Doe Family Will

Doe Family
Last Will & Testament
– Package –
File# 183051
– Electronic Signatures Verification Status –
ALL APPLICABLE DOCUMENTS NOT "ESIGNED"
(See Electronic Signature Page)
~ Provided By ~
MY LIFECARD PLAN
7373 E. Doubletree Ranch Rd., #200
Scottsdale, AZ 85258
www.MYLIFECARDPLAN.com

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GENERAL INSTRUCTIONS / IMPLEMENTATION
Congratulations on your purchase! You have taken the first steps to help (i) enable specific
proxy management of your assets in your stead, and (ii) ensure your medical (emergency)
preparedness. Now you will need to properly implement your plan. Enclosed are the documents
that comprise your –
Last Will & Testament Package
As you conduct a general review of the documents, search for the pages that must be signed by
you and your Witnesses and a Notary Public. Below is a checklist of the pages that should be
signed and implemented immediately.
PLEASE NOTICE: A SHADED CHECKED BOX is positioned at the lower right hand
corner of the (twenty/20) pages where either (a) each of you have to sign, (b) the Notary Public
has to sign, (c) witnesses enter their names and sign, and/or (d) the current date is to be entered.
The "Portable Document Format" / PDF page numbers posted to the right (>) of the document
page numbers (listed below) locate the "signature page(s)" of each document stored in your
electronic (Last Will & Testament Package) PDF file.
(NOTE: The Agent Notices are not to be signed until the time they are to be used.)
 Last Will & Testament(s) / Pages 13 & 14 > PDF/15-16&31-32
 Durable Power(s) of Attorney / Assets / Page(s) 3 & 4 > PDF/37,38&41,42
 Durable Power(s) of Attorney for Health Care / Page(s) 4 > PDF/48&52
 Advanced Health Care Directive(s) / Page(s) 8 > PDF/63&73
 Durable HIPAA Statement(s) / Pages 1 & 2 > PDF/64-65&74-75
 Pro-Life Living Will(s)* / Pages 1 & 2 > PDF/76-77&78-79
 Living Will Declaration(s) / Page(s) 3 > PDF/81,82&84,85
*The "Pro-Life" Living Will states that the Declarant does not want to be denied hydration
and/or tube feeding – under any circumstances. Be advised that such a signed declaration may
be deemed to be in conflict with a regular Living Will Declaration and/or other entries you may
make in your Advanced Directives.
NOTICE: The instructional information contained in this Last Will & Testament
Package is for reference ONLY, and is not intended to replace legal, tax planning, or
personal health care counsel. You should obtain independent counsel before acting on any
directives or other information described herein.

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LAST WILL AND TESTAMENT
JOHN W. DOE
I, JOHN W. DOE, a resident of Maricpoa County, State of Arizona, declare that this is
my Last Will and Testament. I hereby revoke all my previous Wills and codicils.
ARTICLE I
– Introductory Provisions –
Marital Status.
1.1. I am married to JANE E. DOE and all references in this Will to my spouse
are to JANE E. DOE.
Identification of Living Children.
1.2. The name(s) of the primary beneficiary(s) of my Will who shall receive of
my probate estate – if my spouse does not survive me – accordingly as such
dispositive terms are prescribed in Sections 3.4/3.5 (below) is/are:
JAMES G. DOE & JOYCE L. DOE
Children Defined.
1.3. All references to “child” or “children” are to the child or children as may be
listed in Section 1.2 (above), and including any child or children subsequently
born to or legally adopted by me after the date of this Will.
ARTICLE II
– Personal Property Allocations –
Tangible Personal Property.
2.1. I give all of my tangible personal property, including my interest in any
insurance on that property (if any), to my spouse. However, if my spouse does not
survive me and there are no entries on such Personal Property Allocations page,
then my personal property shall be distributed as provided in Sections 3.4 – 3.8 of
this Will.
LW&T Page 1 (of 14)

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2.2. If my spouse does not survive me and the beneficiaries of my Will are not
able to agree on the division and distribution of my tangible personal property
and there are no entries in the Personal Property Allocations page, in such case,
then my Executor shall divide and allocate the property as the Executor believes to
be in accordance with my wishes. The decision(s) of the Executor thereof shall be
deemed valid, complete and final.
Specific Gifts.
2.3. Notwithstanding Section 2.1 and 2.2 (above), if I have made any
handwritten entries on the Directive of Specific Personal Property Allocations
(Page 11 of 13) with my signature thereon, then the specific allocations of such
Directive shall apply concerning specific gifts of my personal property.
ARTICLE III
– Balance of My Probate Estate –
Disposition of My Probate Estate if My Spouse Survives Me.
3.1. I give the residue of my entire estate to my spouse, JANE E. DOE.
Disposition Eligibility for Marital Deduction.
3.2. I intend that the disposition in the preceding section be eligible for the
federal estate tax marital deduction, and that this instrument shall be construed
accordingly. No fiduciary under this Will shall take any action or exercise any
power that may impair the federal estate tax marital deduction.
If My Spouse Does Not Survive Me or Disclaims.
3.3. If my spouse does not survive me – or shall disclaim all or any part
prescribed to my spouse herein where any such disclaimed interest shall be part
(or all) of the residue of my probate estate – then I give the residue of my probate
estate pursuant to Sections 3.4 – 3.9, as follows:
(See Section 3.4/3.5 Estate Allocation Terms on Following Page)
LW&T Page 2 (of 14)

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Division of My Probate Estate if My Spouse Does Not Survive Me.
3.4. IF MY SPOUSE DOES NOT SURVIVE ME, my Executor shall divide my
probate estate into as many portions of equal market value as are necessary to
create one (1) equal share for each beneficiary named in Section 1.2 (supra).
3.5. My Executor shall then distribute said equal shares outright respectively
to each of the beneficiaries identified in Section 1.2, or otherwise according to
certain Specific Directives that may be prescribed in Section 3.6 (below).
(a) Contingent Distributions. If any beneficiary named in Section 1.2, who
is then living at the time of the execution of my Will, does not survive me then
such deceased beneficiary's portion shall be distributed EQUALLY TO HIS (HER)
SURVIVING LEGAL CHILDREN/ISSUE, BY RIGHT OF REPRESENTATION.
And, if any such beneficiary does not survive me and leaves no surviving
children/issue, in such case, then that decedent beneficiary's portion shall be
distributed equally to the other surviving beneficiaries listed in Section 1.2 (or as
otherwise may be prescribed in Section 3.6, below).
(b) Notwithstanding the provisions as defined above, sub-paragraph “(e)”
(listed below) contains a Schedule of Other/Alternate Primary Beneficiaries
which is a list of beneficiaries (if any) and the percentages of my probate estate
that each respective beneficiary listed therein shall receive prior to the allocations
and distributions prescribed in Sections 1.2 & 3.4/3.5.
(c) In such case of the usage of the Schedule of Other/Alternate Primary
Beneficiaries, the allocations in Sections 1.2 & 3.4/3.5 shall be deemed to be
allocations of the remainder of my probate estate remaining after the
allocations/distributions prescribed in sub-paragraphs “(d)” & “(e)” (and/or
under Section “3.6” / by Special Directives, if applicable) or shall be deemed as
the "Alternate Distribution Schedule” concerning my Will if the beneficiaries listed
thereof are to receive all – that is, a one hundred percent (100%) aggregate – of my
probate estate.
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(d) If any beneficiary listed in sub-paragraph (e) does not survive me then
such decedent person’s designated portion shall be allocated to those other
beneficiaries listed there in prorata portions of the aggregate percentage of my
probate estate allocated below – unless other provided in Section 3.6 (below):
(e) Schedule of Other / Alternate Primary Beneficiaries:
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
(f) Notwithstanding the above, in the event that any beneficiary of my
probate estate is then a debtor to me – verified by a written instrument of debt –
at the time of my decease then the following shall apply: (i) the share of such
indebted beneficiary shall be decreased by a certain formula amount that is equal
to the total outstanding value of debt(s) such person owed me, which amount is
then (ii) multiplied by a percentage that corresponds to the value of my probate
estate (including the value of the debt[s] owed to me) – that such indebted person
is not entitled to receive which shall be referred to as the percentage amount;
wherein, (iii) such formulated percentage amount shall be subtracted from such
indebted person’s share and added prorata to the portion(s) distributable to the
other beneficiary(s) of my probate estate who are then living.
(g) The following identified person(s) has/have been intentionally
disinherited and is/are not to receive any portion(s) of my Will:
_______________________________________________________________
_______________________________________________________________
LW&T Page 4 (of 14)

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Alternate and/or Additional Specific Directives of This Will.
NOTICE: Use space below to enter other terms/directives that you want
mandated through your Will including but not limited to allocations, if
any, to (other) beneficiaries for distributions of "in cash" and/or "in kind":
3.6. The following terms shall ADDITIONALLY apply as to or in place of the
administrative and/or allocation terms and/or decrees of my Will
notwithstanding any provisions otherwise prescribed anywhere herein to the
contrary. Any allocations to beneficiaries prescribed below – whether in cash
and/or in kind and/or in unequal percentage amounts – shall be deemed and
administrated as part of the Schedule of Other/Alternate Primary Beneficiaries with
respect to the terms of allocation/administration prescribed above:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
< < < End of Section 3.5 > > >
Beneficiary Under Age 21.
3.7. If a beneficiary of this Will is under twenty-one (21) years of age, or
otherwise deemed as dependent, then my Executor shall establish a “trust” for
such beneficiary and pay to or apply for the benefit of such beneficiary, in
Executor’s discretion, as much of the income of that beneficiary’s said trust as
deemed necessary for his/her health, support, maintenance and education. If my
Executor deems the income to be insufficient, he/she may also pay to or apply for
the benefit of such beneficiary as much of the principal of beneficiary’s trust as my
Executor, in his/her unhindered discretion, deems necessary for the beneficiary’s
health, support, maintenance and education. My Executor, in lieu of making
direct payments to the beneficiary, may make payments to the beneficiary’s
conservator or guardian, to the beneficiary’s custodian under the Uniform Gifts to
Minors Act or Uniform Transfers to Minors Act of any state, to one or more
suitable persons as my Executor deems proper, or to accounts in the beneficiary’s
name with financial institutions.
LW&T Page 5 (of 14)

