GENERAL DURABLE POWER OF ATTORNEY

THE POWERS YOU GRANT BELOW ARE EFFECTIVE

ONLY IF YOU BECOME DISABLED OR INCOMPETENT

NOTICE:  THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING.  THEY ARE EXPLAINED
IN THE UNIFORM STATUTORY FORM POWER OF ATTORNEY ACT. IF YOU HAVE ANY QUESTIONS ABOUT
THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE.  THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO
MAKE MEDICAL AND OTHER HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF
ATTORNEY IF YOU LATER WISH TO DO SO.

I ____________________________________________________________________________
_____________________________________________ [insert your name and address] appoint
_____________________________________________ [insert the name and address of the person appointed] as my Agent
(attorney-in-fact) to act for me in any lawful way with respect to the following initialed subjects:

TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT OF (N) AND IGNORE THE LINES IN
FRONT OF THE OTHER POWERS.

TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT
OF EACH POWER YOU ARE GRANTING.

TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU MAY, BUT NEED NOT, CROSS OUT
EACH POWER WITHHELD.

Note:  If you initial Item A or Item B, which follow, a notarized signature will be required on behalf of the Principal.

INITIAL

_______ (A) Real property transactions.  To lease, sell, mortgage, purchase, exchange, and acquire, and to agree, bargain, and
contract for the lease, sale, purchase, exchange, and acquisition of, and to accept, take, receive, and possess any interest in real
property whatsoever, on such terms and conditions, and under such covenants, as my Agent shall deem proper; and to maintain,
repair, tear down, alter, rebuild, improve manage, insure, move, rent, lease, sell, convey, subject to liens, mortgages, and security
deeds, and in any way or manner deal with all or any part of any interest in real property whatsoever, including specifically, but
without limitation, real property lying and being situated in the State of _________________, under such terms and conditions,
and under such covenants, as my Agent shall deem proper and may for all deferred payments accept purchase money notes
payable to me and secured by mortgages or deeds to secure debt, and may from time to time collect and cancel any of said notes,
mortgages, security interests, or deeds to secure debt.

_______ (B) Tangible personal property transactions.  To lease, sell, mortgage, purchase, exchange, and acquire, and to agree,
bargain, and contract for the lease, sale, purchase, exchange, and acquisition of, and to accept, take, receive, and possess any
personal property whatsoever, tangible or intangible, or interest thereto, on such terms and conditions, and under such covenants,
as my Agent shall deem proper; and to maintain, repair, improve, manage, insure, rent, lease, sell, convey, subject to liens or
mortgages, or to take any other security interests in said property which are recognized under the Uniform Commercial Code as
adopted at that time under the laws of the State of ______________________ or any applicable state, or otherwise hypothecate
(pledge), and in any way or manner deal with all or any part of any real or personal property whatsoever, tangible or intangible,
or any interest therein, that I own at the time of execution or may thereafter acquire, under such terms and conditions, and under
such covenants, as my Agent shall deem proper.

_______ (C) Stock and bond transactions.  To purchase, sell, exchange, surrender, assign, redeem, vote at any meeting, or
otherwise transfer any and all shares of stock, bonds, or other securities in any business, association, corporation, partnership, or
other legal entity, whether private or public, now or hereafter belonging to me.

_______ (D) Commodity and option transactions.  To buy, sell, exchange, assign, convey, settle and exercise commodities
futures contracts and call and put options on stocks and stock indices traded on a regulated options exchange and collect and
receipt for all proceeds of any such transactions; establish or continue option accounts for the principal with any securities or
futures broker; and, in general, exercise all powers with respect to commodities and options which the principal could if present
and under no disability.
_______ (E) Banking and other financial institution transactions.   To make, receive, sign, endorse, execute, acknowledge,
deliver and possess checks, drafts, bills of exchange, letters of credit, notes, stock certificates, withdrawal receipts and deposit
instruments relating to accounts or deposits in, or certificates of deposit of banks, savings and loans, credit unions, or other
institutions or associations.  To pay all sums of money, at any time or times, that may hereafter be owing by me upon any
account, bill of exchange, check, draft, purchase, contract, note, or trade acceptance made, executed, endorsed, accepted, and
delivered by me or for me in my name, by my Agent.  To borrow from time to time such sums of money as my Agent may deem
proper and execute promissory notes, security deeds or agreements, financing statements, or other security instruments in such
form as the lender may request and renew said notes and security instruments from time to time in whole or in part.  To have free
access at any time or times to any safe deposit box or vault to which I might have access.

