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HomeMy WebLinkAbout10-24-11 (2)Durable General Power of Attorney with Advance Health Care Directives of Curtis E. Smith, Sr. NOTICE THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY. YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY. YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT' S FUNDS. A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT IS NOT ACTING PROPERLY. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU. I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS CONTENTS. (~,/ f ~; f~v S~`~ Curtis E. Smith, Sr. ~P-~~~~ Date c-~ ::_. r;~~~~ -.....{ -__ _-_. -~ y " - ~.~ c7 _ ['-• "":.7 Durable General Power of Attorney with Advance Health Care Directives of Curtis E. Smith, Sr. I, Curtis E. Smith, Sr., of Carlisle, Cumberland County, Pennsylvania do hereby make constitute and appoint my wife, Kathy Smith as my true and lawful attorney-in-fact with general power to do and perform all matters and things on my behalf. I declare this instrument to be my Durable General Power of Attorney, revoking all prior Durable General Powers of Attorney. This power of attorney shall not be affected by disability of the principal. My attorneys-in-fact shall have full power of substitution for me and in my name, to transact all of my business and to manage all of my property and medical and mental health affairs, as I might do if personally present, including, but not limited to exercising the following powers: MANAGEMENT OF ASSETS 1. Cash Accounts. To collect and receive any money and assets to which I may be entitled; to deposit cash and checks in any of my accounts; to endorse for deposit, transfer or collection, in my name and for my account, any checks payable to my order; and to draw and sign checks for me and in my name, including any accounts now in existence or opened by my attorneys-in-fact in my name at any bank or banks, savings society or elsewhere; and to receive and apply the proceeds of such checks as my attorneys-in-fact deem best; and to act as my representative payee for all Social Security, Medicare, and other federal and state benefits. 2. Stocks and Bonds. To take custody of my stocks, bonds, and other investments of all kinds, to give orders for the sale, surrender or exchange of any such investments and to receive the proceeds therefrom; to sign and deliver assignments, stock and bond powers and other documents required for any such sale, assignment, surrender or exchange; to give orders for the purchase of stocks, bonds, and other investments of any kind and to settle for same; to give instructions as to the registration thereof and the mailing of dividends and interest; to clip and deposit coupons attached to any coupon bonds, whether now owned by me or hereafter acquired; to represent me at shareholders' meetings and vote proxies on my behalf, and generally to handle and manage my investments. 3. Personal Property. To buy or sell my tangible personal property or any interest therein, at public or private sale for cash or credit or by any other means whatsoever; to acquire, dispose of, repair, alter or manage my tangible personal property or any interests therein. 4. Real Estate. To lease, sell, release, convey, extinguish or mortgage any interest in any real estate I own, on such terms as my attorneys-in-fact deem advisable, and to purchase or otherwise acquire any interest in or acquire possession of real property and to accept all deeds for such property, and to manage, repair, improve, maintain, restore, build or develop any real property in which I now have or may later acquire an interest. Page 1 of 6 5. Safe Deposit Boxes. To have access to any and all safe deposit boxes now or hereafter standing in my name; and add to and to remove all or any part of the contents thereof; and to enter into leases for such safe deposit boxes or surrender same. 6. Insurance. To procure, change, carry or cancel insurance of such kind, in such amounts, against any and all risks affecting property or persons against liability, damage, or claim of any sort. 7. Benefit Plans. To engage in retirement plan transactions including but not limited to applying for and receiving any government or private insurance, retirement or other benefits to which I may be entitled and to exercise any right to elect benefits or payment options. 8. Taxes. To prepare, execute and file in my name and on my behalf any tax returns such as Internal Revenue Service forms numbered 1 through 10,000, including return, report, protest, application for correction of assessed value of real or other property or claim for refund in any connection with any tax imposed by any government, and to obtain an extension of time for any of the foregoing or to execute waivers of restrictions on the assessment of deficiency on any tax. 9. Employment of Others. To employ lawyers, investment counselors, accountants, custodians, physicians, dentists, nurses, therapists, and other persons to render services for, or to, me or my estate and to pay the usual and reasonable fees and compensation of such persons for their services. 10. Claims. To institute, prosecute, defend, compromise or otherwise dispose of any claim, and to appear for me in any proceedings at law or in equity. 11. Gifts. To make limited gifts in cash or in kind. 12. Elective Share. To claim an elective share of the estate of my deceased spouse. 13. Trusts To create a trust for my benefit, make additions to any trust now existing or later created, and to withdraw and receive the income or corpus of any trust held for my benefit. 14. Loans. To borrow for my benefit. Page 2 of 6 HEALTH CARE PROVISIONS. 