New York

Each of the undersigned, individually and severally, being duly sworn, deposes and says: The within will was subscribed at the end thereof by {testatorName}, the above named Testator, in our presence (or the Testator's signature was acknowledged to us as having been previously affixed), and at the same time the Testator published and declared the instrument to be their Last Will and Testament. We, at the request of the Testator, each signed our names as attesting witnesses thereto and affixed our residence addresses at the end of the Will, and all of our signings as witnesses both attesting the Testator's signature took place within one thirty (30) day period, as required by N.Y. EPTL §3-2.1(a)(4). The Testator was at that time 18 years of age or older, of sound mind and memory, and under no constraint or undue influence of any person, so far as we could determine.

N.Y. EPTL §3-3.2: an attesting witness who also takes a beneficial disposition under the will is a competent witness, and the will remains valid; however the disposition to that witness is void unless there are at least two other disinterested attesting witnesses. Even with two other disinterested attesting witnesses, the disposition is void if the will cannot be proved without that witness's testimony (subparagraph (a)(2) of the same section). A witness whose disposition is void and who would be a distributee if the will were not established may take so much of the intestate share as does not exceed the value of the void disposition (recoverable from the residuary or, if the disposition passes in intestacy, ratably from the other distributees); a witness who would not be a distributee takes nothing (subparagraph (a)(3)).

General categories: A. Real estate transactions B. Chattel and goods transactions C. Bond, share, and commodity transactions D. Banking transactions E. Business operating transactions F. Insurance transactions G. Estate transactions H. Claims and litigation I. Personal and family maintenance J. Benefits from governmental programs or civil or military service K. Health care billing and payment matters; records, reports, and statements (NOT health care decisions) L. Retirement plan transactions M. Tax matters N. All other matters O. Full and unqualified authority to delegate any of the foregoing powers P. Grant of all of the above powers (A through O)

Under New York's 2021 POA reform (effective June 13, 2021), the separately executed Statutory Gifts Rider is eliminated. All modifications to the statutory powers above, including expanded gift authority, gifts to the agent, and changes to beneficiary designations, are made in this section and must be expressly authorized here to be effective. Default gift authority. The agent's default gift power lives in N.Y. Gen. Oblig. Law §5-1502I(14), and modifications to that authority are made in the statutory short form Modifications section under §5-1513. The 2021 POA reform (L. 2020, ch. 323) repealed the separately executed Statutory Gifts Rider (former §5-1514) and raised the prior $500-per-year aggregate gift cap to $5,000 aggregate per calendar year. The $5,000 figure is the AGGREGATE annual cap regardless of the number of donees; the 2021 reform did not tie the default cap to the IRC §2503(b) federal annual exclusion. Without an express modification below, and only if I grant my agent authority for personal and family maintenance, my agent's gift power is limited to continuing the gifts I customarily made to individuals and charitable organizations before this power of attorney was created, and to no more than $5,000 in the aggregate in any one calendar year. To grant my agent broader gift authority, including gifts up to the IRC §2503(b) annual exclusion per donee per calendar year, gifts to the agent(s) themselves, gift-splitting under IRC §2513, and changes to beneficiary designations on retirement plans, life insurance, and transfer-on-death accounts, I must expressly initial the corresponding options below. [ ] Expand the agent's annual gift authority from the $5,000-aggregate default to {cap} per donee per calendar year. (To track inflation automatically, the principal may write in 'IRC §2503(b) annual exclusion per donee'.) [ ] Authorize my agent(s) to make gifts of my property to themselves, individually or in trust, in such amounts and on such terms as the agent considers appropriate, subject to the aggregate annual cap above and the agent's fiduciary duties under N.Y. Gen. Oblig. Law §5-1505. (Under the 2021 POA reform, self-gifts must be expressly authorized in the statutory short form Modifications section under §5-1513; the separately executed Statutory Gifts Rider, former §5-1514, has been repealed.) [ ] Authorize my agent to change beneficiary designations on retirement plans, life insurance, and transfer-on-death accounts. [ ] Authorize my agent to access, manage, transfer, and dispose of my digital assets, including the contents of electronic communications, online accounts, cryptocurrency, and digital files, pursuant to N.Y. EPTL Article 13-A. This authorization serves as my lawful consent under 18 U.S.C. §2702 and analogous state law for custodians to disclose to my agent the contents of my electronic communications.

1. Designation of Health Care Agent 2. Additional Instructions 3. Health Care Instructions (life-sustaining treatment, artificial nutrition and hydration, CPR) 4. Organ Donation 5. HIPAA Authorization (Will.com add-on; not part of PHL §2981 statutory form) 6. Duration

N.Y. Pub. Health Law §2981(2)(a): the health care proxy must be signed and dated by the principal in the presence of two adult witnesses, who must also sign and must state that the principal appeared to execute the proxy willingly and free from duress. The person appointed as agent may not act as a witness. Under §2981(2)(b), for a principal residing in a mental hygiene facility operated or licensed by the Office of Mental Health, at least one witness must be an individual not affiliated with the facility, and where that facility is also a hospital as defined in Mental Hygiene Law §1.03(10), at least one witness must be a qualified psychiatrist or psychiatric nurse practitioner.