_______ (F) Business operating transactions.  To conduct, engage in, and otherwise transact the affairs of any and all lawful
business ventures of whatever nature or kind that I may now or hereafter be involved in. To organize or continue and conduct any
business which term includes, without limitation, any farming, manufacturing, service, mining, retailing or other type of business
operation in any form, whether as a proprietorship, joint venture, partnership, corporation, trust or other legal entity; operate, buy,
sell, expand, contract, terminate or liquidate any business; direct, control, supervise, manage or participate in the operation of any
business and engage, compensate and discharge business managers, employees, agents, attorneys, accountants and consultants;
and, in general, exercise all powers with respect to business interests and operations which the principal could if present and
under no disability.

_______ (G) Insurance and annuity transactions.  To exercise or perform any act, power, duty, right, or obligation, in regard to
any contract of life, accident, health, disability, liability, or other type of insurance or any combination of insurance; and to
procure new or additional contracts of insurance for me and to designate the beneficiary of same; provided, however, that my
Agent cannot designate himself or herself as beneficiary of any such insurance contracts.

_______ (H) Estate, trust, and other beneficiary transactions.  To accept, receipt for, exercise, release, reject, renounce,
assign, disclaim, demand, sue for, claim and recover any legacy, bequest, devise, gift or other property interest or payment due or
payable to or for the principal; assert any interest in and exercise any power over any trust, estate or property subject to fiduciary
control; establish a revocable trust solely for the benefit of the principal that terminates at the death of the principal and is then
distributable to the legal representative of the estate of the principal; and, in general, exercise all powers with respect to estates
and trusts which the principal could exercise if present and under no disability; provided, however, that the Agent may not make
or change a will and may not revoke or amend a trust revocable or amendable by the principal or require the trustee of any trust
for the benefit of the principal to pay income or principal to the Agent unless specific authority to that end is given.

_______ (I) Claims and litigation.  To commence, prosecute, discontinue, or defend all actions or other legal proceedings
touching my property, real or personal, or any part thereof, or touching any matter in which I or my property, real or personal,
may be in any way concerned. To defend, settle, adjust, make allowances, compound, submit to arbitration, and compromise all
accounts, reckonings, claims, and demands whatsoever that now are, or hereafter shall be, pending between me and any person,
firm, corporation, or other legal entity, in such manner and in all respects as my Agent shall deem proper.

_______ (J) Personal and family maintenance.  To hire accountants, attorneys at law, consultants, clerks, physicians, nurses,
agents, servants, workmen, and others and to remove them, and to appoint others in their place, and to pay and allow the persons
so employed such salaries, wages, or other remunerations, as my Agent shall deem proper.

_______ (K) Benefits from Social Security, Medicare, Medicaid, or other governmental programs, or military service.  To
prepare, sign and file any claim or application for Social Security, unemployment or military service benefits; sue for, settle or
abandon any claims to any benefit or assistance under any federal, state, local or foreign statute or regulation; control, deposit to
any account, collect, receipt for, and take title to and hold all benefits under any Social Security, unemployment, military service
or other state, federal, local or foreign statute or regulation; and, in general, exercise all powers with respect to Social Security,
unemployment, military service, and governmental benefits, including but not limited to Medicare and Medicaid, which the
principal could exercise if present and under no disability.

