HomeMy WebLinkAbout01-20-12DURABLE POWER OF ATTORNEY
I, MARK HART, of Cumberland County Nursing Home, Carlisle, Pennsylvania, do hereby appoint
MIRIAM PIERCE, my foster sister, as my agent with full power of substitution, for me and in my name, to
transact all my business and to manage all my property acrd affairs as I might do if personally present.
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 my patient care account at the Cumberland County Nursing Home; 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 accomrts opened by my agent in my name at any bank or banks,
savings society or elsewhere; and to receive and apply the proceeds of such checks as my agent deems best;
and to act as my representative payee for all Social Security, Medicare, and other federal and state benefits.
2. Personal Property. To buy or sell 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.
3. Insurance. To procure, change, carry or cancel insurance of such kind in such amounts agaittst any
and all risks affecting property or persons against liability, damage or claim of any sort.
4. Benefrt Plans. To apply for and receive any government, insurance and retirement benefits to which
I may be entitled and to exercise any right to elect benefits or payment options.
5. 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 valuation 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.
6. Employment of Others. To employ lawyers, investment counsel, accountants, custodians, physicians,
dentists, nurses, therapists, and other persons to reader services for, or to me, or my estate and to pay t}re usual
and reasonable fees and compensation of such persons for their services.
7. Claims. To institute, prosecute, defend, compromise or otherwise dispose of and to appear for the
in any proceedings at law or in equity.
8. Medical Procedrtres. To arrange for and consent to or to withhold medical, therapeutical and surgical
procedures for me, including the administration of drugs.
9. Admission Into Facilities. To apply for my admission into medical, nursing, residential, rehabilitation,
convalescent or other similar facilities on my behalf, and to sign any consent or admission forms required by
such facilities which are consistent with this power, and to enter into agreements for my care by such facilities
or elsewhere during my lifetime or for lesser periods of time as my agent may designate, including the .retention
of nurses for my care.
10. General Authority. To do all other things which my agent shall deem necessary and proper in order
to carry out the foregoing powers which shall be construed as broadly as possible.
11. Reliance on Power. T}tis 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 has actual knowledge of my death. `; n
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12. Hold Harmless. All actions of my agent shall bind me and my heirs, distributee, 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, distributee, legal representatives, successors and assigns will hold
such party or parties harmless from any loss suffered or liability incurred by such party or parties while acting
in accordance with this power prior to that party's receipt of written notice of any such termination or
amendment.
13. 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.
Durable Power of Attorney
This power of attorney shall not be affected by my subsequent disability or incapacity. All acts done
by my agent pursuant to this power during any period of my disability or incapacity shall have the same effect
and enure to my benefit and bind me and my successors in interest as if I were competent and not disabled.
ili general, I give to my said attorney-in-fact, full power to act in the management and disposition of all
of my estate, affairs, and property of every kind and wherever situate, in such manner and with such authority
as I myself might exercise.
I have signed this power of attorney this~$~E, day of ~...e.~/+.~-~~ __, 1.997.
Witnesses: ~
MARK HA T -Designator ~~~,.{
Social Secu y Number
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
AND NOW, this ~ €~~ day of _~ 1997, MARK HART,
and _ ~ ScJ ,the Designator and
the wi esses, respectiv y, whose names are signed to the foregoing instrument, being first duly sworn, do
hereby declare to the undersigned authority that the Designator signed and executed the instrument as his
Durable Power of Attorney and that he signed willingly, and that he executed it as her free and voluntary act
for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Designator,
signed the Power of Attorney as witnesses and that to the best of each witness' knowledge and belief the
Designator was at that time eighteen years of age or older, of sound mind and under no undue constraint or
influence.
IN WITNESS WHEREOF, I have hereunder set my hand and official seal.
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Notary Public
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Nex 7~~P., Cumb2d ,,ma,qt~yy
M9rComn E~ires Nov.B, 1597
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