Haviland, Edgar Clark
September 4, 2003
AFFIDAVIT
I, Barbara Haviland, having Power of Attorney for Edgar Clark Haviland (copy
attached), sole surviving son of Janet Haviland atka Janet Clark Haviland, do hereby
attest that he is the sole surviving heir of Janet Haviland, deceased, who is the owner of
Block 7, Lot 147, Space 3 in the Clearwater Municipal Cemetery.
Please take this affidavit as authority to grant interment rights for my husband,
Edgar Clark Haviland and myself, Barbara Haviland in Block 7 Lot 147, Space 3. We
understand that the maximum capacity of a space is two burials provided at least one
person is cremated.
I, further agree to release, indemnify and hold the City of Clearwater harmless
from liability in the event of any claim arising from the use of the above described
property for the interment of the above named individuals.
SIGNATURE/
ADDRESS/PHONE
~~
Barbara Haviland
096-0 - Lf-/.,-fh C0e., IV. #..$ -- I
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~ BEFORE ME, the undersigned, personally appeared Barbar Haviland on
, filSA .. ',2003, who executed the foregoing instrument and
ac nowledged the execution thereof to be her free act and deed for the use and
purposes herein set forth, and who has produced a as
means of identification or iswersonally known to~
e
Stacey Datson
My Commission DD075084
Expires November 28, 2005
, I.....' tv v 0 '-' I U ex 7
/.920 02/22 '02 11: 06 ID :AMSUJTH LAW DEPT
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FAX: 1 205 583 4497
PAGE 2
STATE OF . Flnrlar\
COUNTY OF' P lI2P I / as
Before me, the undersigned authority. personally appeared
("Affiant"), who swore or aflinned that:
fur /rtr.a HrtJ[J IQ/,x!
1.
Affi~9s the Attorney-in-Fact named in the Durable Power of AI ttome)' executed
by rrJ qar ~V l'/ctrt/ . (UPrincipal") on Q a 71 ()O .
To the best ofttle Aftlant's knowledge after diligent search and inquiry:
2.
A. The Principal is not deceased, has not been adjudicated incapacitated, and
has not revoked, partially or completely terminated, or suspended the
Durable Power of Attorney; and
B. A petiticln to determine the incapacity of or to appoint a guardian for the
Principal is not pen',iing.
3. Affiant agrees not to exercise any powers granted by the Durable Power of
Attorney if Affiant attains knowledge that it has been revok~ partially or completely
terminated, suspende~ or is no- longer valid because of the death or adjudication of incapacity of
the Principal.
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SWDl3i1b~al>edbeforemetbis 1'6 day rmrc-h
2~ by n. Ct I 1 who is personally known to me or who has produced
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Signature of Notary
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Nam~~ofNotary, printed 0... stamped
My Commission Expires: .
[SEAL]
",.....\l::....... VICKI L FftANI(
~Wi''f~:~ MY COMt.tISSION' CC f/3SQ22
- : . - EXPIRES: May 9, 2004
, Yo Bonded TllIU NaIary Public Undellflilo:s
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DURABLE POWER OF ATTORNEY
(Financial and Medical)
BY THIS DURABLE POWER OF ATTORNEY I, EDGAR C. HAVILAND, ("Principal") of
Pinellas County, Florida, appoint my wife, BARBARA HAVILAND, as my attorney-in-fact to manage
my affairs as indicated below.
This Durable Power of Attorney is not affected by my subsequent incapacity except as provided
by Florida Statute Section 709.08, and is exercisable from the date of execution.
1. General Grant of Power
I hereby grant to my Agent, full power and authority to exercise or perform any act, power, duty,
right or obligation whatsoever that I now have or may hereafter acquire, relating to arty person, matter..
transaction or any interest in property owned by me, including, without limitation, my interest in all real
property, including homestead real property; all personal property, tangible or intangible; all property held
in any type of joint tenancy, including a tenancy in common, joint tenancy with right of survivorship, or
a tenancy by the entirety: all property over which I hold a general, limited, or special power of
appointment; chooses in action; and all other contractual or statutory rights or elections, including, but not
limited to, any rights or elections in any probate or similar proceedings which I am or may be entitled~ all
as to such property now owned or hereafter acquired by me. I grant to my Agent full power and authority
to do everything necessary in exercising any of the powers herein granted as fully as I might or could do
if personally present, with full power of substitution or revocation. Except as otherwise limited by
applicable law, or by this durable power of attorney, my attorney-in-fact has full authority to perform,
without prior court approval, every act authorized and specifically enumerated in this durable power of
attorney, the powers herein granted, including, but not limited to, the following:
,.