_______ (L) Retirement plan transactions.  To contribute to, withdraw from and deposit funds in any type of retirement plan
(which term includes, without limitation, any tax qualified or nonqualified pension, profit sharing, stock bonus, employee savings
and other retirement plan, individual retirement account, deferred compensation plan and any other type of employee benefit
plan); select and change payment options for the principal under any retirement plan; make rollover contributions from any
retirement plan to other retirement plans or individual retirement accounts; exercise all investment powers available under any
type of self-directed retirement plan; and, in general, exercise all powers with respect to retirement plans and retirement plan
account balances which the principal could if present and under no disability.

_______ (M) Tax matters.  To prepare, to make elections, to execute and to file all tax, social security, unemployment insurance,
and informational returns required by the laws of the United States, or of any state or subdivision thereof, or of any foreign
government; to prepare, to execute, and to file all other papers and instruments which the Agent shall think to be desirable or
necessary for safeguarding of me against excess or illegal taxation or against penalties imposed for claimed violation of any law
or other governmental regulation; and to pay, to compromise, or to contest or to apply for refunds in connection with any taxes or
assessments for which I am or may be liable.

_______ (N) ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL ANY OTHER LINES IF YOU
INITIAL LINE (N).

SPECIAL INSTRUCTIONS:

ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE POWERS
GRANTED TO YOUR AGENT.

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

THIS POWER OF ATTORNEY SHALL BE CONSTRUED AS A GENERAL DURABLE POWER OF ATTORNEY.

THIS POWER OF ATTORNEY BECOMES EFFECTIVE ONLY UPON MY DISABILITY OR INCAPACITY. I shall be
considered disabled or incapacitated for purposes of this power of attorney if a physician certifies in writing at a date later than
the date this power of attorney is executed that, based on the physician's medical examination of me, I am mentally incapable of
managing my financial affairs. I authorize the physician who examines me for this purpose to disclose my physical or mental
condition to another person for purposes of this power of attorney. A third party who accepts this power of attorney is fully
protected from any action taken under this power of attorney that is based on the determination made by a physician of my
disability or incapacity.

(YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER PERSONS AS NECESSARY TO ENABLE THE AGENT
TO PROPERLY EXERCISE THE POWERS GRANTED IN THIS FORM, BUT YOUR AGENT WILL HAVE TO MAKE ALL
DISCRETIONARY DECISIONS. IF YOU WANT TO GIVE YOUR AGENT THE RIGHT TO DELEGATE
DISCRETIONARY DECISION-MAKING POWERS TO OTHERS, YOU SHOULD KEEP THE NEXT SENTENCE,
OTHERWISE IT SHOULD BE STRICKEN.)

Authority to Delegate.  My Agent shall have the right by written instrument to delegate any or all of the foregoing powers
involving discretionary decision-making to any person or persons whom my Agent may select, but such delegation may be
amended or revoked by any agent (including any successor) named by me who is acting under this power of attorney at the time
of reference.

(YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL REASONABLE EXPENSES INCURRED IN
ACTING UNDER THIS POWER OF ATTORNEY. STRIKE OUT THE NEXT SENTENCE IF YOU DO NOT WANT YOUR
AGENT TO ALSO BE ENTITLED TO REASONABLE COMPENSATION FOR SERVICES AS AGENT.)

Right to Compensation.  My Agent shall be entitled to reasonable compensation for services rendered as agent under this power
of attorney.

(IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAME(S) AND ADDRESS(ES) OF SUCH
SUCCESSOR(S) IN THE FOLLOWING PARAGRAPH.)

Successor Agent.  If any Agent named by me shall die, become incompetent, resign or refuse to accept the office of Agent, I
name the following (each to act alone and successively, in the order named) as successor(s) to such Agent:

________________________________________________________________________

________________________________________________________________________

Choice of Law.  THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF THE STATE OF
_______________ WITHOUT REGARD FOR CONFLICTS OF LAWS PRINCIPLES. IT WAS EXECUTED IN THE STATE
OF ___________________ AND IS INTENDED TO BE VALID IN ALL JURISDICTIONS OF THE UNITED STATES OF
AMERICA AND ALL FOREIGN NATIONS.

