Will, Living Will and Healthcare Proxy are three essential estate and medical planning tools, which implement one's decisions about distribution of assets after death, and medical directives when one is not able to make the said vital decisions. As all three are legal documents, they must comply with established legal requirements to be implemented. The following sample documents are not legal advise or substitute for professional assistance but for informational purposes only.
All three documents must be in writing, signed and dated, executed with free will, proper understanding and approval of contents, in the presence of two witnesses, who must sign and date attesting that they witnessed not only document signing but execution with free will, consent and without undue influence.
Sample Will (married with children) :
LAST WILL AND TESTAMENT
I, ___________________, years of age, residing at ______________________, Town of _________, County of ___________ , and State of ________________, being of sound and disposing mind, and not acting under duress, menace, fraud, or undue influence of any person, do make, publish, and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils previously made by me at any time.
I am married. My spouse’s name is ________________. All references in this Will to my “spouse” is to him/her.
I have _______ living children, the issue of my marriage to _________________, as follows:
______________________, born on _____________, presently residing at __________ ______________. His/her telephone number is _________________.
________________, born on ___________, presently residing at ______________. His/her telephone number is ________________.
References in this Will to my children include all the children mentioned in this Paragraph.
It is my intention by this Will to dispose of all of my property, both real and personal, of whatever nature and wherever situated.
I direct my executor, hereinafter named, to pay any all of my funeral expenses, including cremation and the disposition of the ashes, or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of court, expenses of my last illness, unsatisfied charitable pledges, expenses of estate administration, and all debts, liens, and other claims enforceable against my estate.
I give to my spouse, _____________ all the rest, residue, and remainder of my property, assets, accounts and estate, including any interest I may have in our home located at _______________________________, in County of Monroe, or any other home which we may be occupying as our principal residence at my death, subject to any mortgage or encumbrance and all unpaid real property taxes and special assessment which are a lien at the date of my death.
If my spouse, ___________________, does not survive me for 30 days, I give, all my interest in real property as well as other assets, to both of my children, i.e., my son/daughter, _______________,who presently resides at ______________________, and my Son/daughter, ________________, who presently reside at _______________, named above, in equal shares, if they survive me by 30 days.
If either of my children does not so survive me, then I give his or her share of the residue to his or her lawful descendants living at my death, by right of representation, and if either of the said children does not so survive me and dies leaving no lawful descendants living at my death, then to the survivor of my children.
If neither my spouse, my children, nor any lawful descendants survive me by 30 days, I give the residue of my estate to my heirs as determined by the laws of the State of ________ relating to descent and distribution.
I nominate and appoint ______________________, my spouse/son/daughter, who presently resides at __________________________, Town of _________, County of ____________, State of _____________, Executor of this Will.
If _____________ does not survive me, or if he/she does not qualify or is unwilling to act as such executor, I nominate and appoint, my spouse/son/daughter, _________________ who presently resides at _______________________________, as Executor of this Will.
If ______________ does not survive me, or if he/she does not qualify or is unwilling to act as such executor, I nominate and appoint, my spouse/son/daughter, ________, who presently reside at ______________________________, as Executor of this Will.
No executor shall be required to post any bond, surety or other security in _______ or any other State, territory or country.
IN WITNESS WHEREOF, I, _______________, sign, seal, publish and declare this instrument as my last will and testament this ______ day of ___________, 2020.
Executed at ___________ __________________________
The foregoing instrument was signed, sealed, published and declared by __________, the above-named Testator, to be his/her last will and testament in our presence, all being present at the same time, and we, at his/her request and in his/her presence and in the presence of each other, have subscribed our names as witnesses on the date above written.
Witness 1: _____________________________
Witness 2: _____________________________
TO MY FAMILY, MY PHYSICIAN, MY LAWYER, MY CLERGYMAN
TO ANY MEDICAL FACILITY IN WHOSE CARE I HAPPEN TO BE
TO ANY INDIVIDUAL WHO MAY BECOME RESPONSIBLE FOR MY
HEALTH, WELFARE OR AFFAIRS
I, _____________________________, being of sound mind, do hereby willfully and voluntarily make known my desire that my health care providers and others involved in my care withdraw, withhold, or provide medical treatment in accordance with my following wishes and I, do hereby declare as under:
In the event, I am unable to communicate and diagnosed to be in a terminal or permanent unconscious condition with no reasonable expectation of my recovery from physical or mental disability certified by two physicians, I want the life-sustaining procedures withheld or withdrawn, including, but not limited to, surgery, antibiotics, cardiac resuscitation, respiratory support, artificially administered feeding and fluids. I, therefore, direct that treatment be limited to comfort measures only, even if they shorten my life, and medication be mercifully administered to me to alleviate suffering even though this may hasten the moment of death.