a) Collect all sums of money and other property that may be payable or belonging to me, and
to execute receipts, releases, cancellation or discharges.
b) Settle any account in which I have any interest and to payor receive the balance of that
account as the case may require.
c) Borrow money on such terms and with such security as my attorney may think fit and to
execute all notes, mortgages, and other instruments that my attorney finds n~ or desirable.
d) Draw, accept, endorse or otherwise deal with any checks or other commercial or mercantile
instruments for my benefit, specifically including the right to make withdrawals from any savings account
or savings and loan deposits.
e) Redeem bonds issued by the United States government or any of its agencies, any other
bonds and any certificates of deposit or other similar assets belonging to me.
f) Sell bonds, shares of stocks, warrants, debentures, or other assets belonging to me, and
execute all assignments and other instruments necessary or proper for transferring them to the purchasers
or purchasers, and give good receipts and discharges for all money payable in respect to them. Also, to
execute stock powers or similar documents on my behalf and delegate to a transfer agent or similar agent
the authority to register any stocks, bonds, or other securities either into or out of my name or nominee's
name.
g) Sell, rent, lease for any term, mortgage or exchange any real estate or interest in it, including
homestead property, for such considerations and upon such terms and conditions as my attorney may see
fit, and execute, acknowledge and deliver all instruments conveying or encumbering title to property
owned by me alone as well as any owned by me and by any other person, jointly. If I am married, the
attorney-in-fact may not mortgage or convey my homestead property without joinder of my spouse or my
spouse's legal guardian. Joinder by my spouse may be accomplished by the exercise of authority in a
durable pow~r of attorney executed by my joining spouse, and either my spouse or I may appoint the other
as attorney-in-fact.
The attorney-in-fact herein named and his successor(s) are all granted the authority to sell, to
convey, to maintain, to mortgage or to dispose of any of my personal or real property, and to execute any
and all documents necessary to effectuate the sale and/or conveyance, and to encumber, and to dispose of,
the property. Such documents shall include, but not be limited to, contracts, deeds, affidavits, bills of sales,
closing statements, mortgages, notes and such other instruments as may be required to carry out the
purposes herein expressed, and I, EDGAR C. HAVILAND, hereby give and grant unto the attorney-in-fact
named herein and her successor(s), said attorney, full power and authority to do and perform all and every
act and thing whatsoever requisite and necessary to be done in and about the premises as fully, to all
intents and purposes, as I, EDGAR C. HA Vll..AND, might or could do if personally 'present, with full
power of substitution and revocation,' hereby ratifying and confirming all that said attorney or her
successor( s) shall lawfully do or cause to be done by virtue hereof.
h) To represent me before the Treasmy Department in connection with any matter involving
any federal taxes in which I am a party, to make, sign, execute, verify and file any return required to be
made under the revenue law of the United States, or the Internal Revenue Code; or under the statutes of
any state and to file any claim for refund, offer and compromise or application for a closing agreement,
receive refund checks, execute waivers of any period oflimitation, request extensions of time, execute any
waiver of restrictions on assessment for collection of any tax, and execute Petition for Appeal to the United
States Tax Court.
The above powers conferred upon my attorney-in-fact extend to all of my right, title and interest
in any property in which I have an interest jointly with any other person, whether in an estate by the
entirety, joint tenancy or tenancy in common.
2. Limitations
Notwithstanding the powers contained in this durable power of attorney, myattomey-in-
fact may not:
a) Perform duties under a contract that requires the exercise of my personal services;
b) Make any affidavit as to my personal knowledge;
c) Vote in any public election on my behalf;
d) Execute or revoke any will or codicil on my behalf;
e) Create, amend, modify, or revoke any document or other disposition effective at my death
or transfer assets to an existing trust created by me unless expressly authorized by thus power of attorney;
f) Exercise powers and authority granted to me as trustee or as court-appointed fiduciary.
