EL-17-1852 �£
.. _
Miami Shores Village� } �itr>fi>�lal
10050 N.E.2nd Avenue NE �
Miami Shores,FL 33138-0000 , �`,
Phone (305)795 2204 if`St81
R7 x
a� t
ham; Expiration: 01/17/201
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Project Address Parcel Number Applicant
868 NE 100 Street 1132060340020
ROXANNE PERRY
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
ROXANNE PERRY 868 NE 100 ST
MIAMI SHORES FL 33138-2512
Contractor(s) Phone Cell Phone Valuation: $ 750.00
LONGMAN ELECTRIC INC (305)758-1211
_........ _ w . ..�._._.__- Total Sq Feet: 0
Type of Work:NEW SMOKE DETECTORS. Available Inspections:
Additional Info: Inspection Type:
Classification:Residential
Review Electrical
Scanning:1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $0.60 Invoice# EL-7-17-64628
DBPR Fee $2.25 07/19/2017 Credit Card $50.00 $109.10
DCA Fee $2.25
Education Surcharge $0.20 07/21/2017 Credit Card $ 109.10 $0.00
Permit Fee-Additions/Alterations $150.00
Scanning Fee $3.00
Technology Fee $0.80
Total: $159.10
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction d.zoning. Fu ermore, authorize the above-named contractor to do the work stated.
July 21,2017
Authorized Signature:Owner /LJApplicant / Contractor / Agent Date
Building Department Copy
July 21,2017 1
a
Miami Shores Village �� -
Building Department JU 19 2-17
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY:
I—
(305)795-2204 Fax:(305)756-8972
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 I � „----
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [:]RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
IV
�g� CONTRACTOR DRAWINGS
JOB ADDRESS: 5(Q`/ ,6 vE, &I q4 4
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: � Flood Zone: BFE: FFE: p
OWNER:Name(Fee Simple Titleholder):tloxa 'ne �r' Y.,> Phone#: ��q r
Address: *5 'V& 1®d i � 5�
City: Aaml State: EL- Zip: 355 31?�
Tenant/Lessee Name: Phone#:
Email: .i
CONTRACTOR:Company Nampe: Llf� Qdric' /'9 Phone#: S®5, /5VI�L
Address: o� F, /
City: State: Zip: 32//
Qualifier Name:�✓ll.�fit� i�iw,,Aa► Phone#: 3®S— 7,S_9f F d
State Certification or Registration/#: Rt1 0®3`7 13 Certificate of Competency#:
DESIGNER:Architect/Engineer: N A Phone#:
Address: 7 City: State: Zip:
Value of Work for this Permit:$ 7� Square/Linear Footage of Work:
Type of Work: ❑ Addiction ❑ Alteration :9 New ❑ Repair/Replace ❑ Demolition
/V
Description of Work: AV J- 11 6—' b����a
.. ,. . 4 iT. a r•-a
Specify color of color thru tile:°
Submittal Fee$ s®° Permit Fee$ d d CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$ A
(Revised02/24/2014)
a
Bonding Company's Name(if applicable) A114 ,
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
6"61,1,eir4p.,,Z�rdNeiP6W6fgnature
er a 'mefSignature
WNER or AGENT / CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
7 day of LfU/ 20 /7 by17 1�))�� day of ���y ,20 17 by
who is personally known to (�
!/IQ4-1 C0C`061 6LO .who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: f - Sign:
Print: Print:
M"PWft State of%die • Michelle Perez
Seal: • IAdw-liF;Perez Seal: moo` MY Commission GG 084009
MY Commissirti GG 084089 o►a° Ex palms 04/0812021
ora° Expires 04rtW-021
APPROVED BY ans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
Property Search Application- Miami-Dade County Page 1 of 1
F
OFFICE OF THE PROPERTY APPRAISER
Summary Report
Generated On:7/19/2017
Property Information
Folio: 11-3206-0340020
Property Address: 868 NE 100 ST x
Miami Shores,FL 33138-2512
4 4
Owner ROXANNE PERRY TRS
100 MAPLE AVE#305 � w _
Mailing Address
WHITE PLAINS,NY 10601 USA � r
PA Primary Zone 1100 SGL FAMILY-2301-2500 SQA
0101 RESIDENTIAL-SINGLE '
Primary Land Use _ , • 5
,. .
