therein.

Datedthis___________dayof____________,____________.

_______________________________________________________

NOTARYPUBLIC

MyCommissionExpires:__________________________________

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