3. Health Care Surroeate Provisions
In the event that I have been determined by a court of competent jurisdiction to be incapacitated
to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to
designate as my surrogate for health care decisions, the attomey-in- fac named herein, my wife, BARBARA
HAVILAND for health care decisions.
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This designation revokes any prior health care surrogate designation which I may have made.
I fully understand that this designation will permit my surrogate to make health care decisions and
to provide, withhold, or withdraw consent on my behalf; to apply for public benefits to defray the costs
of health care; and to authorize my admission to or transfer from a health care facility.
Additional Instructions:
Without limitations on the right and authority of my surrogate, my Surrogate has the authority to
do the following:
a) Have final authority to act for me and to make health care decisions for me in matters
regarding my health care during my said incapacity;
b) Consult with appropriate health care providers to provide informed consent in my best
interests as the Surrogate perceives same;
c) Give any consent in writing using the appropriate consent forms;
d) Have access to all my appropriate clinical records and may authorize the release of
information and clinical records to appropriate persons to ensure the continuity of my health care;
e) Apply for public benefits, including but not limited to, Medicare and Medicaid for me, and
to have access to information regarding my income and assets to the extent required to make application;
f) Authorize the transfer and admissions of me to or from a health care facility;
g) Withhold or withdrawal life-prolonging or death-delaying procedures in accordance with
a written declaration, living will or last illness will and testaments I may have or will in the future make;
h) Seek Court orders providing for the withholding and withdrawal of life-prolonging or death-
delaying procedures in accordance with a living will or last illness will and testament or declaration I may
have made;
i) Do all acts and make all decisions regarding my health care as authorized by law.
My Surrogate shall not be liable or responsible for any costs or expenses of my medical treatment
or care except as expressly stated by Statute and my Surrogate's signature on any admissions papers for
a health care facility shall not make the Surrogate liable or responsible for any costs or expenses incurred
for my care at such health care facility, it being understood that the Surrogate acts for me and in my stead,
and I, alone, would be liable or responsible for such costs and expenses.
I further affinn that this designation is not being made as a condition of treatment or admission to
a health care facility.
4. Standard of Care
Except as otherwise provided herein, any attorney-in-fact named herein is a fiduciary who must
observe the standards of care applicable to trustee as described in Florida Statute Section 737.302. My
attorney-in-fact is not liable to third parties for any act pursuant to this durable power of attorney if the act
was authorized at the time. If the exercise of the power is improper, my attorney-in-fact is liable to
interested persons as described in Florida Statues Section 731.201 for damage or loss resulting from a
breach of fiduciary duty by my attorney-in-fact to the same extent as the trustee of an express trust. If my
attorney-in-fact has accepted appointment either expressly in writing or by acting under the power, my
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or anyother person forth~co~e;quence.~fthe exeictse~'A~~ting attorney-m-fact lsnot hablefotthe':'~Fe.
consequences of an act in 'Which the-attOmey-iii-faCt iD.\vhiciiihe':attomey:'iii~f8Ct joins at the direction of' ,......
the majority of the joint attOm~~-faCt if the a#Oiney~in~faci~xpresses such dissent in ~ting; to any':"" : . ,;
of theoilici-joint att~ri1eYS~i#~~,llt..~~..~f'o,re~tM:~Ti1~~(~~]~i#4er,:~~1~;:;,4~'-~1;:;....,...~("Y:,::~":.;.:.{;?:(.::~\~;~:f.gz::';;f[i\~l.a.t,\: ;s'r'l.'
. ,.... d)' .' UIl1ess'my~lepo~'ofattomeyprOVides:btherWiSe:in 8utboritYinvested iIi"D.1u1tipl~" ",:',;'
attorneys-in-faCt Iriay be ~xerCised by one or more that IeDiain: after thedeatb., resignation or incapacitY of . .
one or more ofthemul~p~e.att:orneys':'in-fact.
6. Intel"j)retation and Governine Law
This instrument is executed by me in the State of Florida, but it is my inten!ion -that this power of
attorney shall be exercisable in ag.y other state or jurisdiction where I may have any property or interests
in property.