FAMILY: 1 UNIT � ,` � �
Beds l Baths I Half 2/2/0
Floors 1
Living Units 1
Actual Area 2,012 Sq.Ft
Living Area 1,655 Sq.Ft
Adjusted Area 1,833 Sq.Ft Taxable Value Information
Lot Size 8,850 Sq.Ft
1953
2017 2016 2015
Year Built
County
Assessment Information Exemption Value $50,000 $50,000 $50,000
Year 2017 2016 2015 Taxable Value $86,905 $84,090 $83,158
Land Value $265,791 $229,776 $212,488 School Board
Building Value $127,577 $127,577 $127,577 Exemption Value $25,000 $25,000 $25,000
XF Value $1,665 $1,672 $1,525 Taxable Value $111,905 $109,090 $108,158
Market Value $395,033 $359,025 $341,590 City
Assessed Value $136,905 $134,090 $133,158 Exemption Value $50,000 $50,000 $50,000
Taxable Value $86,905 $84,090 1 $83,158
Benefits Information Regional
Benefit Type 2017 2016 2015 Exemption Value $50,000 $50,000 $50,000
Save Our Homes Assessment $258,128 $224,935 $208,432 Taxable Value $86,905 $84,090 $83,158
Cap Reduction
Homestead Exemption $25,000 $25,000 $25,000 Sales Information
Second Previous Price OR Book- Qualification Description
Homestead Exemption $25,000 $25,000 $25,000 Sale Page p
Note:Not all benefits are applicable to all Taxable Values(i.e.County, 11/05/2008 $10 26704 Sales which are disqualified as a result of
School Board,City,Regional). 0032 examination of the deed
11/01/1994 $40,000 16572- Sales which are qualified
Short Legal Description 2743
5-6 53 42
MIAMI SHORES SEC 8 PB 14-33
LOT 3&E1/2 LOT 4 BLK 169
LOT SIZE 75.000 X 118
OR 16572-27431194 1
The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser
and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at hfp://www.miamidade.gov/info/disclaimer.asp
Version:
http://www.niiamidade.gov/propertysearch/ 7/19/2017
DURABLE POWER OF ATTORNEY
I, Roxanne Perry, as of this May 30, 2012, hereby appoint and empower my son,
Bradford Benton Perry, as my true and lawful attorney-in-fact("my Agent"), to act for me and in
my name and on my behalf to exercise the powers listed in this Durable Power of Attorney.
Except as otherwise provided in the Florida Power of Attorney Act (Fla. Stat. Ch. 709), my
Agent may exercise these powers independently and without the approval of any court. My
Agent, however, shall exercise all powers in a fiduciary capacity in good faith, as a prudent
person would using reasonable care, skill, and caution.
Third Parties. Any third party to whom this Durable Power of Attorney is presented
may rely upon an affidavit by my Agent stating, to the best of my Agent's knowledge and belief,
that this power has not been revoked, that I am then living, and that no proceedings have been
initiated to determine my incapacity. No third party relying on this power and that affidavit will
be liable for any losses, damages, or claims caused by compliance with the action requested by
my Agent, unless that third party has actual knowledge of my death or the revocation of this
power.
A THIRD PARTY WHO IMPROPERLY REFUSES TO ACCEPT THIS POWER
OF ATTORNEY WILL BE LIABLE FOR DAMAGES, INCLUDING REASONABLE
ATTORNEY'S FEES AND COSTS, INCURRED IN ANY ACTION OR PROCEEDING
THAT CONFIRMS THE VALIDITY OF THIS POWER OF ATTORNEY.
