This is a download of legal forms for:DAVENPORT’S

MASSACHUSETTS WILL AND ESTATE PLANNING

LEGAL FORMS BOOK

See book for instructions on filling out forms.This download has forms in Word format for people to either

1) print out and hand-write in words to complete and then sign, or2) first open in any word processing program to type in some words, then maybe print to hand-write in more words, and then sign.

THERE ARE 9 MAIN WILL AND ESTATE PLANNING FORMS IN BOOK 1. Last Will And Testament (lets one give orders to at death gift property, select guardians for children and dependents, and control other matters);2. Self-Proving Affidavit (document done with a Will to help with work afterdeath of showing a Will was signed correctly); 3. Tangible Personal Property List (lets one in a simple document done outside a Will write down gifts to transfer certain property at death);4. Health Care Proxy (like a “Living Will” lets health care instructions be givenand person be named to control one’s health care in case this is needed);5. Durable Power of Attorney (lets power over money, property, and other matters be shared with another person so they can help manage things);6. Caregiver Authorization Affidavit (for up to 2 years lets power over child’s health care and schooling be shared with another person usually because parents will be absent, however other person must live with child); and7. Temporary Agent Affidavit (for up to 60 days lets broad power over child’s property, health care, schooling, home discipline, and other matters be shared with other person, without need for other person to live with child);8. Final Wishes (lets person give instructions about funeral, cremation, burial, and related matters rather than let closest family control this, however any pre-arranged funeral contracts will be carried out); and9. Do-Not-Resuscitate and M.O.L.S.T. (these forms must be signed by a doctor or nurse practitioner and using 1 of these 2 forms shows paramedics and others whether to try restarting the heart, breathing, and other major actions (the D.N.R. is simpler than the M.O.L.S.T. which stands for Massachusetts Orders for Life Sustaining Treatment)

FORM 1

L AST WILL AND TESTAMENT

LAST WILL AND TESTAMENT

I, _____________________________ a resident of ____________________

County, Massachusetts, do hereby make, publish, and declare this to be my Last Will and

Testament (called here my “Will”), hereby revoking all Wills, Testaments, and Codicils

earlier made by me.

1. TANGIBLE PERSONAL PROPERTY LIST. I may leave one or more signed

writings separate from and written before or after this Will giving some of my tangible

personal property as allowed by law, including but not limited to Mass. Gen. Laws ch. 190B

§ 2-513. I make the gifts described in such writings, except I do not make certain gifts of

some property if the named recipient does not survive me or if the property is covered by a

specific gift in this Will. Notwithstanding the above any writing not found by 60 days after

my death shall be treated as void and its gifts shall abate.

2. SPECIFIC GIFTS. I give the following specific and other gifts:

I give ______________________________________________________________

to _______________________________________________________ if they survive me;

I give ______________________________________________________________

to _______________________________________________________ if they survive me;

I give ______________________________________________________________

to _______________________________________________________ if they survive me;

I give ______________________________________________________________

to _______________________________________________________ if they survive me;

I give ______________________________________________________________

to _______________________________________________________ if they survive me;

I give ______________________________________________________________

to _______________________________________________________ if they survive me;

I give ______________________________________________________________

to ___________________________________________________ if they survive me; and

I give ______________________________________________________________

to _______________________________________________________ if they survive me.

3. RESIDUE. I give the residue of my estate consisting of all property I can

distribute by Will not distributed by the preceding provisions of this Will, including any real

property, personal property, or other property of any kind and wherever located, as follows:

to ______________________________________________________________________

if they survive me, but if they all do not survive me then I give the just described property

to ______________________________________________________________________

or their lineal descendants per stirpes.

4. ADMINISTRATION. I name _________________________________________

as personal representative of my Will and of my estate. I give my personal representative

the fullest power, authority, and discretion allowed to administer my Will and estate

including the power to without court approval sell, lease, keep, or exchange real or other

property without liability for decrease in value, to settle claims for and against the estate,

and to pay debts. I request unsupervised administration of my Will and estate and

administration in as informal a manner as possible. Any personal representative shall not

be required to furnish a surety, bond, or surety on a bond including for the performance of

duties in any jurisdiction regardless of any law.