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Beneficiary Over Age 21.
3.8. If beneficiary of this Will is twenty-one (21) years of age or older, then my
Executor shall distribute the balance of the net income and principal of that
beneficiary’s allocated trust/portion(s) outright to him/her as soon as
administratively possible. Notwithstanding, my Executor may arbitrarily hold any
such beneficiary's portion IN TRUST for a later outright distribution period if such
action is deemed prudent as it would pertain to that beneficiary's best interest in
consideration of all then existing circumstances, and would therefore administer
any such beneficiary's portion for his/her benefit per those terms prescribed in
Sections 3.4/3.5/3.6 (above).
Final Distribution.
3.9. If, under the foregoing provisions, a portion of my estate shall be
undisposed of, then such non-disposed portion shall be distributed to my legal
heirs whose identity(s) and respective share(s) shall be determined as though my
death had occurred immediately following the happening of the event requiring
distribution of such undisposed portion of my estate, and according to the laws of
succession then in force in the State of Arizona.
ARTICLE IV
– Nominated Executor –
Nomination of Executor.
4.1. I nominate my spouse, JANE E. DOE, as Executor of my Will.
Successor Executors.
4.2. If my spouse is unable or unwilling to serve or continue as Executor of
my Will, then I nominate JAMES G. DOE to serve as my Executor. If JAMES G.
DOE is unable or unwilling to serve or continue as the Executor of my Will, in
such case, then I nominate JOYCE L. DOE to serve.
Waiver of Bond.
4.3. No bond or undertaking shall be required of any Executor nominated
herein.
LW&T Page 6 (of 14)

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General Powers of My Executor.
4.4. I authorize but do not direct my Executor to sell any property belonging to
my estate, either with or without notice. My Executor is further authorized to
invest and reinvest any surplus money, in any kind of property, real, personal, or
mixed, and every kind of investment, specifically including, but not limited to,
interest-bearing accounts, corporate obligations of every kind, preferred or
common stocks, shares of investment trusts, investment companies, mutual funds,
or common trust funds, including funds administered by the Executor, and
mortgage participations, that persons of prudence, discretion and intelligence
acquire for their own account, and to either continue the operation of any business
belonging to my estate for such time and in such manner as it may deem advisable
and for the best interest of my estate, or to sell or liquidate said business at such
time and upon such terms as my Executor may deem advisable and for the best
interest of my estate; and any such operation, sale or liquidation shall be at the risk
of my estate and without liability on the part of my Executor for any losses
resulting therefrom.
Independent Administration Permitted.
4.5. My Executor shall have all powers now or hereafter conferred on Executors
by law then in force in the State of Arizona except as otherwise specifically
provided in this Will, including any powers enumerated in this Will.
Division or Distribution in Cash or Kind.
4.6. In order to satisfy a pecuniary gift or to distribute or divide assets into
shares or partial shares, the Executor may distribute or divide those assets in kind,
or divide undivided interests in those assets, or sell all or any part of those assets
and distribute or divide the property in cash, in kind, or partly in cash and partly
in kind. Property distributed to satisfy a pecuniary gift under this instrument
shall be valued at its fair market value at the time of distribution.
Power to Make Tax Elections.
4.7. To the extent permitted by law, and without regard to the resulting effect on
any other provision of this Will, on any person interested on the amount of taxes
that may be payable, my Executor shall have the power to elect an alternative
valuation date for estate tax purposes; choose the methods to pay any death taxes;
elect to treat or use any item for state or federal estate or income tax purposes as
an income tax deduction or an estate tax deduction; disclaim all or any portion of
any interest in property passing to my estate at or after my death; and determine
when an item is to be treated as taken into income or used as a tax deduction.
LW&T Page 7 (of 14)

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ARTICLE V
– Nominated Guardian –
Nomination of Guardian and Successor.
(Not Applicable to this Will)
Waiver of Bond.
5.2. No bond or undertaking shall be required of any guardian as nominated
(per Section 5.1) in this Will.
Powers of Guardian(s).
5.3. It is my intent that any guardian nominated in this Will shall have the same
authority with respect to the person of the ward as a parent having legal custody
of a child would have. It is my intent that all powers granted to guardians named
herein may be exercised without unnecessary court authorization.
ARTICLE VI
– Concluding Provisions –
Debts, Taxes and Expenses.
6.1. All of my funeral, last illness, administration expenses and death taxes, shall
be paid out of the residue of my estate, subject, however, to the provisions below.
Payment of Debt.
6.2. Except for any indebtedness that I may have to any qualified pension, profit
sharing or similar plan (other than loans against a voluntary contribution
account), which indebtedness shall be promptly paid following my death, the
provisions of this Will shall not operate to accelerate any liability; and all
indebtedness of mine for which any properties or insurance policies stand as
collateral security shall remain an encumbrance upon the same, which shall pass
subject to such indebtedness without reimbursement of any kind from my estate.
LW&T Page 8 (of 14)

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Payment of Death Taxes.
6.3. The Executor shall pay death taxes, whether or not attributable to property
inventoried in my probate estate, by prorating and apportioning them among the
persons having an interest in my estate according to the apportionment provisions
as described under Section 2207 of the Internal Revenue Code.
Definition of Death Taxes.
6.4. The term “death taxes” as used in this Will, shall mean all inheritance,
estate, succession, and other similar taxes that are payable by any person on
account of that person’s interest in my estate or by reason of my death, including
penalties and interest, but excluding the following:
(a) Any (other) additional tax – not described above – that may be
assessed in my estate shall be paid by those trusts and/or beneficiaries who
receive the assets upon which the additional tax is assessed.
(b) Any federal or state tax imposed on a generation-skipping transfer, as
that term is defined in the federal tax laws, shall be paid by those trusts and/or
beneficiaries who receive the assets upon which the additional tax is assessed.
Simultaneous Death.
6.5. If any beneficiary under this Will and I die simultaneously, or if it cannot be
established by clear and convincing evidence whether that beneficiary or I died
first, I shall be deemed to have survived that beneficiary, and this Will shall be
construed accordingly.
Period of Survivorship.
6.6. For the purposes of this Will, a beneficiary shall not be deemed to have
survived me if that beneficiary dies within thirty (30) days after my death.
No-Contest Clause.
6.7. If any heir, devisee, legatee or beneficiary under this Will, or any of my heirs
or any person claiming under this Will, my estate, or any trust established by me,
whether directly or indirectly, singly or in conjunction with any other person
commits any of the actions listed in this Section (et seq.), then all legacies,
bequests, devises and interests given under this Will to that person shall be
forfeited as though he or she predeceased me without surviving issue:
LW&T Page 9 (of 14)

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(a) Contests or otherwise objects in any court to the validity of this Will, or
any share or subtrust created by this Will, or any beneficiary designation account
signed by me;
(b) Files suit on a creditor’s claim filed in a probate of my estate, or a
creditor’s claim on any other document, after rejection or lack of action by the
respective fiduciary;
(c) Claims ownership to any asset held in joint tenancy by me, other than
as a surviving joint tenant;
(d) Files a petition for family allowance in a probate of my estate; or
brings, joins or is a party to a petition for settlement or for compromise affecting
the terms of this instrument;
(e) Object in any manner to any action taken or proposed to be taken in
good faith by the Executor of my estate or the Executor of any of my trusts
(including, without limitation, the good faith exercise or non-exercise of a
discretion granted to the Executor or Executor), whether said Executor or Executor
is acting under court order, notice of proposed action or otherwise; or,
(f) Successfully or unsuccessfully attacks or seeks to impair or invalidate
any of the following: any designation of beneficiaries for any insurance policy on
my life; any trust which I have created during my lifetime; or any gift which I
have made during my lifetime.
Expenses.
6.8. Expenses to resist any contest or other attack of any nature upon my estate
shall be paid from my estate as expenses of administration.
Severable.
6.9. In the event that any provision of this Will is held to be invalid, void or
illegal, the same shall be deemed severable from the remainder of the provisions
of this Will, and shall in no way affect, impair or invalidate any other provision in
this Will. If such provision shall be deemed invalid due to its scope and breadth
as described in this Will, such provision shall be deemed valid to the extent of the
scope or breadth permitted by law.
LW&T Page 10 (of 14)

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Perpetuities Savings Clause.
6.10. Notwithstanding any other provision of this Will, unless otherwise allowed
by applicable state law, every trust created by this Will shall terminate no later
than twenty-one (21) years after the death of the last survivor of my issue and the
beneficiaries of this Will who are alive at my death. If a trust is terminated under
this section of the Will, the Executor shall distribute all of the principal and
undistributed income of the trust to the income beneficiaries of that trust in
proportion to which they are entitled (or eligible, in the case of discretionary
payments) to receive immediately before the termination. If that proportion is not
fixed by the terms of this Will, the Executor shall distribute all of the trust
property to the persons then entitled or eligible to receive income from the trust
outright in a manner that, in the Executor’s opinion, shall give effect to my intent
in creating the trust(s). The Executor’s decision is to be final and incontestable by
anyone.
Severability Clause.
of this Will and shall in no way affect, impair or invalidate any other provision in
this Will. If such provision shall be deemed invalid due to its scope and breadth,
such provision shall be deemed valid to the extent of the scope or breadth
permitted by law.
Arizona Law to Apply.
6.12. All questions concerning the validity and interpretation of this Will,
including any trusts created by this Will, shall be governed by the laws of the State
of Arizona in effect at the time this Will is executed.
ARTICLE VII
– Contents, Testimonial and Attestation Provisions –
Signature and Attestation.
This Last Will & Testament consists of seven (7) Articles – this Article inclusive –
and thirteen (13) pages. Following this (final) Article Seven, Testator’s signature,
and the witnesses’ attestations hereof is a self-proving affidavit identified on and
listed as Page 14.