Durable Power. This Durable Power of Attorney will not be affected by my subsequent
incapacity except as provided in Chapter 709 of the Florida Statutes. It is my specific intent that
the power conferred on my Agent will be exercisable from the date of this Durable Power of
Attorney, and will remain effective thereafter, notwithstanding my subsequent disability or
incapacity, except as otherwise specifically provided by statute.
My Agent will have the following powers and duties:
GENERAL AUTHORITY
1. To manage all assets and properties belonging to me or in which I have any interest, and to
expend whatever funds my Agent deems proper for the preservation, maintenance, or
improvement of those assets or properties.
2. To exercise all powers even though my Agent may also be acting individually or on behalf
of any other person or entity interested in the same matters (as more fully set forth in the
Additional Provisions section).
3. To seek on my behalf the assistance of a court or other governmental agency to carry out an
act authorized in this power of attorney and to enforce the exercise of these powers granted
to my Agent.
4. To execute, acknowledge, seal, deliver, file, or record any instrument or communication the
Agent considers desirable to accomplish a purpose of a transaction, including creating at any
time a schedule listing some or all of my property and attaching it to the power of attorney;
5. To exercise any authority reasonably necessary to give effect to an express grant of specific
authority in this power of attorney.
6. To the extent not limited under the law of the jurisdiction in which this power of attorney is
presented, to take all other actions as may be necessary or appropriate for my personal
well-being and the management of my affairs, as fully and as effectively as if made or done
by me personally.
REAL PROPERTY
To manage and conserve any real property, or any interest or incidents in real property, on my
behalf as stated below. Such property and incidents in property include any interest in
homestead property, mineral rights, and cooperative apartments. I give my Agent the following
powers:
7. To receive, buy, sell, exchange, lease, encumber, and convey such property; to impose
restrictions and covenants; to grant options, releases, and easements, including for public
use; to adjust boundaries; and to partition or consent to partitioning, subdivide, apply for
zoning or other governmental permits, plat or consent to platting, and engage in
development activities for such property.
8. To pay or contest any taxes due on such property, and to receive refunds.
9. To engage in any form of litigation regarding the possession, ownership or liability
involving such property, including foreclosure on a mortgage, or enforcement of a contract
for sale (including specific performance).
10. To create or receive a security interest in such property, and to satisfy a mortgage.
11. To lease or sublease such property; any such lease will be valid and binding for its full term
even if it extends beyond the duration of this power of attorney.
12. To insure the property against liability or casualty or other loss, and to maintain, repair or
alter such property, including removing or erecting structures on the property.
13. If not prohibited in this Durable Power of Attorney, to change the form of title of such
property, including contribution into a business entity in exchange for an interest in that
entity.
14. To join with other persons with whom I own property as joint tenants with right of
survivorship or as tenants by the entireties in any transaction regarding that property.
2
15. With respect to income-producing real property, my Agent will have the powers:
a. To retain and operate the property for as long as advisable;
b. To control, direct, and manage the property, determining the manner and extent of my
Agent's active participation in these operations, and to hire one or more supervisors
for the property;
c. To hire and discharge employees, fix their compensation, and define their duties;
d. To invest funds in other land holdings and to use those funds for all improvements,
operations, or similar purposes;
e. To retain any of the net earnings for working capital and other purposes as advisable
in conformity with sound and efficient management; and
f. To purchase and sell machinery, equipment, and supplies of all kinds as needed for
the operation and maintenance of the property.
TANGIBLE PERSONAL PROPERTY
To manage and conserve any tangible personal property, or any interest in tangible personal
property, including exempt property, on my behalf, as follows:
16. To receive, buy, sell, exchange, or otherwise dispose of such property, even if without
consideration.
17. To pay or contest any taxes due on such property, and to receive refunds.
18. To engage in any form of litigation regarding the possession, ownership or liability
involving such property.