5. GUARDIANS. If any of my children have not reached age 18 I nominate,

appoint, and name _______________________________________________ as guardian

including over the person of such children. I also nominate, appoint, and name

________________________________________________________ as conservator for

such children or other minors who receive or possess money or property and also over

their estate and property. All guardians and conservators shall serve without surety, bond,

or surety on a bond to the extent allowed by law.

6. MISCELLANEOUS. The following shall apply to this Will:

A gift made to multiple beneficiaries shall be equally shared among beneficiaries

unless a specific share or percentage is stated, subject to other terms of this Will.

For a gift made to multiple beneficiaries if any do not survive the testator the

surviving beneficiaries shall equally divide a non-surviving beneficiary’s share.

In the section called “Specific Gifts” the gifts are specific gifts except that a gift of a

money amount shall be a valid general gift.

A gift to multiple beneficiaries shall be sold and the proceeds distributed to them by

the personal representative unless all beneficiaries agree on how to use the gift.

. The word survive means to outlive testator by 30 days, and survive as a condition is

absolute which if not met ends any beneficial interest which instantly lapses.

. The residue includes lapsed or failed gifts, and the residue includes property the

testator has any power of appointment or testamentary disposition over.

. The word gift includes a devise, bequest, grant, legacy, or any other transfer of

property called for by this Will.

. The word personal representative shall also mean executor and administrator.

Plural, singular, or gender meaning of words and phrases where appropriate do not

limit any Will provision, and “they” means one or several persons.

SIGNATURE

IN WITNESS WHEREOF, I say and declare that this is my Will which I

execute willingly as Testator as a free and voluntary act for the purposes expressed

herein, and that I am 18 years of age or older and of sound mind and under no constraint

or undue influence, this ___ day of __________________, 20____.

_________________________

Signature of Testator

WITNESSES

We declare and say that in our presence on the date appearing above

_______________________________, Testator, signed and declared this document to be

Testator’s Will in the presence of both of us, who then at the Testator's request and in

Testator's presence and in the presence of each other we who are 18 years of age or older

and of sound mind have signed our names below as Witnesses, and that we believe the

Testator to be 18 years of age or older, of sound mind and memory, and under no

constraint or undue influence.

Signature of Witness: ________________________

Address of Witness: _____________________________________________________

Signature of Witness: ________________________

Address of Witness: _____________________________________________________

FORM 2

SELF-PROVING AFFIDAVIT

SELF-PROVING AFFIDAVIT.. (Mass. Gen. Laws chapter 190B section 2-504).

The Commonwealth of Massachusetts

__________________, ss.

We, ____________________, _____________________, and _____________________,

the testator and the witnesses, respectively, whose names are signed to the attached or

foregoing instrument, being first duly sworn, do hereby declare to the undersigned

authority that the testator signed and executed the instrument as the testator’s will and that

he or she had signed willingly (or willingly directed another to sign for him or her), and that

he or she executed it as his or her free and voluntary act for the purposes therein expressed,

and that each of the witnesses, in the presence and hearing of the testator, signed the will

as witness and that to the best of his or her knowledge the testator was at that time 18

years of age or older, of sound mind, and under no constraint or undue influence.

_____________________________ Testator

_____________________________ Witness

_____________________________ Witness

Subscribed, sworn to and acknowledged before me by ____________________________,

the testator, and subscribed and sworn to before me by ___________________________,

and ____________________________, witnesses, this ___ day of __________________.

(Signed) ____________________

(Official capacity of officer)

FORM 3

TANGIBLE PERSONAL PROPERTY L IST

TANGIBLE PERSONAL PROPERTY LIST

I, the undersigned, wish this list to serve as a separate writing referred to in a Will and giving tangible personal property as allowed by law including but not limited to Mass. Gen. Laws ch 190B § 2-513 (“Separate Writing Identifying Devise of Certain Types of Tangible Property”). I give property listed below if the recipient named next to the property survives me as a Will defines and if no specific gift in a Will gives the property. If the same property is given in more than one of these lists for that property the more recent list shall control.

PROPERTY TO BE DISTRIBUTED TO______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

______________________________________ _____________________

Date: ____________ Signed: ________________________

FORM 4

HEALTH CARE PROXY

HEALTH CARE PROXY..1. APPOINTMENT. I, ______________________________ residing at ________________________________________ do hereby appoint as my Health Care Agent with authority to make health care decisions on my behalf ______________________ residing at ___________________________________ telephone _______________________________.