This instrument is to be construed and interpreted as a durable power of attorney as provided for
in Florida Statute Section 709.08, and as a health care surrogate as provided for in Florida Statute 765, as
these statutes may be amended from time to time. The enumeration of specific powers herein is not
intended to, nor does it, limit or restrict the general powers herein granted to my Agent. This instrument
is executed and delivered in .the State of Florida, and the laws of the State of Florida shall govern~ all
questions as to the validity of this power and the construction of its provisions, ,;,. .
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7.
Third Partv Reliance .. .
. a) Any third party may rely upon the authority granted in my durable power of attorney until
the third party has receiv:ed notice as provided herein. ' .
b) Until a third party has received notice of revocation pursuant to the terms contained herein,
partiaJ or complete teimination of the durable power of attorney by adjudication of incapacity, suspension
by initiation of proceedings to determine incapacity, my death, or the occurrence of an event referenced
. in this durable power of attorney, the third party may act in reliance upon the authority granted in this
'-. durable power of attorney.
c) A third party that has not received written notice hereunder may, but need not, require that
my attorney-in-fact execute an affidavit stating that there haS been no revocation, partial or complete
termination, or suspension of the dmable power of attorney at the time the power of attorney is exercised.
d)' Third parties who act in reliance upon the authority granted to my attorney-in-fact hereunder
and in accontance with the instructions of the attorney-in-factwill be held harmless by me for any loss
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suffered or liability incurred as a result of actions taken prior to receipt of written notice of revocation,
suspensions, notice of a petition to determine incapacity, partial or complete determination, or my death.
A person whq acts in good faith upon any representation, direction, decision, or act of my attorney-in-fact
is not liable to me or to my estate, beneficiaries or joint owners for those acts.
e) My attorney-in-fact is riot liable for any acts or decisions made by her in good faith and
under the terms of the durable power of attorney.
8, Notice
a) A notice, including, but not limited to, a notice of revocation, partial or complete,
termination, suspension, or otherwise, is not effective until written notice is served upon my attorney-in-
fact or any third persons relying upon this durable power of attorney.
b) Notice must be in writing and served on the person or entity to be bound by such notice.
Service may be by any form of mail that requires a signed receipt or by personal delivery as provided in
the Florida Statutes for service of process, and must otherwise be in accordance with. Florida Statute
Section 708.08.
9. Damages and Costs
In any judicial action regarding this durable power of attorney, including, but not limited to, the
unreasonable refusal of a third party to allow an attorney-in-fact to act pursuant to the power, and
challenges to the proper exercise of authority by the attorney-in-fact, per statute, the prevailing party is
entitled damages and costs, including reasonable attorney's costs.
10. Validity
This durable power of attorney shall be non-delegable, except as to the stock powers which may
be delegated to a transfer agent per paragraph l.f. hereunder, and shall be valid until such time as I shall
die, revoke the power, or shall be adjudged totally or partially incompetent by a court of competent
jurisdiction. I may revoke the power only by providing written notice to my Agent. All acts of my Agent
taken or done without actUal knowledge of 1) my death, 2) adjudication of my incompetency, or 3) my
revocation are valid and effective, and are hereby ratified and confmned.
11. Revocation of Prior Instruments
By this instrument, I hereby revoke any power of attorney, durable or otherwise, that I may have
executed prior to the date of this durable power of attorney.
I hereby confIrm all acts of my attorney-in-fact pursuant to this power.
Any act that is done under this power between the revocation of this instrument and notice of that
revocation to my attorney shall be valid unless the person claiming the benefit of the act had notice of that
revocation.
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IN WITNESS WHEREOF I have set my hand and seal on this~7f~ day of September, 2000.
Signed, Sealt?d, and Delivered
in presence of:
~
13, V~ M cZ't~lQ..,
Printed Name
~J3.~
~L E CLII<<.
Printed Name
STATE OF FLORIDA
COUNTY OF PINELLAS
,
E~~:~c?~ .-.~--
The foregoing instrument was acknowledged before me this J7~ day of September, 2000, by
EDGAR C. HAVILAND, ~is not known to me and who produced / as
identification..
~~_ BRYAN AoIdACHlAN
~ 'fJ COMMISSlON # CC691S94
~ ~ EXPIRES OCT 26, 2001
~ ~ BONDED THRU
OF ~ ATlANTIC BONDING CO., INC.
wpwin\fonns\durable.poa
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