19. To create or receive a security interest in or grant options regarding such property.
20. To lease or sublease such property; any such lease will be valid and binding for its full term
even if it extends beyond the duration of this power of attorney.
21. To insure, store,move, maintain,repair or alter such property.
22. If not prohibited in this instrument, to change the form of title of such property, including
contribution into a business entity in exchange for an interest in that entity.
23. To operate, insure, license and register with any state or government agency, any and all
vehicles of which I am the registered or legal owner.
24. To surrender possession of such property to me or to members of my family without liability
for wear,tear, and obsolescence of the property.
3
INVESTMENTS
25. To invest in assets, securities, or interests in securities of any nature, whether domestic or
foreign markets, including (without limit) stocks, bonds, mutual funds, index funds, or
investment funds, including common trust funds, provided such securities are traded on a
regulated exchange.
26. To establish or maintain and to trade in credit or margin accounts (whether secured or
unsecured), and to pledge assets for that purpose.
27. To hold funds uninvested for such periods as the Agent deems prudent, and to invest in any
assets the Agent deems advisable even though they are not technically recognized or
specifically listed in so-called "legal lists," without responsibility for depreciation or loss on
account of those investments, or because those investments are non-productive, as long as
the Agent acts in good faith.
28. To trade in commodities, options, futures, precious metals, and currencies, provided such
items are traded on a regulated exchange.
29. To employ a custodian or agent ("the Custodian") located anywhere within the United
States, at my expense, whether or not such Custodian is an affiliate of an Agent; to register
securities in the name of the Custodian or a nominee thereof without designation of
fiduciary capacity; and to appoint the Custodian to perform such other ministerial functions
as the Agent may direct, all as permitted in Fla. Stat. Chapter 709. While such securities
are in the custody of the Custodian, the Agent will be under no obligation to inspect or
verify such securities, nor will the Agent be responsible for any loss by the Custodian.
30. To employ any investment management service, financial institution, or similar organization
to advise the Agent; to handle investment of my assets; and to render all accountings of
funds held on my behalf under custodial, agency, or other agreements. If the Agent is an
individual, these costs may be paid from my assets in addition to compensation payable to
the Agent.
31. To receive and hold certificates and other evidences of ownership with respect to stocks and
bonds, or to hold such securities in street certificates or in a book entry system.
32. To exercise voting rights with respect to stocks and bonds in person or by proxy, enter into
voting trusts, and consent to limitations on the right to vote.
33. To the extent not limited in the Special Transactions section, to apply for, fund, modify,
withdraw from, or terminate a qualified tuition plan authorized under 26 USC §529, or its
successor provisions, for any of my descendants, including the right to combine accounts, to
transfer an account from one state to another, to redirect the investment of the account (to
the extent permitted by law), or to change the designated beneficiary of the plan.
4
r
34. To conduct investment transactions as provided in Fla. Stat. §709.2208(2).
FINANCIAL MATTERS
35. To collect, receive, and receipt for any and all sums of money or payments due or to become
due to me.
36. To continue, establish, modify, or terminate an account, credit or debit card, electronic
transfer authorization, or other banking arrangement with a bank, trust company, savings
and loan association, credit union, thrift company, brokerage firm, insurance company, or
other financial institution selected by the Agent.
37. To make, assign, draw, endorse, discount, guarantee, and negotiate promissory notes,
checks, drafts, and other negotiable or nonnegotiable paper.
38. To deposit to or withdraw from, by check, order, electronic funds transfer, wire transfer, or
otherwise, money or property of mine held by a financial institution.
39. To receive statements of account, notices, and similar documents from a financial institution
and act with respect to them; to contract with a financial institution for services, including
renting a safe deposit box or space in a vault.
40. To enter any safe deposit box or vault on which I am a signer and withdraw or add to the
contents.