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Directive of Specific Personal Property Allocations
I, JOHN W. DOE, in accordance with Section 2.3, of Article II, in my Last Will &
Testament, hereby bequeath certain tangible personal property of mine to the persons
identified below respective of each separate item adjacent to the person’s name. All
such entries on this page may only be handwritten in by me.
Personal Property Item Recipient
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
x______________________________
JOHN W. DOE

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IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND ON THIS _______
DAY OF ___________________, 2013.
x________________________________
JOHN W. DOE
Signed, sealed, published and declared by the above named Testator as (and for) his
Last Will & Testament in our presence who, at his request, in his presence and in the
presence of each other, we have hereunto subscribed our names as witnesses.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address
STATE OF ARIZONA
COUNTY OF MARICPOA
On this _______ day of _________________, 2013, before me, _____________________,
the undersigned Notary Public, personally appeared JOHN W. DOE, and the above
identified witnesses, who proved to me on the basis of satisfactory evidence to be the
persons whose names are subscribed to the within instrument and acknowledged to me
that they signed the same in their authorized capacity, and that by their signatures
executed this instrument.
I certify under PENALTY OF PERJURY under the laws of the State of Arizona that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature: ______________________________ (Seal)


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SELF PROVING AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICPOA
I, JOHN W. DOE, the Testator of the within, hereby certify that I executed my
signature on said Will this ________ day of ___________________, 2013. I further
certify that I requested signatures as witnesses to my Last Will & Testament from the
following individuals:
_______________________________ (and) _______________________________
Witness Name Witness Name
x_______________________________
JOHN W. DOE
We, __________________________ & _________________________, (the witnesses),
being first duly sworn, do depose and say to the undersigned authority that we
witnessed the Testator's execution of his Will and that he signed it willingly and that
each of us, in the presence and hearing of the Testator, hereby sign herein as witness to
his signing, and that to the best of our knowledge he is eighteen years of age or older,
of sound mind, under no constraint or undue influence and competent to make
testamentary disposition of real and personal property.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address
On this _______ day of ________________, 2013, before me, ______________________,
the undersigned Notary Public, personally appeared JOHN W. DOE, and the above
Signature: ______________________________ (Seal)


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LOCATER/IDENTIFIER REFERENCE LEDGER
JOHN W. DOE
Listed below are names, w/relationships (to Testator), addresses and phone numbers of
individuals who are parties of this Last Will & Testament Package including beneficiaries,
personal representatives, agents, and/or guardians.
Individual Address/Phone
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________

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JOHN W. DOE
Listed below are names, w/relationships (to Testator), addresses and phone numbers of
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________

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LAST WILL AND TESTAMENT
JANE E. DOE
I, JANE E. DOE, a resident of Maricpoa County, State of Arizona, declare that this is
my Last Will and Testament. I hereby revoke all my previous Wills and codicils.
ARTICLE I
– Introductory Provisions –
Marital Status.
1.1. I am married to JOHN W. DOE and all references in this Will to my spouse
are to JOHN W. DOE.
Identification of Living Children.
1.2. The name(s) of the primary beneficiary(s) of my Will who shall receive of
my probate estate – if my spouse does not survive me – accordingly as such
dispositive terms are prescribed in Sections 3.4/3.5 (below) is/are:
JAMES G. DOE & JOYCE L. DOE
Children Defined.
1.3. All references to “child” or “children” are to the child or children as may be
listed in Section 1.2 (above), and including any child or children subsequently
born to or legally adopted by me after the date of this Will.
ARTICLE II
– Personal Property Allocations –
Tangible Personal Property.
2.1. I give all of my tangible personal property, including my interest in any
insurance on that property (if any), to my spouse; however, if my spouse does not
survive me and there are no entries on such Personal Property Allocations page,
then my personal property shall be distributed as provided in Sections 3.4 – 3.8
(infra) of this Will.
LW&T Page 1 (of 14)

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2.2. If my spouse does not survive me and the beneficiaries of my Will are not
able to agree on the division and distribution of my tangible personal property
and there are no entries in the Personal Property Allocations page, in such case,
then my Executor shall divide and allocate the property as the Executor believes to
be in accordance with my wishes. The decision(s) of the Executor thereof shall be
deemed valid, complete and final.
Specific Gifts.
2.3. Notwithstanding Section 2.1 and 2.2 (above), if I have made any
handwritten entries on the Directive of Specific Personal Property Allocations
(Page 11 of 13) with my signature thereon, then the specific allocations of such
Directive shall apply concerning specific gifts of my personal property.
ARTICLE III
– Balance of My Probate Estate –
Disposition of My Probate Estate if My Spouse Survives Me.
3.1. I give the residue of my entire estate to my spouse, JOHN W. DOE.
Disposition Eligibility for Marital Deduction.
3.2. I intend that the disposition in the preceding section be eligible for the
federal estate tax marital deduction, and that this instrument shall be construed
accordingly. No fiduciary under this Will shall take any action or exercise any
power that may impair the federal estate tax marital deduction.
If My Spouse Does Not Survive Me or Disclaims.
3.3. If my spouse does not survive me – or shall disclaim all or any part
prescribed to my spouse herein where any such disclaimed interest shall be part
(or all) of the residue of my probate estate – then I give the residue of my probate
estate pursuant to Sections 3.4 – 3.9, as follows:
(See Section 3.4/3.5 Estate Allocation Terms on Following Page)
LW&T Page 2 (of 14)

