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FLORIDA GENERAL DURABLE POWER OF ATTORNEY
THE POWERS YOU GRANT BELOW ARE EFFECTIVE
EVEN IF YOU BECOME DISABLED OR INCOMPETENT
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING.
THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY
ACT. IF YOU HAVE ANY QUESTIONS ABOUT THESE POWERS, OBTAIN COMPETENT
LEGAL ADVICE. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL
AND OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF
ATTORNEY IF YOU LATER WISH TO DO SO. THIS POWER OF ATTORNEY IS EFFECTIVE
IMMEDIATELY AND WILL CONTINUE TO BE EFFECTIVE EVEN IF YOU BECOME
DISABLED, INCAPACITATED, OR INCOMPETENT.
I _________________________________________________________________________
__________________________________________ [insert your name and address] appoint
__________________________________________________________________________
__________________________________________ [insert the name and address of the
person appointed] as my Agent (attorney-in-fact) to act for me in any lawful way with respect to
the following initialed subjects:
TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (N) AND
IGNORE THE LINES IN FRONT OF THE OTHER POWERS.
TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS,
INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE GRANTING.
TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT
NEED NOT, CROSS OUT EACH POWER WITHHELD.
Note: If you initial Item A or Item B, which follow, a notarized signature will be required
on behalf of the Principal.
INITIAL
_______ (A) Real property transactions. To 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, on such terms and conditions, and under such covenants, as my Agent 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 Agent 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.
_______ (B) Tangible personal property transactions. To lease, sell, mortgage, purchase,
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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 Agent shall deem proper; 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
hypothecate (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 Agent shall deem proper.
_______ (C) Stock and bond transactions. To purchase, sell, exchange, surrender, assign,
redeem, vote at any meeting, or otherwise transfer any and all shares of stock, bonds, or other
securities in any business, association, corporation, partnership, or other legal entity, whether
private or public, now or hereafter belonging to me.
_______ (D) Commodity and option transactions. 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.
_______ (E) Banking and other financial institution transactions. To make, receive, sign,
endorse, execute, acknowledge, deliver and possess checks, drafts, bills of exchange, letters
of credit, notes, stock certificates, withdrawal receipts and deposit instruments relating to
accounts or deposits in, or certificates of deposit of banks, savings and loans, credit unions, or
other institutions or associations. To pay all sums of money, at any time or times, that may
hereafter be owing by me upon any account, bill of exchange, check, draft, purchase, contract,
note, or trade acceptance made, executed, endorsed, accepted, and delivered by me or for me
in my name, by my Agent. To borrow from time to time such sums of money as my Agent may
deem proper and execute promissory notes, security deeds or agreements, financing
statements, or other security instruments in such form as the lender may request and renew
said notes and security instruments from time to time in whole or in part. To have free access
at any time or times to any safe deposit box or vault to which I might have access.
_______ (F) Business operating transactions. 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.
_______ (G) Insurance and annuity transactions. To exercise or perform any act, power,
duty, right, or obligation, in regard to any contract of life, accident, health, disability, liability, or
other type of insurance or any combination of insurance; and to procure new or additional
contracts of insurance for me and to designate the beneficiary of same; provided, however, that
my Agent cannot designate himself or herself as beneficiary of any such insurance contracts.
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_______ (H) Estate, trust, and other beneficiary transactions. To accept, receipt for,
exercise, release, reject, renounce, assign, disclaim, demand, sue for, claim and recover any
legacy, bequest, devise, gift or other property interest or payment due or payable to or for the
principal; assert any interest in and exercise any power over any trust, estate or property
subject to fiduciary control; establish a revocable trust solely for the benefit of the principal that
terminates at the death of the principal and is then distributable to the legal representative of
the estate of the principal; and, in general, exercise all powers with respect to estates and
trusts which the principal could exercise if present and under no disability; provided, however,
that the Agent may not make or change a will and may not revoke or amend a trust revocable
or amendable by the principal or require the trustee of any trust for the benefit of the principal to
pay income or principal to the Agent unless specific authority to that end is given.
_______ (I) Claims and litigation. 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, 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, in such manner
and in all respects as my Agent shall deem proper.
_______ (J) Personal and family maintenance. To hire accountants, attorneys at law,
consultants, clerks, physicians, nurses, agents, servants, workmen, and others and to remove
them, and to appoint others in their place, and to pay and allow the persons so employed such
salaries, wages, or other remunerations, as my Agent shall deem proper.
_______ (K) Benefits from Social Security, Medicare, Medicaid, or other governmental
programs, or military service. To prepare, sign and file any claim or application for Social
Security, unemployment or military service benefits; sue for, settle or abandon any claims to
any benefit or assistance under any federal, state, local or foreign statute or regulation; control,
deposit to any account, collect, receipt for, and take title to and hold all benefits under any
Social Security, unemployment, military service or other state, federal, local or foreign statute
or regulation; and, in general, exercise all powers with respect to Social Security,
unemployment, military service, and governmental benefits, including but not limited to
Medicare and Medicaid, which the principal could exercise if present and under no disability.