41. To adjust, renew or extend the time of payment of commercial paper, a debt owed to me, a
debt I owe, or a debt guaranteed by me, or any other financial transaction.
42. To borrow money on my behalf and pledge as security my personal property; to apply for,
receive, and use letters of credit from a financial institution, and give an indemnity or other
agreement in connection with them.
43. To conduct banking transactions as provided in Fla. Stat. §709.2208(1).
BUSINESSES AND CONTRACTS
44. To act for me in any business or enterprise, including sole proprietorships, general or limited
partnerships, joint ventures, business trusts, land trusts, limited liability companies, and
other domestic and foreign forms of organizations (each referred to as an "Entity"), in which
I am now or have been engaged or interested.
45. To change the form of organization or governing jurisdiction under which an Entity is
operated, or its name, or any of the above, and to continue any unincorporated business that
the Agent determines is not advisable to incorporate.
5
0 '
46. To buy, sell, enlarge or reduce my ownership interest in any Entity, and to contribute
additional capital into an Entity in which I have an interest.
47. To enter into an ownership agreement with other persons to take over all or part of the
operation of an Entity.
48. To establish the value of an Entity under a buy-sell agreement to which I am a party, and to
enforce the terms of any agreement relating to ownership (or sale) of an interest in an Entity.
49. To participate in any type of liquidation or reorganization of any enterprise.
50. To vote and exercise all rights and options, or empower another to vote and exercise those
rights and options as permitted by law, concerning any interests in an Entity, in securities, or
in other assets; to enter into or approve agreements for merger, reorganization, conversion,
domestication or equivalent transactions with respect to any Entity; and to enter into voting
trusts and other agreements or subscriptions.
51. To exercise in person or by proxy, or enforce by litigation or otherwise, a right, power,
privilege, or option I have as the holder of stocks and bonds;
52. To compromise, arbitrate, or otherwise adjust claims in favor of or against any Entity in
which I have an interest.
53. Except as otherwise provided under Fla. Stat. §709.2201(3)relating to contracts for personal
services, to contract with any person or Entity for any purpose (including contracts between
me and my Agent), and to perform that contract; to agree to any termination, release,
rescission or modification of any contract or agreement.
INSURANCE,ANNUITIES,AND RETIREMENT FUNDS
For purposes of this section, a "Contract" means a contract of insurance on my life, a contract of
insurance regarding my disability or long term care, or an annuity (however denominated). A
"Plan" means a retirement plan or account created by an employer, by me, or by another person
to provide retirement benefits or deferred compensation for me as a participant, beneficiary, or
owner, including a plan or account under the following sections of the Internal Revenue Code (as
amended from time to time): an individual retirement account under §§408, 408A, or 408(q); an
annuity or mutual fund custodial account under §403(b); a pension, profit-sharing, stock bonus,
or other retirement plan qualified under §401(a); a plan under §457(b), and a nonqualified
deferred compensation plan under §409A. To the extent not limited in the Special Transactions
section, I give my Agent the following powers:
54. To continue, pay the premium or make a contribution on, modify, exchange, rescind,
release, or terminate a Contract, whether or not I am a beneficiary under the contract, and
whether owned by me or obtained by my Agent;
55. To procure new Contracts for me and any member of my family;
6
56. To exercise the following rights for Contracts:
a. To obtain a loan secured by a Contract or to borrow against its value;
b. To surrender a Contract and receive its cash surrender value;
c. To exercise any election available under that Contract;
d. To exercise investment powers, if applicable;
e. To change the manner of paying premiums and to select the form and timing of the
payment of proceeds;
f. To change or convert the Contract to another type;
g. To sell, assign, or otherwise transfer the Contract.
57. To obtain property, casualty, liability or any other insurance for me and my property.
58. With respect to a Plan, I give my Agent the following powers:
a. To select the form and timing of payments and withdraw benefits from the Plan;
b. To make rollovers, including a direct trustee-to-trustee rollover, of benefits from one
Plan to another;
c. To establish a Plan in my name;
d. To make contributions to a Plan;
e. To exercise investment powers, if applicable;
f. To borrow from, sell assets to, or purchase assets from a Plan.
