Florida

State of Florida County of _______________ I, {testatorName}, declare to the officer taking my acknowledgment of this instrument, and to the subscribing witnesses, that I signed this instrument as my will. ___________________________________ Testator We, _______________ and _______________, have been sworn by the officer signing below, and declare to that officer on our oaths that the testator declared the instrument to be the testator's will and signed it in our presence and that we each signed the instrument as a witness in the presence of the testator and of each other. ___________________________________ Witness ___________________________________ Witness Acknowledged and subscribed before me by means of [ ] physical presence or [ ] online notarization by the testator, {testatorName}, who [ ] is personally known to me or [ ] has produced ____________________ (state type of identification, see Fla. Stat. §117.05(5)(b)2.) as identification, and sworn to and subscribed before me by each of the following witnesses: _______________ (type or print name of first witness) who [ ] is personally known to me or [ ] has produced ____________________ as identification, by means of [ ] physical presence or [ ] online notarization; and _______________ (type or print name of second witness) who [ ] is personally known to me or [ ] has produced ____________________ as identification, by means of [ ] physical presence or [ ] online notarization. Subscribed by me in the presence of the testator and the subscribing witnesses, by the means specified herein, all on _____________ (date). ___________________________________ (Signature of Officer) ___________________________________ (Print, type, or stamp commissioned name and affix official seal)

General categories: A. Real property B. Tangible personal property C. Stocks, bonds, and other securities D. Banking and financial institution transactions E. Business operating transactions F. Insurance and annuity transactions G. Estates, trusts, and other beneficiary interests H. Claims and litigation I. Personal and family maintenance J. Benefits from governmental programs or civil or military service K. Tax matters Hot powers (require separate authorization): M. Make a gift (Fla. Stat. §709.2202(1)(c)) N. Create an inter vivos trust (Fla. Stat. §709.2202(1)(a)) O. With respect to a trust created by or on behalf of the principal, amend, modify, revoke, or terminate the trust, but only if the trust instrument explicitly provides for amendment, modification, revocation, or termination by the settlor's agent (Fla. Stat. §709.2202(1)(b)) P. Waive the principal's right to be a beneficiary of a joint and survivor annuity (Fla. Stat. §709.2202(1)(f)) Q. Disclaim or refuse an interest in property (Fla. Stat. §709.2202(1)(g)) R. Create or change rights of survivorship (Fla. Stat. §709.2202(1)(d)) S. Create or change a beneficiary designation (Fla. Stat. §709.2202(1)(e))

1. Name and Designation of Health Care Surrogate 2. Alternate Surrogate 3. Authorization to Access Health Information (HIPAA) 4. Health Care Decision Authorization 5. Specific Instructions and Limitations 6. Organ Donation 7. Revocation