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Division of My Probate Estate if My Spouse Does Not Survive Me.
3.4. IF MY SPOUSE DOES NOT SURVIVE ME, my Executor shall divide my
probate estate into as many portions of equal market value as are necessary to
create one (1) equal share for each beneficiary named in Section 1.2 (supra).
3.5. My Executor shall then distribute said equal shares outright respectively
to each of the beneficiaries identified in Section 1.2, or otherwise according to
certain Specific Directives that may be prescribed in Section 3.6 (below).
(a) Contingent Distributions. If any beneficiary named in Section 1.2, who
is then living at the time of the execution of my Will, does not survive me then
such deceased beneficiary's portion shall be distributed EQUALLY TO HIS (HER)
SURVIVING LEGAL CHILDREN/ISSUE, BY RIGHT OF REPRESENTATION.
And, if any such beneficiary does not survive me and leaves no surviving
children/issue, in such case, then that decedent beneficiary's portion shall be
distributed equally to the other surviving beneficiaries listed in Section 1.2 (or as
otherwise may be prescribed in Section 3.6, below).
(b) Notwithstanding the provisions as defined above, sub-paragraph “(e)”
(listed below) contains a Schedule of Other/Alternate Primary Beneficiaries
which is a list of beneficiaries (if any) and the percentages of my probate estate
that each respective beneficiary listed therein shall receive prior to the allocations
and distributions prescribed in Sections 1.2 & 3.4/3.5.
(c) In such case of the usage of the Schedule of Other/Alternate Primary
Beneficiaries, the allocations in Sections 1.2 & 3.4/3.5 shall be deemed to be
allocations of the remainder of my probate estate remaining after the
allocations/distributions prescribed in sub-paragraphs “(d)” & “(e)” (and/or
under Section “3.6” / by Special Directives, if applicable) or shall be deemed as
the "Alternate Distribution Schedule” concerning my Will if the beneficiaries listed
thereof are to receive all – that is, a one hundred percent (100%) aggregate – of my
probate estate.
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(d) If any beneficiary listed in sub-paragraph (e) does not survive me then
such decedent person’s designated portion shall be allocated to those other
beneficiaries listed there in prorata portions of the aggregate percentage of my
probate estate allocated below – unless other provided in Section 3.6 (below):
(e) Schedule of Other / Alternate Primary Beneficiaries:
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
_________________________________ / _______%
Beneficiary Name
(f) Notwithstanding the above, in the event that any beneficiary of my
probate estate is then a debtor to me – verified by a written instrument of debt –
at the time of my decease then the following shall apply: (i) the share of such
indebted beneficiary shall be decreased by a certain formula amount that is equal
to the total outstanding value of debt(s) such person owed me, which amount is
then (ii) multiplied by a percentage that corresponds to the value of my probate
estate (including the value of the debt[s] owed to me) – that such indebted person
is not entitled to receive which shall be referred to as the percentage amount;
wherein, (iii) such formulated percentage amount shall be subtracted from such
indebted person’s share and added prorata to the portion(s) distributable to the
other beneficiary(s) of my probate estate who are then living.
(g) The following identified person(s) has/have been intentionally
disinherited and is/are not to receive any portion(s) of my Will:
_______________________________________________________________
_______________________________________________________________
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Alternate and/or Additional Specific Directives of This Will.
NOTICE: Use space below to enter other terms/directives that you want
mandated through your Will including but not limited to allocations, if
any, to (other) beneficiaries for distributions of "in cash" and/or "in kind":
3.6. The following terms shall ADDITIONALLY apply as to or in place of the
administrative and/or allocation terms and/or decrees of my Will
notwithstanding any provisions otherwise prescribed anywhere herein to the
contrary. Any allocations to beneficiaries prescribed below – whether in cash
and/or in kind and/or in unequal percentage amounts – shall be deemed and
administrated as part of the Schedule of Other/Alternate Primary Beneficiaries with
respect to the terms of allocation/administration prescribed above:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
< < < End of Section 3.5 > > >
Beneficiary Under Age 21.
3.7. If a beneficiary of this Will is under twenty-one (21) years of age, or
otherwise deemed as dependent, then my Executor shall establish a “trust” for
such beneficiary and pay to or apply for the benefit of such beneficiary, in
Executor’s discretion, as much of the income of that beneficiary’s said trust as
deemed necessary for his/her health, support, maintenance and education. If my
Executor deems the income to be insufficient, he/she may also pay to or apply for
the benefit of such beneficiary as much of the principal of beneficiary’s trust as my
Executor, in his/her unhindered discretion, deems necessary for the beneficiary’s
health, support, maintenance and education. My Executor, in lieu of making
direct payments to the beneficiary, may make payments to the beneficiary’s
conservator or guardian, to the beneficiary’s custodian under the Uniform Gifts to
Minors Act or Uniform Transfers to Minors Act of any state, to one or more
suitable persons as my Executor deems proper, or to accounts in the beneficiary’s
name with financial institutions.
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Beneficiary Over Age 21.
3.8. If beneficiary of this Will is twenty-one (21) years of age or older, then my
Executor shall distribute the balance of the net income and principal of that
beneficiary’s allocated trust/portion(s) outright to him/her as soon as
administratively possible. Notwithstanding, my Executor may arbitrarily hold any
such beneficiary's portion IN TRUST for a later outright distribution period if such
action is deemed prudent as it would pertain to that beneficiary's best interest in
consideration of all then existing circumstances, and would therefore administer
any such beneficiary's portion for his/her benefit per those terms prescribed in
Sections 3.4/3.5/3.6 (above).
Final Distribution.
3.9. If, under the foregoing provisions, a portion of my estate shall be
undisposed of, then such non-disposed portion shall be distributed to my legal
heirs whose identity(s) and respective share(s) shall be determined as though my
death had occurred immediately following the happening of the event requiring
distribution of such undisposed portion of my estate, and according to the laws of
succession then in force in the State of Arizona.
ARTICLE IV
– Nominated Executor –
Nomination of Executor.
4.1. I nominate my spouse, JOHN W. DOE, as the Executor of my Will.
Successor Executors.
4.2. If my spouse is unable or unwilling to serve or continue as Executor of
my Will, then I nominate JAMES G. DOE to serve as my Executor. If JAMES G.
DOE is unable or unwilling to serve or continue as the Executor of my Will, in
such case, then I nominate JOYCE L. DOE to serve.
Waiver of Bond.
4.3. No bond or undertaking shall be required of any Executor nominated
herein.
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General Powers of My Executor.
4.4. I authorize but do not direct my Executor to sell any property belonging to
my estate, either with or without notice. My Executor is further authorized to
invest and reinvest any surplus money, in any kind of property, real, personal, or
mixed, and every kind of investment, specifically including, but not limited to,
interest-bearing accounts, corporate obligations of every kind, preferred or
common stocks, shares of investment trusts, investment companies, mutual funds,
or common trust funds, including funds administered by the Executor, and
mortgage participations, that persons of prudence, discretion and intelligence
acquire for their own account, and to either continue the operation of any business
belonging to my estate for such time and in such manner as it may deem advisable
and for the best interest of my estate, or to sell or liquidate said business at such
time and upon such terms as my Executor may deem advisable and for the best
interest of my estate; and any such operation, sale or liquidation shall be at the risk
of my estate and without liability on the part of my Executor for any losses
resulting therefrom.
Independent Administration Permitted.
4.5. My Executor shall have all powers now or hereafter conferred on Executors
by law then in force in the State of Arizona except as otherwise specifically
provided in this Will, including any powers enumerated in this Will.
Division or Distribution in Cash or Kind.
4.6. In order to satisfy a pecuniary gift or to distribute or divide assets into
shares or partial shares, the Executor may distribute or divide those assets in kind,
or divide undivided interests in those assets, or sell all or any part of those assets
and distribute or divide the property in cash, in kind, or partly in cash and partly
in kind. Property distributed to satisfy a pecuniary gift under this instrument
shall be valued at its fair market value at the time of distribution.
Power to Make Tax Elections.
4.7. To the extent permitted by law, and without regard to the resulting effect on
any other provision of this Will, on any person interested on the amount of taxes
that may be payable, my Executor shall have the power to elect an alternative
valuation date for estate tax purposes; choose the methods to pay any death taxes;
elect to treat or use any item for state or federal estate or income tax purposes as
an income tax deduction or an estate tax deduction; disclaim all or any portion of
any interest in property passing to my estate at or after my death; and determine
when an item is to be treated as taken into income or used as a tax deduction.
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ARTICLE V
– Nominated Guardian –
Nomination of Guardian and Successor.
(Not Applicable to this Will)
Waiver of Bond.
5.2. No bond or undertaking shall be required of any guardian as nominated
(per Section 5.1) in this Will.
Powers of Guardian(s).
5.3. It is my intent that any guardian nominated in this Will shall have the same
authority with respect to the person of the ward as a parent having legal custody
of a child would have. It is my intent that all powers granted to guardians named
herein may be exercised without unnecessary court authorization.
ARTICLE VI
– Concluding Provisions –
Debts, Taxes and Expenses.
6.1. All of my funeral, last illness, administration expenses and death taxes, shall
be paid out of the residue of my estate, subject, however, to the provisions below.
Payment of Debt.
6.2. Except for any indebtedness that I may have to any qualified pension, profit
sharing or similar plan (other than loans against a voluntary contribution
account), which indebtedness shall be promptly paid following my death, the
provisions of this Will shall not operate to accelerate any liability; and all
indebtedness of mine for which any properties or insurance policies stand as
collateral security shall remain an encumbrance upon the same, which shall pass
subject to such indebtedness without reimbursement of any kind from my estate.
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Payment of Death Taxes.
6.3. The Executor shall pay death taxes, whether or not attributable to property
inventoried in my probate estate, by prorating and apportioning them among the
persons having an interest in my estate according to the apportionment provisions
as described under Section 2207 of the Internal Revenue Code.
Definition of Death Taxes.
6.4. The term “death taxes” as used in this Will, shall mean all inheritance,
estate, succession, and other similar taxes that are payable by any person on
account of that person’s interest in my estate or by reason of my death, including
penalties and interest, but excluding the following:
(a) Any (other) additional tax – not described above – that may be
assessed in my estate shall be paid by those trusts and/or beneficiaries who
receive the assets upon which the additional tax is assessed.
(b) Any federal or state tax imposed on a generation-skipping transfer, as
that term is defined in the federal tax laws, shall be paid by those trusts and/or
beneficiaries who receive the assets upon which the additional tax is assessed.
Simultaneous Death.
6.5. If any beneficiary under this Will and I die simultaneously, or if it cannot be
established by clear and convincing evidence whether that beneficiary or I died
first, I shall be deemed to have survived that beneficiary, and this Will shall be
construed accordingly.
Period of Survivorship.
6.6. For the purposes of this Will, a beneficiary shall not be deemed to have
survived me if that beneficiary dies within thirty (30) days after my death.
No-Contest Clause.
6.7. If any heir, devisee, legatee or beneficiary under this Will, or any of my heirs
or any person claiming under this Will, my estate, or any trust established by me,
whether directly or indirectly, singly or in conjunction with any other person
commits any of the actions listed in this Section (et seq.), then all legacies,
bequests, devises and interests given under this Will to that person shall be
forfeited as though he or she predeceased me without surviving issue:
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(a) Contests or otherwise objects in any court to the validity of this Will, or
any share or subtrust created by this Will, or any beneficiary designation account
signed by me;
(b) Files suit on a creditor’s claim filed in a probate of my estate, or a
creditor’s claim on any other document, after rejection or lack of action by the
respective fiduciary;
(c) Claims ownership to any asset held in joint tenancy by me, other than
as a surviving joint tenant;
(d) Files a petition for family allowance in a probate of my estate; or
brings, joins or is a party to a petition for settlement or for compromise affecting
the terms of this instrument;
(e) Object in any manner to any action taken or proposed to be taken in
good faith by the Executor of my estate or the Executor of any of my trusts
(including, without limitation, the good faith exercise or non-exercise of a
discretion granted to the Executor or Executor), whether said Executor or Executor
is acting under court order, notice of proposed action or otherwise; or,
(f) Successfully or unsuccessfully attacks or seeks to impair or invalidate
any of the following: any designation of beneficiaries for any insurance policy on
my life; any trust which I have created during my lifetime; or any gift which I
have made during my lifetime.
Expenses.
6.8. Expenses to resist any contest or other attack of any nature upon my estate
shall be paid from my estate as expenses of administration.
Severable.
of this Will, and shall in no way affect, impair or invalidate any other provision in
this Will. If such provision shall be deemed invalid due to its scope and breadth
as described in this Will, such provision shall be deemed valid to the extent of the
scope or breadth permitted by law.

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Perpetuities Savings Clause.
6.10. Notwithstanding any other provision of this Will, unless otherwise allowed
by applicable state law, every trust created by this Will shall terminate no later
than twenty-one (21) years after the death of the last survivor of my issue and the
beneficiaries of this Will who are alive at my death. If a trust is terminated under
this section of the Will, the Executor shall distribute all of the principal and
undistributed income of the trust to the income beneficiaries of that trust in
proportion to which they are entitled (or eligible, in the case of discretionary
payments) to receive immediately before the termination. If that proportion is not
fixed by the terms of this Will, the Executor shall distribute all of the trust
property to the persons then entitled or eligible to receive income from the trust
outright in a manner that, in the Executor’s opinion, shall give effect to my intent
in creating the trust(s). The Executor’s decision is to be final and incontestable by
anyone.
Severability Clause.
of this Will and shall in no way affect, impair or invalidate any other provision in
this Will. If such provision shall be deemed invalid due to its scope and breadth,
such provision shall be deemed valid to the extent of the scope or breadth
permitted by law.
Arizona Law to Apply.
6.12. All questions concerning the validity and interpretation of this Will,
including any trusts created by this Will, shall be governed by the laws of the State
of Arizona in effect at the time this Will is executed.
ARTICLE VII
– Contents, Testimonial and Attestation Provisions –
Signature and Attestation.
This Last Will & Testament consists of seven (7) Articles – this Article inclusive –
and thirteen (13) pages. Following this (final) Article Seven, Testator’s signature,
and the witnesses’ attestations hereof is a self-proving affidavit identified on and
listed as Page 14.