ESTATES,TRUSTS,AND OTHER BENEFICIAL INTERESTS
To the extent not limited in the Special Transactions section, to act for me regarding any trust,
probate estate, guardianship, conservatorship, escrow, custodianship or fund in which I may have
a right or beneficial interest, including:
59. To make an election on my behalf for me to receive an elective share of my husband's
estate, if any, as provided by Florida law from time to time.
60. To exercise for my benefit a presently exercisable general power of appointment.
61. To transfer property to the trustee of a trust created by me or for my benefit.
7
62. To accept, receipt for, sell, assign, pledge, or exchange my interest; to reject or disclaim, or
consent to a modification of,my interest.
63. To initiate and pursue litigation, including settlement, compromise, or alternative dispute
resolution, regarding my interest, including a determination of the meaning, validity, or
effect of a deed, Will, declaration of trust, or other instrument or transaction affecting my
interest, or to remove, substitute, or surcharge a fiduciary.
CLAIMS AND LITIGATION
64. To sue in my name and behalf for the recovery of any and all sums of money or other things
of value, payments due or to become due to me, or damages I have sustained or will sustain;
to seek an attachment, garnishment, order of arrest, or other preliminary, provisional, or
intermediate relief and use an available procedure to effect or satisfy a judgment, order, or
decree; and to collect, hold and disburse any property received in satisfaction of judgments.
65. To initiate or participate in adjustments of claims, either by me or against me, including
submission to alternative dispute resolution, and to settle or compromise such claims.
66. To participate and bind me in any litigation, including: to waive or accept service of process
on my behalf; to appear for me; to agree to stipulations or admission of facts on my behalf
(other than a representation as to my personal knowledge); to verify pleadings, seek
appellate review, procure and give surety and indemnity bonds, authorize and pay for
records and briefs; to receive, execute, and file a consent, waiver, release, confession of
judgment, satisfaction of judgment, notice, agreement, or other instrument; and to make or
accept a tender or offer of judgment.
67. To pay any and all bills, accounts, claims, and demands now or hereafter payable by me,
including a judgment, award, order or settlement made in connection with a claim or
litigation.
68. To assert and maintain before a court or administrative agency a claim for relief or cause of
action, or to seek an injunction, specific performance, or other relief.
69. To act for me with respect to any bankruptcy or insolvency concerning me or some other
person, or with respect to a reorganization or receivership which affects my interest in any
property.
PERSONAL AND FAMILY MATTERS
70. To demand, obtain, review, and release to others medical records, documents, or
communications protected by the patient-physician privilege, attorney-client privilege, or
any similar privilege, including all records subject to, and protected by, the Health Insurance
Portability and Accountability Act of 1996, as amended ("HIPAA"). I designate my Agent
as my personal representative under HIPAA. My Agent may also enforce any or all of the
8
privileges listed above.
71. To nominate on my behalf a person (including my Agent) or entity to be appointed by a
court of appropriate jurisdiction as guardian of my person or property, or both, or as
custodian for my property during the pendency of any proceedings to determine my legal
capacity.
72. To receive and open my mail, change my mailing address, and otherwise represent me in
any matter concerning the U.S. Postal Service.
73. To access communications intended for me, and communicate on my behalf, whether by
mail, electronic transmission, telephone, or other means.
74. To access my accounts involving web-based communications, such as email, memberships
in organizations or commercial enterprises, and social media, all of which require a user
name and password for access, even to the extent of compelling the provider to reset my
information to data of my Agent's choosing.
75. To the extent not limited in the Special Transactions section, to continue or discontinue my
membership in any club, religious institution, society, order, or other organization (whether
individual or family) and to continue or discontinue payment of dues, fees, or contributions
to those organizations.