15. Provisions. A. To request, review, and receive any information, oral or written, regarding my personal affairs or my physical or mental health, including medical authorizations and hospital records, and to execute any releases or other documents that may be required in order to obtain this information. B. To authorize my admission or discharge, even against medical advice, to or from a medical, nursing, residential, mental health, or other facility, to enter into agreements for my care, and to authorize medical, surgical, psychological and psychiatric procedures and treatment. C. To make decisions about accepting, refusing, or withdrawing treatment, including but not limited to life prolonging procedures, in accordance with my wishes as stated in this document, and as told to my attorneys-in-fact by me from time to time. In the event my wishes are not clear or a situation arises that I did not anticipate, then my attorneys-in-fact are authorized to make decisions based upon what is known of my wishes, which follow. D. My Wishes. If I experience extreme mental or physical deterioration such that there is no reasonable expectation of recovery or regaining a meaningful quality of life, then life-prolonging measures should not be initiated, or if they have been, they may be discontinued. Those life-prolonging procedures or treatments that may be withheld or withdrawn include, but are not limited to, cardiac resuscitation, respiratory support (ventilator), artificially administered fluids and nutrition, blood or blood products, surgery or invasive testing and kidney dialysis. I do, however, want antibiotic or like medicine and pain ameliorating drugs. I CERTIFY THAT I HAVE READ THE PROVISIONS OF THE ARTICLE AUTHORIZING MY ATTORNEYS-IN-FACT TO REFUSE MEDICAL TREATMENT FOR ME UNDER THE CIRCUMSTANCES SPECIFIED IN THIS ARTICLE, THAT SUCH PROVISIONS HAVE BEEN EXPLAINED TO ME TO MY SATISFACTION, THAT I UNDERSTAND SUCH PROVISIONS AND THAT THEY STATE MY WISHES ND DESIRES UNDER THE CIRCUMSTANCES DESCRIBED. ~ ~ r-~;1 Curtis E. Smi{+h, Sr. 16. Nomination of Guardian. In accordance with any statute which authorizes me to nominate the guardian of my estate or person if incapacity proceedings regarding my estate or person are hereafter commenced, I hereby nominate my wife, Kathy Smith as guardians of my estate and person. Page 3 of 6 17. General Authority. To do all other things which my attorneys-in-fact deem necessary and proper in order to carry out the foregoing powers which shall be construed as broadly as possible. 18. Reliance on Power. This power may be accepted and relied upon by anyone to whom it is presented until such person either receives written notice of revocation by me or a guardian or similar fiduciary of my estate or person, or has actual knowledge of my death. 19. Hold Harmless. All actions of my attorneys-in-fact shall bind me and my heirs, distributees, legal representatives, successors and assigns, and for the purpose of inducing anyone to act in accordance with the powers I have granted herein, I hereby represent, warrant and agree that if this power of attorney is terminated or amended for any reason, I, and my heirs, distributees, legal representatives, successors and assigns, will hold such party or parties harmless for any loss suffered or liability incurred by such party or parties while acting in accordance with this power prior to the party's receipt of written notice of any such termination or amendment. 20. Dele atg ion. My herein named attorneys-in-fact may, in their individual sole discretion, delegate any portion or all of their authority granted by this document to one or more individuals or corporations of their choosing. 21. Gender and Number. Wherever any words are used herein in the masculine gender, they shall be construed as though they were also used in the feminine gender or neuter gender in all cases when they would so apply and wherever any words are used herein in the singular form, they shall be construed as though they were also in the plural form in all cases where they would so apply and vice versa. 22. Pennsylvania Law Governs. Questions pertaining to the validity, construction and powers created under this instrument shall be determined in accordance with the laws of the Commonwealth of Pennsylvania. 23. Photocot~v. A photocopy of this document shall be as effective as the original. I have signed this Durable General Power of Attorne this day of ~~°/ , 2011 ~, ~ Curtis E. mith, Sr. Social Security #: 205-54-0549 Page 4 of 6 We, (~~~iS ~%- ~.1 ~'7"~_~ J~ and ~. ,sign our names to this instrument, being first duly sworn, and do hereby dec are to the undersigned authority that Curtis E. Smith, Sr., signs, executes and publishes this Durable General Power of Attorney with Advance Health Care Directives and that Curtis E. Smith, Sr. signs it willingly, and that each of us, in the presence and hearing of Curtis E. Smith, Sr. and each other, hereby signs this Durable General Power of Attorney with Advance Health Care Directives as witnesses to the signing, and that to the best of our knowledge Curtis E. Smith, Sr. is eighteen years of age or older, of sound mind, and under no constraint or undue influence. 1~'.~ ~i ~~~ ~F ~~~~~~ ~~~ I SS ADDRESS d ~ d~~ WITNESS ADDRESS COMMONWEALTH OF PENNSYLVANIA, COUNTY OF (~" Before me, the undersigned authority, pers nail appeared the above named lc~h , ~ ~i~ , ,~. ,and ,known to me (or satisfactorily proven) being duly sworn according o law acknowledged the above as t it act and deed. SWO TO AND SUBSCRIBED before met ' `~'~ day ,(~ l , 2011, o~G~/ Date ommission Expires otary Pub1I~ATARiAt sEAI IISA A DUPERY Notary Public NEVWIILE BORO., CUMSERIAND COUNTY My Commisilon Expire Apr 6. 201 Z Page 5 of 6 I, Kathy Smith, have read the attached power of attorney and am the person identified as the agent for the principal. ~I hereby acknowledge that when I act as agent: I shall exercise the powers for the benefit of the principal. I shall keep the assets of the principal separate from my assets. I shall exercise reasonable caution and prudence. I shall keep a full and accurate record of all actions, receipts and disbursements on behalf of the principal. Kathy Smit Date Page 6 of 6