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Directive of Specific Personal Property Allocations
I, JANE E. DOE, in accordance with Section 2.3, of Article II, in my Last Will &
Testament, hereby bequeath certain tangible personal property of mine to the persons
identified below respective of each separate item adjacent to the person’s name. All
such entries on this page may only be handwritten in by me.
Personal Property Item Recipient
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
_________________________________ ______________________________
x______________________________
JANE E. DOE

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IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND ON THIS _______
DAY OF ___________________, 2013.
x________________________________
JANE E. DOE
Signed, sealed, published and declared by the above named Testator as (and for) her
Last Will & Testament in our presence who, at her request, in her presence and in the
presence of each other, we have hereunto subscribed our names as witnesses.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address
STATE OF ARIZONA
COUNTY OF MARICPOA
On this _______ day of _________________, 2013, before me, _____________________,
the undersigned Notary Public, personally appeared JANE E. DOE, and the above
Signature: ______________________________ (Seal)


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SELF PROVING AFFIDAVIT
STATE OF ARIZONA
COUNTY OF MARICPOA
I, JANE E. DOE, the Testator of the within, hereby certify that I executed my signature
on said Will this ________ day of ___________________, 2013. I further certify that I
requested signatures as witnesses to my Last Will & Testament from the following
individuals:
_______________________________ (and) _______________________________
Witness Name Witness Name
x_______________________________
JANE E. DOE
We, __________________________ & _________________________, (the witnesses),
being first duly sworn, do depose and say to the undersigned authority that we
witnessed the Testator's execution of her Will and that she signed it willingly and that
each of us, in the presence and hearing of the Testator, hereby sign herein as witness to
her signing, and that to the best of our knowledge she is eighteen years of age or older,
of sound mind, under no constraint or undue influence and competent to make
testamentary disposition of real and personal property.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address
On this _______ day of ________________, 2013, before me, ______________________,
the undersigned Notary Public, personally appeared JANE E. DOE, and the above
Signature: ______________________________ (Seal)


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JANE E. DOE
Listed below are names, w/relationships (to Testatrix), addresses and phone numbers of
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________

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JANE E. DOE
Listed below are names, w/relationships (to Testatrix), addresses and phone numbers of
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________
_________________________________ _________________________________
Name/Relationship
_________________________________
_________________________________

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NOTICE: THE POWERS GRANTED TO THE AGENT YOU ARE APPOINTING HEREIN
CAN BE VERY BROAD. CONSULTATION WITH A LEGAL ADVISOR IS
RECOMMENDED. THIS DOCUMENT DOES NOT AUTHORIZE THE AGENT NAMED
WITHIN TO MAKE MEDICAL OR OTHER HEALTH-CARE DECISIONS FOR YOU.
YOU MAY REVOKE THIS POWER OF ATTORNEY AT ANY TIME.
DURABLE POWER OF ATTORNEY
– OVER ASSETS –
This Power of Attorney authorizes the person named below as my Attorney-in-Fact to
sell, lease, grant, encumber, release or otherwise convey any interest in my real property,
execute deeds and all other such instruments on my behalf unless I have otherwise limited
such power herein to specific real property or otherwise withheld such power regarding
all real estate transactions as defined below.
I, JOHN W. DOE, the undersigned, have appointed JANE E. DOE, my spouse, to serve as
my lawful Attorney-in-Fact over assets – or if my spouse is unwilling or unable to serve then I
appoint JAMES G. DOE (as my first alternate) or JOYCE L. DOE (as my second alternate)
– to perform for me and in my name certain acts which I might and could do if I were present
and capable by granting herewith the following INITIALED powers:
NOTICE: TO GRANT ALL OF THE FOLLOWING POWERS TO YOUR
ATTORNEY-IN-FACT, INITIAL THE LINE IN FRONT OF - (O) - AND
IGNORE THE LINES IN FRONT OF ALL THE OTHER LISTED POWERS.
NOTICE: 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 YOUR ATTORNEY-IN-FACT.
NOTICE: TO WITHHOLD A FOLLOWING POWER(S), DO NOT INITIAL
THE LINE ADJACENT TO SUCH POWER. YOU MAY, BUT NEED NOT,
CROSS OUT EACH POWER TO BE WITHHELD.
AUTHORIZATION BY INITIALS OF UNDERSIGNED PRINCIPAL:
_______ (A) To engage in banking and/or other financial institution transactions viz:
executing, endorsing, collecting, depositing and receiving checks against or in
my bank (or other) accounts, including checks drawn on the Treasurer of the
United States.
_______ (B) To buy, sell and/or otherwise transfer and/or gift my real estate property or
engage in any related real property transactions.
_______ (C) to buy, sell and/or otherwise transfer and/or gift my tangible personal property
or engage in any related personal property transactions.
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_______ (D) To buy, sell and/or otherwise transfer and/or gift my cash, cash equivalents or
other equitable items.
_______ (E) To engage in stock and/or bond (including stock or bond powers) transactions.
_______ (F) To engage in commodities and/or options transactions.
_______ (G) To engage in operational business transactions.
_______ (H) To engage in insurance and/or annuity transactions.
_______ (I) To engage in personal claims and/or litigation transactions.
_______ (J) To engage in personal and/or family maintenance transactions.
_______ (K) To receive benefits from social security, Medicare, Medicaid, or other
governmental programs, including military service related benefits.
_______ (L) To receive or otherwise handle retirement plan(s) transactions.
_______ (M) To enter in to my safe deposit box and remove the contents thereof.
_______ (N) To handle personal (or related) tax matters.
_______ (O) ALL OF THE POWERS LISTED ABOVE.
_______ (P) TO RECEIVE REASONABLE FEES/REIMBURSEMENT FOR COSTS &
EXPENSES INCURRED AS AN AGENT ACTING HEREUNDER.
NOTICE: IF THIS DOCUMENT HAS BEEN ELECTRONICALLY VERIFIED
("ESIGN/ED") THEN ALL OF THE ABOVE ITEMS (A-P) SHALL BE DEEMED
AS AFFIRMATIVELY CHECKED/INITIALED.
1. Additionally, I give power to my Attorney-in-Fact to assign, transfer, convey and deliver
to the trustee of any trust wherein I maintained a general power of appointment over such trust
any and all of my property such as cash, stocks, bonds, securities, annuities and any other
property of any kind whether real property or personal; to endorse and deliver to said trustee(s)
any checks, drafts, certificates of deposit, notes receivable or other instruments for which I
have an interest in as monies payable or belonging to me; to designate the Trustee, of said
Trust, as the beneficiary any life insurance policies, employee benefit or pension plans or
individual retirement accounts owned by me or in which I have an interest, and, in general, to
do all things which I, as a grantor of a living trust, might do if present and capable.
2. Notwithstanding the above provisions, my Attorney-in-Fact shall have NO power to
transact with any assets/properties which have been transferred to said Trust either by me or by
my Attorney-in-Fact unless the Trustee of said Trust expressly grants to my Attorney-in-Fact
the right to act as a nominee Trustee or agent over any specific asset(s) held in said Trust.

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3. Unless otherwise provided hereunder, this Power of Attorney shall spring into effect
upon the execution of an opinion letter or medical certification of my attending physician
(delivered to my Attorney-in-Fact) certifying my incapacity to carry on my normal fiduciary
affairs because of a mental or physical impairment and shall continue therein until a
certification from a licensed physician declares that the impairment is no longer effective or
applicable. This Power of Attorney shall not be affected by the subsequent disability or
incompetence of the principal. Notwithstanding the terms of this paragraph, to the extent this
Power of Attorney is intended to be exercised in a jurisdiction not then currently recognizing
its efficacy at a "future date" – based upon the occurrence of a future event or contingency –
then this Power of Attorney shall be deemed as being effective immediately as to its
application in any such jurisdiction.
___________________
I understand the full importance of this Durable Power Of Attorney Over Assets
document and I have emotional and mental capacity to execute such document.
x________________________________
JOHN W. DOE
ACKNOWLEDGEMENT
The Declarant signing this foregoing Power of Attorney for Over Assets is personally
known to us or has provided proof of his identity, signed or acknowledged his signature on this
document in our presence, appears to be of sound mind and not under duress, fraud or undue
influence, has not appointed either of us as his health care representative, has not named either
of us as a beneficiary of his estate, and is not a patient for whom either of us is an attending
physician.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address


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STATE OF ARIZONA
COUNTY OF MARICPOA
On this ______ day of ________________, 2013, before me, _____________________, the
undersigned, personally appeared JOHN W. DOE who proved to me on the basis of satisfactory
evidence to be the person whose name is subscribed to the within Durable Power of Attorney
Over Assets instrument and acknowledged to me that he executed the same in his authorized
capacity, and that by his signature executed this instrument and –
_________________________________ & _________________________________
who witnessed the Declarant's signature to this instrument and that to the best of their
knowledge the Declarant was at the time eighteen (18) or more years of age, of sound mind and
under no constraint or undue influence.
I certify under PENALTY OF PERJURY under the laws of the State of Arizona that the foregoing
paragraph is true and correct.
Signature: ___________________________ (Seal)