2. I understand the full import of this declaration and directive, and I am emotionally and
mentally competent to make this declaration and directive.
3. I understand that I may revoke this declaration and directive at any time.
In Witness whereof, I have subscribed my name on this instrument on this ______ day of __________, 2020.
We, whose names are hereto subscribed, DO HEREBY CERTIFY, that on this ____ day of _________ 2020, _________________ , known to us to be the person whose signature appears at the end of the above directive, declared to us, the undersigned, that the above directive, consisting of two pages, including the page on which we have signed as witnesses, was his/her directive. He/she then signed the directive in our presence and sight, and at her request, in her presence and in the presence of each other, we now sign our names as witnesses.
____________, declarant, has been personally known to us and we believe him/her to be of sound mind. We are not related to ______________, by blood or marriage, nor would we be entitled to any part of estate of _______________, on his/her death, nor are we the attending physicians of _________________, or an employee of the attending physician or a health facility in which _________________, is a patient, a patient in the health care facility in which _______________, is a patient, or any person who has a claim against any part of the estate of the _________________, upon her death.
Witness 1: _____________________
Witness 2: ______________________
HEALTH CARE PROXY OF____________________
I, ______________________________ residing at _________________________, telephone number ________________, do hereby appoint my spouse/son/daughter, _______________________ , residing at ____________ ________________ telephone number __________________________ , as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise.
This health care proxy shall take effect in the event that I become unable to make my own health care decisions, as determined by my attending physician (with such confirmations as may be required by law).
I direct my agent to make health care decisions in accordance with my wishes and instructions on life sustaining treatment stated in my Living Will, executed by me on ___________, which is incorporated in this document, or as he or she otherwise knows.
I expressly authorize my health care agent to make health care decisions concerning the administration of artificial nutrition and hydration to me. If such administration is consonant with my recovery from extreme physical or mental disability, then I approve its use. However, if such administration is to be used when there is no reasonable expectation of my recovery from extreme physical or mental disability, then I disapprove its use.
My health care agent shall also have access to, or may disclose or authorize the disclosure of, my health records or information, including "protected health information" as that term is defined by the federal Privacy Rule adopted pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA); to exercise any of my rights with respect to such health records or information under any federal, states, or other law or regulation, including HIP AA the federal Privacy Rule.
In the event that the health care agent appointed above is unable, unwilling or unavailable to act as my health care agent, then I appoint my spouse/son/daughter, ___________ aka/ formerly known as/maiden name _________, residing at __________________, telephone number _____________________, as my alternate health care agent to act with all the authority granted to the agent.
In the event that my spouse/son/daughter, ____________ is unable, unwilling or unavailable to act as my health care agent, then I appoint my spouse/son/daughter, ________ _________, presently residing at _________________________________, telephone number, __________________, as my alternate health care agent to act with all the authority granted to the agent.
(Donation of Organs…. Optional)
____ I do not wish to donate my organs, tissues, or parts.
____ I do not wish to donate my organs, tissues or parts.
____ I do wish to be an organ donor and upon my death I wish to donate:
[ ] (a) Any needed organs, tissues, or parts; OR
[ ] (b) The following organs, tissues, or parts
[ ] (c) My gift is for the following purposes: (put a line through any of the following
you do not want)
This proxy shall remain in effect unless and until I revoke it and shall be recognized as effective by all persons not having actual knowledge of revocation.
Signed this _____ day of _______, 2020 __________________________
Author: Santosh K. Pawar is managing attorney of Law Firm of Santosh K. Pawar. She is licensed to practice in India and U.S. (state of New York). For more information and assistance, contact by email at email@example.com, call at (585) 264-1649 or WhatsApp at (585) 474-0935.