76. Accept or resign on my behalf from any offices or positions which I may hold, including
any fiduciary positions.
77. To hire and compensate attorneys, accountants, advisors, financial consultants, managers,
agents, and assistants (including any individual or entity who provides investment advisory
or management services, or who furnishes professional assistance in making investments)
without liability for any act of those persons, if they are selected and retained with
reasonable care. An Agent may serve in one or more of these capacities and be
compensated separately for the services in each.
78. To discharge (with or without cause) any person hired by me (or on my behalf), by my
Agent, or by any prior Agent, including but not limited to, the categories of persons named
above, and physicians, nurses, care-givers, and domestics.
79. To make periodic payments of child support and other family maintenance required by a
court or governmental agency or an agreement to which I am a party.
GOVERNMENT BENEFITS AND ACTIONS
This section deals with benefits or actions from or relating to any branch or department of the
United States government, any state government, or any foreign government, whether or not
recognized by the United States, including without limitation, the Social Security
Administration, the Department of Veterans Affairs, the Internal Revenue Service, Medicare or
9
Medicaid, and any government department providing payments or grants. I give my Agent the
following powers:
80. To file or process claims, and receive payment for any amounts due me under any such
government program or as payments for retirement from any governmental entity, agency,
or program, including without limit any program or plan administered or sponsored by the
United States, any state (or a subdivision of a state) of the United States, or any branch of
the military.
81. To enroll in, apply for, select, reject, change, amend, or discontinue, on my behalf, a benefit
or program, and to receive and endorse for deposit in any account any payments that I
receive from a governmental source.
82. To file or process claims, and receive payment for medical bills with all insurance
companies through which I have coverage, including but not limited to Medicare and
Medicaid, and to receive from Blue Cross/Blue Shield, Humana, United Health Care,
CHAMPUS, or any other insurer information obtained in the adjudication of any claim in
regard to services furnished to me under Title 18 of the Social Security Act.
83. To prepare, execute, and file a record, report, or other document to safeguard or promote my
interest under a federal or state statute or regulation; to communicate with any representative
or employee of a government or governmental subdivision, agency, or instrumentality, on
my behalf.
84. To create, fund, and maintain an Income Trust pursuant to 42 USC §1396(d)(4)(B) in order
to qualify me or retain my eligibility for Medicaid or any other public assistance benefits.
TAXES
85. To represent me before any office of the Internal Revenue Service or any state agency, to
receive confidential information regarding all tax matters (for my SSN ending in -9431) for
all periods, whether before or after the execution of this Durable Power of Attorney, and to
make any tax elections on my behalf.
86. To prepare, sign and file any tax return on my behalf including income, gift, payroll,
property, Federal Insurance Contributions Act, claims for refund and other tax returns or
other tax-related documents, including receipts, offers, waivers, consents, and agreements.
87. To pay taxes due, collect refunds, post bonds, receive confidential information, and contest
assessments, deficiencies, fines, or penalties determined by the Internal Revenue Service or
any other taxing authority.
88. To execute on my behalf any power of attorney required by the Internal Revenue Service or
other taxing authority with respect to a tax year upon which the statute of limitations has not
run and the following 25 tax years.
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SPECIAL TRANSACTIONS
Certain transactions under this power of attorney may profoundly affect my existing estate plan
and therefore require a separate authorization for my Agent to engage in them. By initialing
next to any items within the respective numbered paragraphs in this Special Transactions section,
I grant my Agent the authority stated in that paragraph with respect to the item initialed. If I
have not initialed an item, my Agent is not authorized to take that action. Reference to my
"husband" means any person or persons whom I later marry.