_______ (L) Retirement plan transactions. 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.
_______ (M) Tax matters. To prepare, to make elections, to execute and to file all tax, social
security, unemployment insurance, and informational returns required by the laws of the United
States, or of any state or subdivision thereof, or of any foreign government; to prepare, to
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execute, and to file all other papers and instruments which the Agent shall think to be desirable
or necessary for safeguarding of me against excess or illegal taxation or against penalties
imposed for claimed violation of any law or other governmental regulation; and to pay, to
compromise, or to contest or to apply for refunds in connection with any taxes or assessments
for which I am or may be liable.
_______ (N) ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ANY OTHER
LINES IF YOU INITIAL LINE (N).
SPECIAL INSTRUCTIONS:
ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR
EXTENDING THE POWERS GRANTED TO YOUR AGENT.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL CONTINUE UNTIL
IT IS REVOKED.
THIS POWER OF ATTORNEY SHALL BE CONSTRUED AS A GENERAL DURABLE POWER
OF ATTORNEY AND SHALL CONTINUE TO BE EFFECTIVE EVEN IF I BECOME
DISABLED, INCAPACITATED, OR INCOMPETENT.
(YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER PERSONS AS NECESSARY
TO ENABLE THE AGENT TO PROPERLY EXERCISE THE POWERS GRANTED IN THIS
FORM, BUT YOUR AGENT WILL HAVE TO MAKE ALL DISCRETIONARY DECISIONS. IF
YOU WANT TO GIVE YOUR AGENT THE RIGHT TO DELEGATE DISCRETIONARY
DECISION-MAKING POWERS TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE,
OTHERWISE IT SHOULD BE STRICKEN.)
Authority to Delegate. My Agent shall have the right by written instrument to delegate any or
all of the foregoing powers involving discretionary decision-making to any person or persons
whom my Agent may select, but such delegation may be amended or revoked by any agent
(including any successor) named by me who is acting under this power of attorney at the time
of reference.
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(YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL REASONABLE
EXPENSES INCURRED IN ACTING UNDER THIS POWER OF ATTORNEY. STRIKE OUT
THE NEXT SENTENCE IF YOU DO NOT WANT YOUR AGENT TO ALSO BE ENTITLED TO
REASONABLE COMPENSATION FOR SERVICES AS AGENT.)
Right to Compensation. My Agent shall be entitled to reasonable compensation for services
rendered as agent under this power of attorney.
(IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND
ADDRESS(ES) OF SUCH SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)
Successor Agent. If any Agent named by me shall die, become incompetent, resign or refuse
to accept the office of Agent, I name the following (each to act alone and successively, in the
order named) as successor(s) to such Agent:
________________________________________________________________________
________________________________________________________________________
Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF THE
STATE OF FLORIDA WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES. IT
WAS EXECUTED IN THE STATE OF FLORIDA AND IS INTENDED TO BE VALID IN ALL
JURISDICTIONS OF THE UNITED STATES OF AMERICA AND ALL FOREIGN NATIONS.
I am fully informed as to all the contents of this form and understand the full import of this grant
of powers to my Agent.
I agree that any third party who receives a copy of this document may act under it. Revocation
of the power of attorney is not effective as to a third party until the third party learns 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.
Signed this _______ day of _______________, 20____
______________________________
[Your Signature]
_______________________________
[Your Social Security Number]
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STATEMENT OF WITNESS
On the date written above, the principal declared to me in my presence that this instrument is
his general durable power of attorney and that he or she had willingly signed or directed
another to sign for him or her, and that he or she executed it as his or her free and voluntary
act for the purposes therein expressed.
_______________________________________ [Signature of Witness #1]
_______________________________________ [Printed or typed name of Witness #1]
_______________________________________ [Address of Witness #1, Line 1]
_______________________________________ [Address of Witness #1, Line 2]
_______________________________________ [Signature of Witness #2]
_______________________________________ [Printed or typed name of Witness #2]
_______________________________________ [Address of Witness #2, Line 1]
_______________________________________ [Address of Witness #2, Line 2]
A Note About Selecting Witnesses: The agent (attorney-in-fact) may not also
serve as a witness. Each witness must be present at the time that principal signs
the Power of Attorney in front of the notary. Each witness must be a mentally
competent adult. Witnesses should ideally reside close by, so that they will be
easily accessible in the event they are one day needed to affirm this document's
validity.
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CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
STATE OF FLORIDA
COUNTY OF ________________
This document was acknowledged before me on _______________ [Date] by
________________________________________________ [name of principal].
[Notary Seal, if any]:
_______________________________
(Signature of Notarial Officer)
Notary Public for the State of Florida
My commission expires:
___________________
ACKNOWLEDGMENT OF AGENT
BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE
FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.
________________________________________________
[Typed or Printed Name of Agent]
________________________________________________
[Signature of Agent]
PREPARATION STATEMENT
This document was prepared by the following individual:
________________________________________________
[Typed or Printed Name]
________________________________________________
[Signature]
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