Florida Durable Power Of Attorney Form Page 3
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1
2
3(v)
To
apply
for
public
benefits,
where
necessary,
such
as
Medicare
and
Medicaid,
for
me
and
have
access
to
information
regarding
my
income
and
assets
to
the
extent
required
to
make
such
application
i f
n ecessary.
(vi)
To
m ake
a ll
h ealth
c are
d ecisions
o n
m y
b ehalf
i ncluding
b ut
n ot
l imited
t o
t hose
s et
f orth
i n
F.S.
Chapter
7 65.
11. GENERAL
P OWERS:
(a) In
general
to
do
all
other
acts,
deeds,
matters
and
things
whatsoever
in
or
about
my
estate,
property
and
affairs,
o r
t o
c oncur
w ith
p ersons
j ointly
i nterested
w ith
m e
t herein
i n
d oing
a ll
a cts,
d eeds,
m atters
a nd
t hings
herein
particularly
or
generally
described,
as
fully
and
effectually
to
all
intents
and
purposes
as
I
could
do
myself.
(b) This
instrument
is
executed
by
me
in
the
State
of
Florida
but
it
is
my
intention
that
the
powers
and
authority
herein
conferred
upon
my
attorney
as
authorized
by
the
laws
of
Florida
now
or
hereafter
in
force
and
effect
shall
b e
e xercisable
i n
a ny
o ther
s tate
o r
j urisdiction
w here
I
m ay
h ave
a ny
p roperty
o r
a ssets.
I
hereby
ratify
and
confirm,
and
promise
at
all
times
to
ratify
and
confirm
all
and
whatsoever
my
duly
authorized
attorney
hereunder
shall
lawfully
do
or
cause
to
be
done
by
virtue
of
these
presents,
including
anything
which
shall
be
done
between
the
r evocation
of
t his
i nstrument
b y
my
death
or
in
a ny
other
m anner
a nd
notice
of
such
r evocation
reaching
m y
attorney;
and
I
hereby
declare
that
as
against
me
and
all
persons
claiming
under
me
everything
which
my
said
attorney
shall
do
or
cause
to
be
done
in
pursuance
hereof
after
such
revocation
as
aforesaid
shall
be
valid
and
effectual
in
favor
of
any
p ersons
c laiming
t he
b enefit
t hereof
w ho,
b efore
t he
d oing
t hereof,
s hall
n ot
h ave
h ad
n otice
o f
s uch
r evocation.
IN
W ITNESS
W HEREOF,
I
h ave
e xecuted
t his
D urable
P ower
o f
A ttorney.
Witness
S ignature
Date
Signature
Date
Witness
S ignature
Date
Print
N ame
State
o f
F lorida
County
o f
Before
me,
the
undersigned
authority,
duly
authorized
to
take
acknowledgements
and
administer
oaths,
personally
appeared
,
p ersonally
k nown
t o
m e
t o
b e
t he
p erson
d escribed
a bove,
w ho
b eing
by
me
f irst
d uly
s worn
s tates
t hat
( His
o r
H er)
i s
t he
p erson
w ho
e xecuted
t he
f oregoing
i nstrument
f or
t he
r easons
expressed
therein.
Dated
t his
day
o f
.
NOTARY
P UBLIC
My
C ommission
E xpires:
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