(Optional: If my Agent is unwilling or unable to serve, I designate ________________ residing at _________________________________________________________ telephone ____________________ as my alternate agent.)

2. WHEN EFFECTIVE. This authority becomes effective if my attending physician determines in writing that I lack the ability to make or communicate health care decisions myself, according to General Laws of Massachusetts Chapter 201D.

3. AUTHORITY OF HEALTH CARE AGENT. I give my Health Care Agent the same authority I have to make all my health care decisions including end of life care and life-sustaining treatment decisions, except (Optional: here or on attached pages

list limits to authority, give instructions, or leave area blank so Agent has full decision making authority) _______________________________________________________________________________________________________________. I authorize my Health Care Agent to make decisions in accordance with his or her assessment of my wishes, or if my Health Care Agent cannot determine my wishes then he or she should make a choice for me based upon what is believed to be my best interests. I give my Health Care Agent the same rights I have to the use and disclosure of my health information and medical records as governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d. Photocopies of this Health Care Proxy shall have the same authority as the original.

4. SIGNATURES

Signature of Principal: ________________________ Date: ______________

Witness StatementWe the witnesses signing below are 18 year of age or older and neither of us is named as the Health Care Agent or alternate. To the best of our knowledge, the above named principal is at least 18 years of age, of sound mind, and willingly executed this document in our presence under no constraint or undue influence.Signature of Witness 1: _____________________ Date: ______________Signature of Witness 2: _____________________ Date: ______________

Health Care Agent (Optional)

I have read this document carefully and accept the appointment.

Signature of Health Care Agent: _____________________ Date: ____________

FORM 5

DURABLE POWER OF ATTORNEY

DURABLE POWER OF ATTORNEYI _________________________________________________________________(insert name and address) appoint ________________________________________________________(insert the name and address of the person appointed) as my agent (attorney-in-fact) to act for me in any way including in any way which I myself could do if I were personally present.

This instrument is to be construed and interpreted as a general durable power of attorney effective immediately.

This power of attorney shall not be affected by subsequent disability or incapacity of the principal, or lapse of time.

(Optional) Instructions for agent: ________________________________________ ____________________________________________________________________________________________________________________________________

I agree any third party who receives a copy of this document may act under it. Revocation of power of attorney is not effective as to a third party until they learn of the revocation. I agree to indemnify the third party for any claims that arise against the third party because of reliance on this power of attorney.

I request my attorney-in-fact serve as any guardian (or any conservator) that may be needed, and I request they serve without surety, bond, or surety on a bond to the extent allowed by law.

SIGNATURESigned this ___ day of _______________________, 20___.

________________________Signature

NOTARYCommonwealth of Massachusetts..

 

________________, ss. On this date, ________________, before me, the undersigned notary public, personally appeared ____________________________, proved to me through satisfactory evidence of identification, which was __________________________, to be the person whose name is signed on the preceding document, and swore under the pains and penalties of perjury that the foregoing statements are true.

______________________

FORM 6

CAREGIVER AUTHORIZATION AFFIDAVIT

CAREGIVER AUTHORIZATION AFFIDAVITMassachusetts General Laws Chapter 201F

I. What this form enables: A parent, legal guardian or legal custodian of a minor, by this affidavit, may

authorize a designated caregiver, who is an adult with whom the minor child resides, to exercise certain concurrent parental rights and responsibilities relative to a designated minor’s education and health care. If a conflicting decision is made under these concurrent rights and responsibilities, the decision of the authorizing party shall supersede the decision of the caregiver.

The caregiver authorization affidavit shall only authorize those rights and responsibilities that the authorizing party possesses and shall not divest the authorizing party of his rights or responsibilities.

Under a caregiver authorization affidavit, a caregiver may: (1) consent to medical, surgical, dental, developmental, mental health or other treatment for the minor under the supervision or upon the advice of a health care professional licensed to practice in the commonwealth;

(2) exercise parental rights to obtain records and other information with regard to health care services and insurance provided to the minor; and (3) make educational decisions on behalf of the minor and in all other ways stand in for the authorizing party with respect to federal, state and district educational policy, including, but not limited to, accessing the minor’s educational records, representing the minor in enrollment, disciplinary, curricular, special education or other educational matters, signing permission slips for school activities and any other decision that facilitates the minor’s educational experience.