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NOTICE: THE POWERS GRANTED TO THE AGENT YOU ARE APPOINTING HEREIN
CAN BE VERY BROAD. CONSULTATION WITH A LEGAL ADVISOR IS
RECOMMENDED. THIS DOCUMENT DOES NOT AUTHORIZE THE AGENT NAMED
WITHIN TO MAKE MEDICAL OR OTHER HEALTH-CARE DECISIONS FOR YOU.
YOU MAY REVOKE THIS POWER OF ATTORNEY AT ANY TIME.
~ OVER ASSETS ~
This Power of Attorney authorizes the person named below as my Attorney-in-
Fact to sell, lease, grant, encumber, release or otherwise convey any interest in my
real property, execute deeds and all other such instruments on my behalf unless I
have otherwise limited such power herein to specific real property or withheld
such power regarding all real estate transactions as defined below.
I, JANE E. DOE, the undersigned, have appointed JOHN W. DOE, my spouse, to serve as
my lawful Attorney-in-Fact over assets – or if my spouse is unwilling or unable to serve then I
appoint JAMES G. DOE (as my first alternate) or JOYCE L. DOE (as my second alternate)
– to perform for me and in my name certain acts which I might and could do if I were present
and capable by granting herewith the following INITIALED powers:
NOTICE: TO GRANT ALL OF THE FOLLOWING POWERS TO YOUR
ATTORNEY-IN-FACT, INITIAL THE LINE IN FRONT OF - (O) - AND
IGNORE THE LINES IN FRONT OF ALL THE OTHER LISTED POWERS.
NOTICE: 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 YOUR ATTORNEY-IN-FACT.
NOTICE: TO WITHHOLD A FOLLOWING POWER(S), DO NOT INITIAL
THE LINE ADJACENT TO SUCH POWER. YOU MAY, BUT NEED NOT,
CROSS OUT EACH POWER TO BE WITHHELD.
AUTHORIZATION BY INITIALS OF UNDERSIGNED PRINCIPAL:
_______ (A) To engage in banking and/or other financial institution transactions viz:
executing, endorsing, collecting, depositing and receiving checks against or in
my bank (or other) accounts, including checks drawn on the Treasurer of the
United States.
_______ (B) To buy, sell and/or otherwise transfer and/or gift my real estate property or
engage in any related real property transactions.
_______ (C) to buy, sell and/or otherwise transfer and/or gift my tangible personal property
or engage in any related personal property transactions.

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_______ (D) To buy, sell and/or otherwise transfer and/or gift my cash, cash equivalents or
other equitable items.
_______ (E) To engage in stock and/or bond (including stock or bond powers) transactions.
_______ (F) To engage in commodities and/or options transactions.
_______ (G) To engage in operational business transactions.
_______ (H) To engage in insurance and/or annuity transactions.
_______ (I) To engage in personal claims and/or litigation transactions.
_______ (J) To engage in personal and/or family maintenance transactions.
_______ (K) To receive benefits from social security, Medicare, Medicaid, or other
governmental programs, including military service related benefits.
_______ (L) To receive or otherwise handle retirement plan(s) transactions.
_______ (M) To enter in to my safe deposit box and remove the contents thereof.
_______ (N) To handle personal (or related) tax matters.
_______ (O) ALL OF THE POWERS LISTED ABOVE.
_______ (P) TO RECEIVE REASONABLE FEES/REIMBURSEMENT FOR COSTS &
EXPENSES INCURRED AS AN AGENT ACTING HEREUNDER.
NOTICE: IF THIS DOCUMENT HAS BEEN ELECTRONICALLY VERIFIED
("ESIGN/ED") THEN ALL OF THE ABOVE ITEMS (A-P) SHALL BE DEEMED
AS AFFIRMATIVELY CHECKED/INITIALED.
1. Additionally, I give power to my Attorney-in-Fact to assign, transfer, convey and deliver
to the trustee of any trust wherein I maintained a general power of appointment over such trust
any and all of my property such as cash, stocks, bonds, securities, annuities and any other
property of any kind whether real property or personal; to endorse and deliver to said trustee(s)
any checks, drafts, certificates of deposit, notes receivable or other instruments for which I
have an interest in as monies payable or belonging to me; to designate the Trustee, of said
Trust, as the beneficiary any life insurance policies, employee benefit or pension plans or
individual retirement accounts owned by me or in which I have an interest, and, in general, to
do all things which I, as a grantor of a living trust, might do if present and capable.
2. Notwithstanding the above provisions, my Attorney-in-Fact shall have NO power to
transact with assets/properties which have been transferred to said Trust either by me or by my
Attorney-in-Fact unless the Trustee of said Trust expressly grants to my Attorney-in-Fact the
right to act as a nominee Trustee or agent over any specific asset(s) held in said Trust.

PDF/41
3. Unless otherwise provided hereunder, this Power of Attorney shall spring into effect
upon the execution of an opinion letter or medical certification of my attending physician
(delivered to my Attorney-in-Fact) certifying my incapacity to carry on my normal fiduciary
affairs because of a mental or physical impairment and shall continue therein until a
certification from a licensed physician declares that the impairment is no longer effective or
applicable. This Power of Attorney shall not be affected by the subsequent disability or
incompetence of the principal. Notwithstanding the terms of this paragraph, to the extent this
Power of Attorney is intended to be exercised in a jurisdiction not then currently recognizing
its efficacy at a "future date" – based upon the occurrence of a future event or contingency –
then this Power of Attorney shall be deemed as being effective immediately as to its
application in any such jurisdiction.
________________
I understand the full importance of this Durable Power Of Attorney Over Assets document
and I have emotional and mental capacity to execute such document.
x________________________________
JANE E. DOE
ACKNOWLEDGEMENT
The Declarant signing this foregoing Power of Attorney for Over Assets is personally
known to us or has provided proof of her identity, signed or acknowledged her signature on this
influence, has not appointed either of us as her health care representative, has not named either
of us as a beneficiary of her estate, and is not a patient for whom either of us is an attending
physician.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address


PDF/42
STATE OF ARIZONA
COUNTY OF MARICPOA
undersigned, personally appeared JANE E. DOE who proved to me on the basis of satisfactory
evidence to be the person whose name is subscribed to the within Durable Power of Attorney
Over Assets instrument and acknowledged to me that she executed the same in her authorized
capacity, and that by her signature executed this instrument and –
_________________________________ & _________________________________
Signature: ___________________________ (Seal)


PDF/43
DURABLE AGENT NOTICE
TO WHOM IT CONCERNS:
I, ________________________________, the undersigned AFFIANT, named as the
Durable (Attorney-in-Fact) Agent for JOHN W. DOE, the principal, in that certain Durable
Power of Attorney Over Assets document dated -
the ______ day of ________________, ________:
(Applicable statement checked by affiant)
_____ Have accepted such appointment and shall act according to the power and authority granted
to me as the durable attorney-in-fact for such named principal; further, I attest that the above
named principal is (i) still alive, (ii) was competent at the time of the execution of said
Power of Attorney and that (iii) such Power of Attorney remains valid and in full effect.
_____ Have not accepted such appointment and shall decline forever my appointment as the
durable attorney-in-fact for such named principal.
_____ Have by succession, according to an appropriate document (concerning the first appointee)
of (ii) Declination Certificate or (ii) Medical Certificate, attached hereto and made a part
hereof, accept such appointment as the durable attorney-in-fact for such named principal.
x________________________________
Affiant
- ACKNOWLEDGEMENT -
STATE OF _______________________
COUNTY OF _____________________
On this ______ day of ______________________, before me, _______________________,
the undersigned Notary Public, personally appeared _________________________________,
(Affiant), who proved to me on the basis of satisfactory evidence to be the person whose name is
subscribed to this instrument and acknowledged to me that he/she executed/signed the same in
his/her authorized capacity, and that by his/her signature executed/signed this instrument.
I certify under PENALTY OF PERJURY under the laws of the State of ___________________
that the foregoing paragraph is true and correct.
Signature: ______________________________ (Seal)

PDF/44
DURABLE AGENT NOTICE
I, ________________________________, the undersigned AFFIANT, named as the
Durable (Attorney-in-Fact) Agent for JANE E. DOE, the principal, in that certain Durable
Power of Attorney Over Assets document dated -
the ______ day of ________________, ________:
(Applicable statement checked by affiant)
_____ Have accepted such appointment and shall act according to the power and authority granted
to me as the durable attorney-in-fact for such named principal; further, I attest that the above
named principal is (i) still alive, (ii) was competent at the time of the execution of said
Power of Attorney and that (iii) such Power of Attorney remains valid and in full effect.
_____ Have not accepted such appointment and shall decline forever my appointment as the
durable attorney-in-fact for such named principal.
_____ Have by succession, according to an appropriate document (concerning the first appointee)
of (ii) Declination Certificate or (ii) Medical Certificate, attached hereto and made a part
hereof, accept such appointment as the durable attorney-in-fact for such named principal.
x________________________________
Affiant
- ACKNOWLEDGEMENT -
STATE OF _______________________
COUNTY OF _____________________
On this ______ day of ______________________, before me, _______________________,
the undersigned Notary Public, personally appeared _________________________________,
(Affiant), who proved to me on the basis of satisfactory evidence to be the person whose name is
subscribed to this instrument and acknowledged to me that he/she executed/signed the same in
his/her authorized capacity, and that by his/her signature executed/signed this instrument.
Signature: ______________________________ (Seal)

