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Arkansas living will and durab... DECLARATION OF LIVING WILL OF Name of Declarant If I should have an incurable or irreversible condition with no hope of recovery that will cause my death within a relatively short time, and I am no

Massachusetts limited power of... Prepared by recording requested by and return to Name Company Address City State Phone Fax Zip ----------------------Above this Line for Official Use Only--------------------- LIMITED POWER OF ATTORNEY STATE OF MASSACHUSETTS COUNTY OF KNOW ALL MEN BY THESE PRESENT THAT I whose address is City State Zip Principal have made constituted and appointed and by these presents do make constitute limited powers to wit Insert powers here. IN WITNESS WHEREOF I have hereunto set my hand and seal this the day of PRINCIPAL ATTESTATION The hereinafter named Witnesses each declare under penalty of perjury under the laws of the State of Massachusetts that the principal is personally known to us that the principal signed and acknowledged this limited power of attorney in our presence that the principal appears to be of sound mind and under no duress fraud or undue influence that we are not the person appointed as attorney-in-fact by this document and that we witnessed this power of attorney in the presence of the principal. We are not related to the principal by blood marriage or adoption and to the best of our knowledge are not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law. See examples at the end of this form FURTHER I do authorize my aforesaid attorney-in-fact to execute acknowledge and deliver any instrument under seal or otherwise and to do all things necessary to carry out the intent hereof hereby granting unto my said attorney-in-fact full power and authority to act in and concerning the premises as fully and effectually as I may do if personally present limited however to the purpose for which this limited power of attorney is executed* PROVIDED however that all business transacted hereunder for me or for my account shall be transacted in my name and that all endorsements and instruments executed by my said attorney-in-fact for the purpose of carrying out the foregoing powers shall contain my name followed by that of my said attorney and the designation attorney-in-fact. I further declare that any act or thing lawfully done hereunder and within the powers herein stated by my said attorney shall be binding on myself and my heirs legal and personal representatives and assigns whether the same shall have been done either before or after my death or other revocation of this instrument unless and until reliable intelligence or notice thereof shall have been received by my said attorney. This Power of Attorney shall be Non-Durable. Durable and shall not be affected by any subsequent disability or incompetence. Third parties may rely upon the representations of the agents as to all matters relating to any power granted to them hereunder and no person who may act in reliance upon the or his estate as result of permitting the agent to exercise any power. WITNESSES Signature Print Name Address City State Zip State of Massachusetts County On this day of 20 before me personally appeared described in and who executed the foregoing instrument and acknowledged that he/she/they executed the same as his/her/their free act and deed* Notary Public My commission expires Principal Name and Address NOTICE THESE ARE SAMPLE POWERS* Collection of Debts.

South carolina general durable... This General Durable Power of Attorney is a general, durable power of attorney which is effective IMMEDIATELY. You can use this form to appoint an attorney-in-fact (agent) to make decisions regarding

Power of attorney for bank acc... SPECIAL DURABLE POWER OF ATTORNEY FOR BANK ACCOUNT MATTERS STATE OF LOUISIANA PARISH OF KNOW ALL MEN BY THESE PRESENTS That I of County Louisiana being of sound mind and memory do hereby make constitute and appoint as my true and lawful agent and attorney in fact hereinafter sometimes called my agent with full power and authority to act for me individually and in my name place and stead with reference to the transaction of any and all business related to or connected with my bank accounts at Bank Address but not limited to the following Making deposits transfers and withdrawals to or from any of my bank accounts at Writing making and endorsing checks drafts and other instruments in connection with my bank accounts at Bank. Opening new checking savings money market certificates of deposit IRA s or other accounts in my name and maintaining same. Approving and authorizing automatic withdrawals from my accounts. Executing signature cards for accounts maintained or opened by my agent in my name. Performing any and all other matters relating to or in connection with my bank accounts at Bank. I direct that the above-related powers and authority of my said agent shall be so exercisable and effective regardless of the fact that I may be mentally or physically incapacitated or incapable of understanding or unable to express myself or act in my own behalf at the time of any action on my behalf by said agent. Such incapacity whether mental or physical that I may exhibit shall not in any way interfere with the authority of my agent herein to act fully on my behalf according to the terms hereof* In other words this Power of Attorney shall not be affected by the subsequent disability incompetence or incapacity of the principal* And I do hereby undertake to ratify and confirm all and singular the acts heretofore performed and to be hereinafter performed by my said agents acting in my name and on my behalf* Bank shall honor this Power of Attorney until and unless Bank receives written notice of revocation of same signed by me. Bank is hereby indemnified and shall be held harmless by the undersigned for any and all actions taken by my agent regarding my accounts at Bank regardless of whether within the intended scope of this Power of Attorney or not therefore Bank shall have no liability for the actions of my agent or for following the directions of my agent in connection with my IN WITNESS WHEREFORE I have executed this Special Power of Attorney on this the day of 20. PRINCIPAL Witness ATTESTATION The hereinafter named Witnesses each declare under penalty of perjury under the laws of the State of Louisiana that the principal is personally known to us that the principal signed and acknowledged this special power of attorney in our presence that the principal appears to be of sound mind and under no duress fraud or undue influence that we are not the person appointed as attorneyin-fact by this document and that we witnessed this power of attorney in the presence of the principal* We are not related to the principal by blood marriage or adoption and to the best of our knowledge are not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law.