II. Steps to authorize caregiver rights and responsibilities:

1. AUTHORIZING PARTY (Parent/Guardian)

I, _______________________, residing at ______________________________________am: (circle one) the parent legal guardian legal custodian of the minor child(ren) listed below.

I do hereby authorize ____________________________________________, residing at_________________________________________________ to exercise concurrently the rights and responsibilities, except those prohibited below, that I possess relative to the education and health care of the minor children whose names and dates of birth are:

________________________________ ___________________________________name date of birth name date of birth

________________________________ ___________________________________name date of birth name date of birth

The caregiver may NOT do the following: (If there are any specific acts you do not want thecaregiver to perform, please state those acts here.)

________________________________________________________________________The following statements are true: (Please read)

There are no court orders in effect that would prohibit me from exercising or conferring the rights and responsibilities that I wish to confer upon the caregiver. (If you are the legal guardian or custodian, attach the court order appointing you.)I am not using this affidavit to circumvent any state or federal law, for the purposes ofattendance at a particular school, or to re-confer rights to a caregiver from whom thoserights have been removed by a court of law.I confer these rights and responsibilities freely and knowingly in order to provide for the child(ren) and not as a result of pressure, threats or payments by any person or agency.I understand that, if the affidavit is amended or revoked, I must provide the amendedaffidavit or revocation to all parties to whom I have provided this affidavit.

This document shall remain in effect until ____________________ (not more than 2 years from today) or until I notify the caregiver in writing that I have amended or revoked it.I hereby affirm that the above statements are true, under pains and penalties of perjury.

Signature: _________________________________

Printed name: ____________________________ Telephone number: ________________________

2. WITNESSES TO AUTHORIZING PARTY SIGNATURE(To be signed by persons over the age of 18 who are not the designated

caregiver.)

Witness No. 1 signature: ___________________________Witness No. 1 printed name and address: ______________________________________

Witness No. 2 signature: ___________________________Witness No. 2 printed name and address: ______________________________________

3. NOTARIZATION OF AUTHORIZING PARTY’S SIGNATURE

Commonwealth of Massachusetts__________________, ss.

On this date, _______________, before me, the undersigned notary public, personally appeared________________________, proved to me through satisfactory evidence ofidentification, which was _________________________________, to be the person whose name is signed on the preceding document, and swore under the pains and penalties of perjury that the foregoing statements are true.

Signature and seal of notary: __________________Printed name of notary: ____________________My commission expires: _____________________

4. CAREGIVER ACKNOWLEDGMENT

I, ______________________________________, am at least 18 years of age and the above child(ren) currently reside with me at _____________________________________. ________________________________________________________. I am the children’s (state your relationship to the child) _____________________________.

I understand that I may, without obtaining further consent from a parent, legal custodianor legal guardian of the child(ren), exercise concurrent rights and responsibilities relativeto the education and health care of the child(ren), except those rights and responsibilitiesprohibited above. However, I may not knowingly make a decision that conflicts with thedecision of the child(ren)’s parent, legal guardian or legal custodian.

I understand that, if the affidavit is amended or revoked, I must provide the amendedaffidavit or revocation to all parties to whom I have provided this affidavit prior to furtherexercising any rights or responsibilities under the affidavit.

I hereby affirm that the above statements are true, under pains and penalties of perjury.

Signature of caregiver: __________________________ Date: _______________

Printed name: _____________________ Telephone Number: ____________________

III. Explanations:

This caregiver authorization affidavit is pursuant to chapter 201F of the General Laws. A dispute arising hereunder shall be the exclusive jurisdiction of the probate courts pursuant to section 3 of chapter 215 of the General Laws.

A person who relies on a caregiver authorization affidavit that is consistent with the requirements of said chapter 201F has no obligation to make any further inquiry or investigation and shall not incur any criminal or civil liability or be subject to professional discipline for doing so, unless he knows facts contrary to the affidavit or knows that an authorizing party has made a decision to supersede the caregiver’s decision. The reliance on the affidavit shall not relieve a person from liability arising from other provisions of the law.

FORM 7

TEMPORARY AGENT AFFIDAVIT

TEMPORARY AGENT AFFIDAVITMassachusetts General Laws Chapter 190B, § 5-103

 1. AUTHORIZING PARTY (Parent/custodian/guardian)..

 

 

I, __________________, residing at _______________________________________ am:(circle one) the parent legal guardian legal custodian of the minor child(ren) listed below.