I am fully informed as to all the contents of this form and understand the full import of this grant of powers to my Agent.

I agree that any third party who receives a copy of this document may act under it. Revocation of the power of attorney is not
effective as to a third party until the third party learns of the revocation. I agree to indemnify the third party for any claims that
arise against the third party because of reliance on this power of attorney.

Signed this _______ day of _______________, 2021.

______________________________
[Your Signature]

STATEMENT OF WITNESS

On the date written above, the principal declared to me in my presence that this instrument is his general durable power of
attorney and that he or she had willingly signed or directed another to sign for him or her, and that he or she executed it as his or
her free and voluntary act for the purposes therein expressed.

_______________________________________ [Signature of Witness #1]

_______________________________________ [Printed or typed name of Witness #1]
_______________________________________ [Address of Witness #1, Line 1]
_______________________________________ [Address of Witness #1, Line 2]

_______________________________________ [Signature of Witness #2]

_______________________________________ [Printed or typed name of Witness #2]
_______________________________________ [Address of Witness #2, Line 1]
_______________________________________ [Address of Witness #2, Line 2]

A Note About Selecting Witnesses:   The agent (attorney-in-fact) may not also serve as a
witness.  Each witness must be present at the time that principal signs the Power of Attorney
in front of the notary. Each witness must be a mentally competent adult.  Witnesses should
ideally reside close by, so that they will be easily accessible in the event they are one day
needed to affirm this document's validity.
ACKNOWLEDGMENT OF AGENT

BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES

THE FIDUCIARY AND OTHER LEGAL RESPONSIBILITIES OF AN AGENT.

________________________________________________
[Signature of Agent]
 AFFIDAVIT OF AGENT (ATTORNEY IN FACT)

STATE OF _______________
COUNTY OF ________________

Before me, the undersigned authority, personally appeared

___________________________ (attorney in fact), ("Affiant"), who swore or affirmed that:

1. Affiant is the attorney in fact named in the General Durable Power of Attorney executed by
__________________________________ (principal) ("Principal") on _______________ (date).

2. This General Durable Power of Attorney is currently exercisable by Affiant. The principal is
domiciled in _____________________________________________ (insert name of state,
territory, or foreign country).

3. To the best of the Affiant's knowledge after diligent search and inquiry:

a. The Principal is not deceased; and

b. There has been no revocation, partial or complete termination by adjudication of incapacity or

by the occurrence of an event referenced in the durable power of attorney, or suspension by
initiation of proceedings to determine incapacity or to appoint a guardian.

4. Affiant agrees not to exercise any powers granted by the Florida General Durable Power of
Attorney if Affiant attains knowledge that it has been revoked, partially or completely
terminated, suspended, or is no longer valid because of the death or adjudication of incapacity of
the Principal.

________________________________________________
[Signature of Affiant]

Sworn to (or affirmed) and subscribed before me this ______day of _____________ [month], _________
[year] by

________________________________________
NOTARY PUBLIC
 
 AFFIDAVIT OF PHYSICIAN

STATE OF_______________
COUNTY OF_______________

Before me, the undersigned authority, personally appeared ______________________________

______________________________ (name of physician), (“Affiant”), who swore or affirmed
that:

1. Affiant is a physician licensed to practice medicine in ________________________________

(name of state, territory, or foreign country) .

2. Affiant is the primary physician who has responsibility for the treatment and care of
_____________________________________________ (principal's name) .

3. To the best of Affiant's knowledge after reasonable inquiry, Affiant believes that the principal
lacks the capacity to manage property, including taking those actions necessary to obtain,
administer, and dispose of real and personal property, intangible property, business property,
benefits, and income.

________________________________________________
[Signature of Affiant]
 

Sworn to (or affirmed) and subscribed before me this ______day of _____________ [month], _________
[year] by

________________________________________
NOTARY PUBLIC