Oklahoma durable power of atto... This General Durable Power of Attorney is a general, durable power of attorney which is effective IMMEDIATELY. You can use this form to appoint an attorney-in-fact (agent) to make decisions regarding

Filable durable healthcare pow... STATE OF ARIZONA DURABLE HEALTH CARE POWER OF ATTORNEY Instructions and Form GENERAL INSTRUCTIONS: Use this Durable Health Care Power of Attorney form if you want to select a person to make future

Mcfarland clinic health care p... Authorization to Release Protected Health Information I understand that if the person(s) and or organizations(s) listed below are not health care providers, health plans or health care clearinghouses,

Navy fed power of attorney for... Dear Member: Enclosed are the documents necessary to open your new Navy Federal Certificate, EasyStartSM Certificate, or Custom Club Account. By completing and returning the forms, you can establish

Arizona dmv power of attorney... POWER OF ATTORNEY with Odometer Disclosure 48-7104 R07/05 www.azdot.gov Clear Year Make Body Style Vehicle Identification Number Attorney-In-Fact (individual or organization you wish to act for you

Iowa bar association form 2013... Your Signature Declarant/Principal Address Street City State and Zip Type or Print Your Name IMPORTANT NOTE THIS DOCUMENT MUST BE SIGNED OR ACKNOWLEDGED BEFORE A NOTARY PUBLIC OR TWO WITNESSES. SEE REVERSE FOR NOTARY OR WITNESS FORMS. IF YOU WANT TO EXECUTE EITHER A LIVING WILL DECLARATION OR A MEDICAL POWER OF ATTORNEY BUT NOT BOTH SEPARATE FORMS ARE AVAILABLE FROM THE IOWA STATE BAR ASSOCIATION. IF YOU HAVE QUESTIONS REGARDING THIS FORM OR NEED ASSISTANCE TO COMPLETE IT YOU SHOULD CONSULT AN ATTORNEY. THE IOWA STATE BAR ASSOCIATION Official Form No. 123 FOR THE LEGAL EFFECT OF THE USE OF THIS FORM CONSULT YOUR LAWYER DECLARATION RELATING TO LIFE-SUSTAINING PROCEDURES Living Will AND DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS Medical Power of Attorney If I should have an incurable or irreversible condition that will result either in death within a relatively short period of time or a state of permanent unconsciousness from which to a reasonable degree of medical certainty there can be no recovery it is my desire that my life not be prolonged by the administration of life-sustaining procedures. The Iowa State Bar Association 2013 IOWADOCS NOTARY PUBLIC FORM STATE OF COUNTY OF ss This record was acknowledged before me this day of by Signature of Notary Public WITNESS FORM We the undersigned hereby state that we signed this document in the presence of each other and the Declarant/Principal and we witnessed the signing of the document by the Declarant/Principal or by another person acting on behalf of the Declarant/Principal at the direction of the Declarant/Principal that neither of us is appointed as attorney in fact by this document that neither of us are health care providers who are presently treating the Declarant/Principal or employees of such a health care provider. If I am unable to participate in my health care decisions I direct my attending physician to withhold or withdraw life-sustaining procedures that merely prolong the dying process and are not necessary to my comfort or freedom from pain* This declaration is subject to any specific instructions or statement of desires I have added in Additional Provisions below. II. POWER OF ATTORNEY FOR HEALTH CARE DECISIONS I born designate Type or Print Name of Agent Street Address City State Zip Code and Phone Number as my attorney in fact my agent and give to my agent the power to make health care decisions for me. This power exists only when I am unable in the judgment of my attending physician to make those health care decisions. The attorney in fact must act consistently with my desires as stated in this document or otherwise made known* Except as otherwise specified in this document this document gives my agent the power where otherwise consistent with the laws of the State of Iowa to consent to my physician not giving health care or stopping health care which is necessary to keep me alive. This document gives my agent power to make health care decisions on my behalf including to consent to refuse to consent or to withdraw consent to any care treatment service or procedure to maintain diagnose or treat a physical or mental condition* This power is subject to any statement of my desires and any limitations included in this document.

Missouri form 5086 2014 2019 MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU Form 5086 PART?A - POWER OF ATTORNEY TO DISCLOSE MILEAGE OR TRANSFER OWNERSHIP SECURE POWER OF ATTORNEY A Secure Power of Attorney may only be used

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