I do hereby appoint ___________________________, residing at ___________________________ ____________________________________ to exercise concurrently any power regarding the care, custody, or property [except the power to consent to marriage or adoption and any additional acts prohibited below], that I possess relative to the minor child(ren) whose names and dates of birth are:

___________________________________ ___________________________________name date of birth name date of birth

___________________________________ ___________________________________name date of birth name date of birth The agent may NOT do the following:  (If there are any specific acts you do not want the agent to perform, please state those acts here.)________________________________________________________________________ 

The following statements are true:  (Please read) There are no court orders in effect that would prohibit me from exercising or conferring the rights and responsibilities that I wish to confer upon the agent.  (If you are the guardian or custodian, please attach the court order appointing you.) I confer these rights and responsibilities freely and knowingly in order to provide for the child(ren) and not as a result of pressure, threats, or payments by any person or agency. I understand that, if the affidavit is amended or revoked, I must provide the amended affidavit or revocation to all parties to whom I have provided the affidavit. 

This document shall remain in effect until ___________________________ (not more than 60 days from today) or until I notify the agent in writing that I have amended or revoked it. I hereby affirm that the above statements are true, under pains and penalties of perjury. Signature:____________________________                            Date: ________________ 

Printed Name: ______________________ Telephone number:  ____________________

2. WITNESSES TO AUTHORIZING PARTY SIGNATURE (To be signed by persons over the age of 18 who are not the designated agent.)

 

Witness No. 1 signature: ___________________________Witness No. 1 printed name and address: ______________________________________

Witness No. 2 signature: ___________________________Witness No. 2 printed name and address: ______________________________________

3. NOTARIZATION OF AUTHORIZING PARTY’S SIGNATURE Commonwealth of Massachusetts 

 

_________________, ss. On this date, ________________, before me, the undersigned notary public, personally appeared ____________________________, proved to me through satisfactory evidence of identification, which was ___________________________________, to be the person whose name is signed on the preceding document, and swore under the pains and penalties of perjury that the foregoing statements are true. 

Signature and seal of notary: ___________________

Printed name of notary: __________________

My commission expires: __________ 

4. TEMPORARY AGENT ACKNOWLEDGMENT I, __________________________________, am at least 18 years of age.

I understand that I may, without obtaining further consent from a parent, legal custodian, or legal guardian of the child(ren), exercise concurrent power relative to the child(ren), except those powers prohibited above. However, I may not knowingly make a decision that conflicts with the decision of the child(ren)’s parent, legal guardian, or legal custodian.

I understand that, if the affidavit is amended or revoked, I must provide the amended affidavit or revocation to all parties to whom I have provided this affidavit prior to further exercising any rights or responsibilities under the affidavit.

I hereby affirm that the above statements are true, under pains and penalties of perjury.

Signature:____________________________                            Date: ________________ 

Printed Name: ______________________ Telephone number:  ____________________

5. NONAPPOINTING PARENT CONSENT (if applicable) I, ___________________________, residing at ________________________________, am the nonappointing parent of the child(ren).  I consent to the designation of _________________________ to be a temporary agent for my child(ren).  I understand that the temporary agent will have any power regarding the care, custody, or property of the child(ren), [except as stated in Section 1]. Signature:____________________________                            Date: ________________ Printed Name: ______________________ Telephone number:  ____________________

FORM 8

FINAL WISHES

FINAL WISHES

(Title 239 of the Code of Massachusetts Regulations, section 3.09)This form should be filled in and signed before a witness and then given to someone or kept in a safe place so people are likely to have this document within days of death. Pre-arranged especially pre-paid funeral and other contracts a person has entered into and not cancelled will likely be followed even if they conflict with the instructions given below.

INSTRUCTIONS. I, ___________________________, hereby state in this witnessed writing the following instructions concerning funeral, cremation, burial, and related matters: _____________________________

______________________________________________________________ ______________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ______________________________________________________________ ______________________________________________________________

SIGNED: __________________________ DATED: ______________

WITNESS

SIGNATURE OF WITNESS: _________________________

FORM 9

DO-NOT-RESUSCITATE AND M.O.L .S.T.

PLEASE ASK YOUR DOCTOR OR NURSE FOR MOST RECENT

DO-NOT-RESUSCITATE FORM ORM.O.L.S.T. FORM

(BUT SEE FOLLOWING PAGES FOR OLDER FORMS)