PDF/45
– FOR HEALTH CARE –
I, JOHN W. DOE, a resident of Maricpoa County, State of Arizona, do now declare this to
be a Durable Power of Attorney for Health Care declaration for me under the laws of any
jurisdiction I may be in at any time of my disability.
1. I hereby appoint JANE E. DOE, my spouse, as my true and lawful Attorney-in-Fact
agent for health care. If my spouse is unable or unavailable to serve as my agent then I
designate JAMES G. DOE (as my alternate agent) to serve. Otherwise, JOYCE L. DOE shall
serve (as my second alternate agent) if my first alternate agent cannot serve, in such case.
2. Unless My ADVANCE HEALTH CARE DIRECTIVE Provides Otherwise For
Specific Instructions Regarding Any Actions and/or Terms Prescribed Herein or That
Revokes This Instrument Entirely – I hereby authorize my Attorney-in-Fact to perform the
following acts if I become incapable of giving informed consent:
A) REQUEST, RECEIVE, AND REVIEW ANY INFORMATION, VERBAL OR WRITTEN,
REGARDING MY PHYSICAL CONDITION OR MENTAL HEALTH INCLUDING,
BUT NOT LIMITED TO, MEDICAL AND HOSPITAL RECORDS AND CONSENT TO
DISCLOSURE OF MY MEDICAL RECORDS;
B) CONSENT, REFUSE TO CONSENT, OR WITHDRAW CONSENT TO ANY
TREATMENT OR CARE TO MAINTAIN, TREAT, OR DIAGNOSE A PHYSICAL OR
MENTAL CONDITION; AND,
C) CONSENT TO WITHDRAWAL OR WITHHOLDING OF ANY TYPE OF
TREATMENT THAT WOULD KEEP ME ALIVE - THIS POWER INCLUDES
THE POWER TO WITHDRAW OR WITHHOLD HYDRATION OR FOOD IF I
AM COMATOSE AND/OR TERMINALLY ILL.
3. I revoke any prior Durable Power of Attorney for Health Care. This Durable Power of
Attorney for Health Care shall take precedence over any power of attorney (general, special, or
medical) which I may sign upon my admission to any hospital or other health care facility. This
Durable Power of Attorney for Health Care supplements (if necessary) any Living Will
Declaration that I have executed.
4. It is my intention, by this instrument, to provide for my personal and medical assistance
without the necessity of court action. Accordingly, I request, in the strongest possible terms that
any court which may receive or act upon a petition for the appointment of a guardian for me
should deny such petition so long as my Attorney-in-Fact is acting as appointed. If any court
shall deem it necessary to appoint a guardian in spite of this request, then I request that my
Attorney-in-Fact be appointed unless I have provided otherwise.
DPA/Health Page 1 (of 4)

PDF/46
5. This instrument shall be governed by the laws of the state of my domicile including its
construction, interpretation and termination and, to the extent permitted by law, shall be
applicable to wherever and in whatever state of the United States or foreign country I may be at
the time.
6. If any part of any provision of this instrument shall be invalid or unenforceable under
applicable law, such part shall be ineffective to the extent of such invalidity only, without
affecting the remaining, valid provisions of this instrument.
7. This instrument may be amended or revoked by me. My Attorney-in-Fact (and any
alternate) may be removed by my revocation or amendment by me. If this instrument has been
recorded in the public records, then the instrument of revocation, amendment or removal shall
be filed or recorded in the same public records. My Attorney-in-Fact may resign by the
execution of a written resignation delivered to me, or if I am mentally incapacitated, by
delivery to any person with whom I am residing or who has the care and custody of me, or in
the case of an alternate, by delivery to my Attorney-in-Fact.
8. My Attorney-in-Fact shall have full power and authority to do so and perform all acts
whatsoever requisite to be done in order to fully accomplish the aforementioned to all intents
and purposes as I might or could do otherwise. I hereby ratify and confirm all that my
Attorney-in-Fact shall do or cause to be done by virtue of this instrument.
9. Every physician, hospital, care provider, or other person, firm or corporation to which
this instrument is presented to (or presented a photocopy hereof) is expressly authorized to
honor and give effect to all instruments signed pursuant to the foregoing authority without
inquiring as to the circumstances of their issuance or the disposition of the property delivered
pursuant thereto.
10. For purposes of this instrument, I shall be considered to be disabled if I lack sufficient
capacity to make or communicate responsible decisions concerning my welfare by reason of
mental illness, mental deficiency, mental disorder, physical illness or disability, chronic use of
drugs, chronic intoxication or other cause. This existence of such a disability shall be
conclusively established by attaching to this instrument the sworn statement of my attending
physician stating that he or she has examined me and believes that the existence of one (or
more) of such stated conditions exists to cause my incapacity.
11. The validity of (i) my restoration of my competency or (ii) the declaration of my
disability which gave rise to the effectiveness of this Durable Power of Attorney for Health
Care may only be revoked by my express written revocation or by the express written
revocation of my duly appointed conservator.
12. In the event that this Durable Power of Attorney for Health Care becomes effective by
reason of my disability, my revocation shall be accompanied by a sworn statement of a
physician stating that he or she (i) has examined me, (ii) believes that the condition giving rise
to the effectiveness of this Durable Power of Attorney for Health Care has been removed and
(iii) believes that I possess the understanding and capacity to make responsible decisions
regarding my welfare.

PDF/47
WARNING TO PERSON EXECUTING THIS DOCUMENT
THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES A DURABLE POWER OF
ATTORNEY FOR HEALTH CARE. BEFORE EXECUTING THIS DOCUMENT, YOU
SHOULD KNOW THESE IMPORTANT FACTS:
 THIS DOCUMENT GIVES THE PERSON YOU HAVE DESIGNATED, AS YOUR
ATTORNEY-IN-FACT, THE POWER TO MAKE HEALTH CARE DECISIONS FOR
YOU, SUBJECT TO ANY LIMITATIONS OR STATEMENT OF YOUR DESIRES
THAT YOU INCLUDE IN THIS DOCUMENT. THE POWER TO MAKE HEALTH
CARE DECISIONS FOR YOU MAY INCLUDE CONSENT, REFUSAL TO CONSENT,
OR WITHDRAWAL OF CONSENT TO ANY CARE, TREATMENT, SERVICE, OR
PROCEDURE TO MAINTAIN, DIAGNOSE, OR TREAT A PHYSICAL OR MENTAL
CONDITION. YOU MAY STATE IN THIS DOCUMENT ANY TYPES OF
TREATMENT OR PLACEMENTS THAT YOU DO NOT DESIRE.
 THE PERSON YOU HAVE DESIGNATED IN THIS DOCUMENT HAS A DUTY TO
ACT IN ACCORDANCE WITH YOUR DESIRES AS STATED IN THIS DOCUMENT
OR OTHERWISE MADE KNOWN. IF YOUR DESIRES ARE UNKNOWN, YOUR
ATTORNEY-IN-FACT IS TO ACT IN YOUR BEST INTERESTS.
 UNLESS OTHERWISE SPECIFIED IN THIS DOCUMENT, YOUR ATTORNEY-IN-
FACT HAS THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU; THIS
MAY INCLUDE CONSENTING TO WITHHOLD TREATMENT WHICH COULD
PROLONG YOUR LIFE.
 NOTWITHSTANDING THIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE
MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOURSELF AS LONG AS
YOU CAN GIVE INFORMED CONSENT WITH RESPECT TO THE PARTICULAR
DECISION. IN ADDITION, NO TREATMENT OR ANY HEALTH CARE
NECESSARY TO KEEP YOU ALIVE MAY BE ADMINISTERED OVER YOUR
OBJECTION.
 YOU HAVE THE RIGHT TO REVOKE THE AUTHORITY GRANTED TO THE
PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE
DECISIONS FOR YOU BY NOTIFYING THE TREATING PHYSICIAN, HOSPITAL,
OR OTHER HEALTH CARE PROVIDER, ORALLY OR IN WRITING.
 THE PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE
DECISIONS FOR YOU HAS THE RIGHT TO EXAMINE YOUR MEDICAL RECORDS
AND TO CONSENT TO THEIR DISCLOSURE UNLESS YOU LIMIT THIS RIGHT IN
THIS DOCUMENT.
 IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.
 THIS HEALTH CARE DECLARATION SHOULD BE SIGNED BY TWO ELIGIBLE
WITNESSES WHO ARE NEITHER BENEFICIARIES OF YOUR ESTATE NOR
RELATED BY BLOOD, MARRIAGE, OR ADOPTION AND PRESENT WHEN YOU
SIGN THIS DOCUMENT BEFORE A NOTARY PUBLIC.

PDF/48
I hereby declare that I have executed this Durable Power of Attorney for Health Care on this
day, the ______ day of _____________________, 2013, consisting of four (4) pages including
the "warning" page (3) and this page.
x________________________________
JOHN W. DOE
ACKNOWLEDGEMENT
The Declarant signing this foregoing Power of Attorney for Health Care is personally known
to us or has provided proof of his identity, signed or acknowledged his signature on this
influence, has not appointed either of us as his health care representative, has not named either
of us as a beneficiary of his estate, and is not a patient for whom either of us is an attending
physician.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address
STATE OF ARIZONA
COUNTY OF MARICPOA
undersigned, personally appeared JOHN W. DOE who proved to me on the basis of satisfactory
evidence to be the person whose name is subscribed to the within instrument and acknowledged to
me that he executed the same in his authorized capacity, and that by his signature executed this
instrument and –
_________________________________ & _________________________________
Signature: ___________________________ (Seal)


