District of Columbia

We, {testatorName}, the Testator, and the Witnesses whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority: The Testator declares: I signed and executed the foregoing instrument as my will, or expressly directed another person to sign it for me in my presence. I signed it willingly and executed it as my free and voluntary act for the purposes expressed in it. I am eighteen years of age or older, of sound and disposing mind and capable of executing a valid deed or contract, and under no constraint or undue influence. Each of the Witnesses declares: The Testator signed the foregoing instrument in our presence, or expressly directed another person to sign it in the Testator's presence, and declared it to be the Testator's will. We are credible witnesses, and each of us thereupon attested the instrument and subscribed our name as a witness in the presence of the Testator. To the best of our knowledge, the Testator was at the time of signing eighteen years of age or older, of sound and disposing mind, and under no constraint or undue influence.

D.C. Code §18-104: a beneficial devise, legacy, estate, interest, gift, or power of appointment given to an attesting witness is void as to that witness and persons claiming under them (§18-104(a)), except that (b) a witness who would be entitled to a share in intestacy may take up to that intestate share and (c) the voidance does not reach charges on real estate for the payment of debts. Unlike NY, WA, IN and AR, D.C. has no rule under which additional disinterested attesting witnesses save the gift. The interested witness is not disqualified as a competent witness to the execution (§18-104(d)).

IMPORTANT INFORMATION This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the Uniform Power of Attorney Act of 2022 (D.C. Official Code §21-2601.01 et seq.). This power of attorney does not authorize the agent to make health-care decisions for you. You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent's authority will continue until you die or revoke the power of attorney or the agent resigns or is unable to act for you. Your agent may be entitled to reasonable compensation unless you state otherwise in the Special Instructions. This form provides for designation of one agent. If you wish to name more than one agent you may name a coagent in the Special Instructions. Coagents are not required to act together unless you include that requirement in the Special Instructions. If your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent. This power of attorney becomes effective immediately unless you state otherwise in the Special Instructions. If you have any questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.

IMPORTANT INFORMATION FOR AGENT (D.C. Code §21-2603.01) Agent's Duties. When you accept the authority granted under this power of attorney, a special legal relationship is created between you and the principal. This relationship imposes upon you legal duties that continue until you resign or the power of attorney is terminated or revoked. You must: (1) Do what you know the principal reasonably expects you to do with the principal's property or, if you do not know the principal's expectations, act in the principal's best interest; (2) Act in good faith; (3) Do nothing beyond the authority granted in this power of attorney; and (4) Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as "agent" in the following manner: (Principal's Name) by (Your Signature) as Agent. Unless the Special Instructions in this power of attorney state otherwise, you must also: (1) Act loyally for the principal's benefit; (2) Avoid conflicts that would impair your ability to act in the principal's best interest; (3) Act with care, competence, and diligence; (4) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal; (5) Cooperate with any person that has authority to make health care decisions for the principal to do what you know the principal reasonably expects or, if you do not know the principal's expectations, to act in the principal's best interest; and (6) Attempt to preserve the principal's estate plan if you know the plan and preserving the plan is consistent with the principal's best interest. Termination of Agent's Authority. You must stop acting on behalf of the principal if you learn of any event that terminates this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include: (1) Death of the principal; (2) The principal's revocation of the power of attorney or your authority; (3) The occurrence of a termination event stated in the power of attorney; (4) The purpose of the power of attorney is fully accomplished; or (5) If you are married to the principal, a legal action is filed with a court to end your marriage, or for your legal separation, unless the Special Instructions in this power of attorney state that such an action will not terminate your authority. Liability of Agent. The meaning of the authority granted to you is defined in the Uniform Power of Attorney Act of 2022 (D.C. Official Code §21-2601.01 et seq.). If you violate the Uniform Power of Attorney Act of 2022 (D.C. Official Code §21-2601.01 et seq.) or act outside the authority granted, you may be liable for any damages caused by your violation. If there is anything about this document or your duties that you do not understand, you should seek legal advice.

D.C. Code §21-2205(c): the durable power of attorney for health care must be dated and signed by the principal and by two adult witnesses who affirm that the principal was of sound mind and free from duress at the time of signing, and those witnesses may not include the principal, the principal's health-care provider, or an employee of that provider. Under §21-2205(d), at least one of the two witnesses must not be related to the principal by blood, marriage, or adoption and must not be entitled to any part of the principal's estate by a current will or by operation of law. The sample form at §21-2207 also has each witness declare that the witness is not the person appointed as attorney in fact by the document.