PDF/49
– FOR HEALTH CARE –
I, JANE E. DOE, a resident of Maricpoa County, State of Arizona, do now declare this to
be a Durable Power of Attorney for Health Care declaration for me under the laws of any
jurisdiction I may be in at any time of my disability.
1. I hereby appoint JOHN W. DOE, my spouse, as my true and lawful Attorney-in-Fact
agent for health care. If my spouse is unable or unavailable to serve as my agent then I
designate (Not Specified) (as my alternate agent) to serve.
2. Unless My ADVANCE HEALTH CARE DIRECTIVE Provides Otherwise For
Specific Instructions Regarding Any Actions and/or Terms Prescribed Herein or That
Revokes This Instrument Entirely – I hereby authorize my Attorney-in-Fact to perform the
following acts if I become incapable of giving informed consent:
A) REQUEST, RECEIVE, AND REVIEW ANY INFORMATION, VERBAL OR WRITTEN,
REGARDING MY PHYSICAL CONDITION OR MENTAL HEALTH INCLUDING,
BUT NOT LIMITED TO, MEDICAL AND HOSPITAL RECORDS AND CONSENT TO
DISCLOSURE OF MY MEDICAL RECORDS;
B) CONSENT, REFUSE TO CONSENT, OR WITHDRAW CONSENT TO ANY
TREATMENT OR CARE TO MAINTAIN, TREAT, OR DIAGNOSE A PHYSICAL OR
MENTAL CONDITION; AND,
C) CONSENT TO WITHDRAWAL OR WITHHOLDING OF ANY TYPE OF
TREATMENT THAT WOULD KEEP ME ALIVE - THIS POWER INCLUDES
THE POWER TO WITHDRAW OR WITHHOLD HYDRATION OR FOOD IF I
AM COMATOSE AND/OR TERMINALLY ILL.
3. I revoke any prior Durable Power of Attorney for Health Care. This Durable Power of
Attorney for Health Care shall take precedence over any power of attorney (general, special, or
medical) which I may sign upon my admission to any hospital or other health care facility. This
Durable Power of Attorney for Health Care supplements (if necessary) any Living Will
Declaration that I have executed.
4. It is my intention, by this instrument, to provide for my personal and medical assistance
without the necessity of court action. Accordingly, I request, in the strongest possible terms that
any court which may receive or act upon a petition for the appointment of a guardian for me
should deny such petition so long as my Attorney-in-Fact is acting as appointed. If any court
shall deem it necessary to appoint a guardian in spite of this request, then I request that my
Attorney-in-Fact be appointed unless I have provided otherwise.

PDF/50
5. This instrument shall be governed by the laws of the state of my domicile including its
construction, interpretation and termination and, to the extent permitted by law, shall be
applicable to wherever and in whatever state of the United States or foreign country I may be at
the time.
6. If any part of any provision of this instrument shall be invalid or unenforceable under
applicable law, such part shall be ineffective to the extent of such invalidity only, without
affecting the remaining, valid provisions of this instrument.
7. This instrument may be amended or revoked by me. My Attorney-in-Fact (and any
alternate) may be removed by my revocation or amendment by me. If this instrument has been
recorded in the public records, then the instrument of revocation, amendment or removal shall
be filed or recorded in the same public records. My Attorney-in-Fact may resign by the
execution of a written resignation delivered to me, or if I am mentally incapacitated, by
delivery to any person with whom I am residing or who has the care and custody of me, or in
the case of an alternate, by delivery to my Attorney-in-Fact.
8. My Attorney-in-Fact shall have full power and authority to do so and perform all acts
whatsoever requisite to be done in order to fully accomplish the aforementioned to all intents
and purposes as I might or could do otherwise. I hereby ratify and confirm all that my
Attorney-in-Fact shall do or cause to be done by virtue of this instrument.
9. Every physician, hospital, care provider, or other person, firm or corporation to which
this instrument is presented to (or presented a photocopy hereof) is expressly authorized to
honor and give effect to all instruments signed pursuant to the foregoing authority without
inquiring as to the circumstances of their issuance or the disposition of the property delivered
pursuant thereto.
10. For purposes of this instrument, I shall be considered to be disabled if I lack sufficient
capacity to make or communicate responsible decisions concerning my welfare by reason of
mental illness, mental deficiency, mental disorder, physical illness or disability, chronic use of
drugs, chronic intoxication or other cause. This existence of such a disability shall be
conclusively established by attaching to this instrument the sworn statement of my attending
physician stating that he or she has examined me and believes that the existence of one (or
more) of such stated conditions exists to cause my incapacity.
11. The validity of (i) my restoration of my competency or (ii) the declaration of my
disability which gave rise to the effectiveness of this Durable Power of Attorney for Health
Care may only be revoked by my express written revocation or by the express written
revocation of my duly appointed conservator.
12. In the event that this Durable Power of Attorney for Health Care becomes effective by
reason of my disability, my revocation shall be accompanied by a sworn statement of a
physician stating that he or she (i) has examined me, (ii) believes that the condition giving rise
to the effectiveness of this Durable Power of Attorney for Health Care has been removed and
(iii) believes that I possess the understanding and capacity to make responsible decisions
regarding my welfare.

PDF/51
WARNING TO PERSON EXECUTING THIS DOCUMENT
THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES A DURABLE POWER OF
ATTORNEY FOR HEALTH CARE. BEFORE EXECUTING THIS DOCUMENT, YOU
SHOULD KNOW THESE IMPORTANT FACTS:
 THIS DOCUMENT GIVES THE PERSON YOU HAVE DESIGNATED, AS YOUR
ATTORNEY-IN-FACT, THE POWER TO MAKE HEALTH CARE DECISIONS FOR
YOU, SUBJECT TO ANY LIMITATIONS OR STATEMENT OF YOUR DESIRES
THAT YOU INCLUDE IN THIS DOCUMENT. THE POWER TO MAKE HEALTH
CARE DECISIONS FOR YOU MAY INCLUDE CONSENT, REFUSAL TO CONSENT,
OR WITHDRAWAL OF CONSENT TO ANY CARE, TREATMENT, SERVICE, OR
PROCEDURE TO MAINTAIN, DIAGNOSE, OR TREAT A PHYSICAL OR MENTAL
CONDITION. YOU MAY STATE IN THIS DOCUMENT ANY TYPES OF
TREATMENT OR PLACEMENTS THAT YOU DO NOT DESIRE.
 THE PERSON YOU HAVE DESIGNATED IN THIS DOCUMENT HAS A DUTY TO
ACT IN ACCORDANCE WITH YOUR DESIRES AS STATED IN THIS DOCUMENT
OR OTHERWISE MADE KNOWN. IF YOUR DESIRES ARE UNKNOWN, YOUR
ATTORNEY-IN-FACT IS TO ACT IN YOUR BEST INTERESTS.
 UNLESS OTHERWISE SPECIFIED IN THIS DOCUMENT, YOUR ATTORNEY-IN-
FACT HAS THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU; THIS
MAY INCLUDE CONSENTING TO WITHHOLD TREATMENT WHICH COULD
PROLONG YOUR LIFE.
 NOTWITHSTANDING THIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE
MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOURSELF AS LONG AS
YOU CAN GIVE INFORMED CONSENT WITH RESPECT TO THE PARTICULAR
DECISION. IN ADDITION, NO TREATMENT OR ANY HEALTH CARE
NECESSARY TO KEEP YOU ALIVE MAY BE ADMINISTERED OVER YOUR
OBJECTION.
 YOU HAVE THE RIGHT TO REVOKE THE AUTHORITY GRANTED TO THE
PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE
DECISIONS FOR YOU BY NOTIFYING THE TREATING PHYSICIAN, HOSPITAL,
OR OTHER HEALTH CARE PROVIDER, ORALLY OR IN WRITING.
 THE PERSON DESIGNATED IN THIS DOCUMENT TO MAKE HEALTH CARE
DECISIONS FOR YOU HAS THE RIGHT TO EXAMINE YOUR MEDICAL RECORDS
AND TO CONSENT TO THEIR DISCLOSURE UNLESS YOU LIMIT THIS RIGHT IN
THIS DOCUMENT.
 IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.
 THIS HEALTH CARE DECLARATION SHOULD BE SIGNED BY TWO ELIGIBLE
WITNESSES WHO ARE NEITHER BENEFICIARIES OF YOUR ESTATE NOR
RELATED BY BLOOD, MARRIAGE, OR ADOPTION AND PRESENT WHEN YOU
SIGN THIS DOCUMENT BEFORE A NOTARY PUBLIC.

PDF/52
I hereby declare that I have executed this Durable Power of Attorney for Health Care on this
day, the ______ day of _____________________, 2013, consisting of four (4) pages including
the "warning" page (3) and this page.
x________________________________
JANE E. DOE
ACKNOWLEDGEMENT
The Declarant signing this foregoing Power of Attorney for Health Care is personally known
to us or has provided proof of her identity, signed or acknowledged her signature on this
influence, has not appointed either of us as her health care representative, has not named either
of us as a beneficiary of her estate, and is not a patient for whom either of us is an attending
physician.
x________________________________ _________________________________
Witness Address
x________________________________ _________________________________
Witness Address
STATE OF ARIZONA
COUNTY OF MARICPOA
undersigned, personally appeared JANE E. DOE who proved to me on the basis of satisfactory
evidence to be the person whose name is subscribed to the within instrument and acknowledged to
me that she executed the same in her authorized capacity, and that by her signature executed this
instrument and –
_________________________________ & _________________________________
Signature: ___________________________ (Seal)


PDF/53
HEALTH CARE AGENT NOTICE
I, ________________________________, the undersigned AFFIANT, named as the Health
Care Agent for JOHN W. DOE, the Principal, in that certain - Durable Power of Attorney
for Health Care document dated -
the ______ day of ________________, ________:
declare and state the following:
I hereby accept this appointment and agree to serve as agent for the Principal concerning his
Health Care decisions in the event that he is incapable in making such decisions himself. I
understand that I have a duty to act consistently with the desires of the Principal as expressed in
such appointment.
I understand that said document gives me authority over health care decisions for him only
if he becomes incapable and that I must act in good faith in exercising my authority under such
appointment. I acknowledge that the principal, if competent, may revoke said Health Care
Power of Attorney at any time and in any manner.
If I choose to withdraw during the time the principal is competent, I must notify him of my
decision. If I choose to withdraw when the principal is incapable of making his own health care
decisions then I must notify his physician.
x________________________________
Affiant
STATE OF _______________________
COUNTY OF _____________________
On this ______ day of ________________, ________, before me, __________________,
the undersigned, personally appeared _________________________________, (Affiant), who
proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to
this instrument and acknowledged to me that he/she executed/signed the same in his/her
authorized capacity, and that by his/her signature executed/signed this instrument.
Signature: ______________________________ (Seal)

Doe Family Will

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