89. Gifts. I authorize my Agent to make gifts of my property outright to, or for the benefit of,
the persons specified below, including by the exercise of any presently exercisable general
power of appointment which I hold or acquire. For these purposes, a gift "for the benefit
of a person includes a gift to a trust in which that person is a beneficiary, to a custodial
account under a state version of the Uniform Transfers (or Gifts) to Minors Act, and to a
tuition savings account or prepaid tuition plan as defined under Internal Revenue Code
§529. Unless I have provided otherwise in this instrument and except for gifts to my
husband, gifts to or for the benefit of my descendants must be made equally among classes
of donees. Each class of donees will consist of a child of mine and the descendants of that
child. If a gift is made to or for the benefit of one or more members in one class of donees,
a concurrent gift of the same amount must be made to or for the benefit of each other class
of donees. A gift to or for the benefit of a class of donees can be divided equally or
unequally among my descendants in that class (and can exclude one or more descendants in
that class), as long as the combined gifts to or for the benefit of each class of donees are
equal. Gifts may be made only to:
my husband, my ancestors, and my descendants
other members of my family, other than those listed above
my Agent, despite any limitation under Fla. Stat. §709.2202(2)
any organization qualifying for a gift tax charitable deduction which I have
supported or which my Agent, in his discretion, believes I would support,
including outright gifts or qualifying split-interest gifts
all of the above in this paragraph
The gifts to the persons I have specified above, if any, may be made in the following
amounts:
in an amount not to exceed$ per donee each calendar year
in an amount per donee each calendar year not to exceed the annual dollar limits
of the federal gift tax exclusion under Internal Revenue Code §2503(b) (annual
exclusion)
any amounts qualifying for federal gift tax exclusion under Internal Revenue
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Code §2503(e) (medical and educational exclusions)
in an aggregate amount not to exceed my Applicable Exclusion Amount as
provided in Internal Revenue Code §2010(c)
if my husband agrees to consent to a split gift pursuant to Internal Revenue
Code §2513, in an amount per donee not to exceed the aggregate Applicable
Exclusion Amounts for both my husband and me
for estate planning purposes, in unlimited amounts, including the gifts listed
above
/NOTE.Do not initial the next item if you have initialed any of the options listed above.1
my Agent may NOT make any gifts of my property or exercise any powers of
appointment I may hold. (I understand this limitation may have unintended or
undesirable effects,but I choose it anyway.)
90. Trusts. I authorize my Agent to deal with trusts created by me, for me, on my behalf, or in
connection with gifts from me to others as provided in the paragraph above authorizing
gifts, as follows:
To create an inter vivos trust, whether revocable or irrevocable, in which I am a
beneficiary
To the extent permitted in the trust agreement, to amend, revoke, or terminate a
trust of which I am a beneficiary, or transfer the assets of such a trust into another
trust under which I am a beneficiary
To create, amend, or revoke trusts for the benefit of others
To participate in either judicial or nonjudicial modification of a trust as permitted
in Fla. Stat. Chapter 736
91. Survivorship and Other Designations. My Agent may create or alter the nature of
accounts in which I have an interest, as follows:
To create or change rights of survivorship in accounts or other assets in which I
have an interest
To change a beneficiary designation for any accounts or financial instruments,
including life insurance policies, annuities, or retirement accounts of any nature
To waive my right to be a beneficiary of a joint and survivor annuity, including a
survivor benefit under a retirement plan of any nature
92. Disclaimers. My Agent may disclaim interests in property on my behalf as follows:
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Disclaim any interest in property I might otherwise receive, either outright or in
trust
Disclaim any powers I have over property or as a beneficiary of any trusts
(excluding any powers I possess in a fiduciary capacity)
Disclaim any powers of appointment I have or may acquire, excluding any
testamentary power of appointment that I currently exercise in my Last Will and
Testament
ADDITIONAL PROVISIONS
Protection for Agent. I understand, acknowledge and anticipate that many of my
Agent's actions taken pursuant to specific grants of authority in this instrument could involve
him in conflicts of interest (created either by me or by my Agent), or call into question my
Agent's apparent loyalty to me, or both. This might result from the totality of the circumstances
facing the Agent at that time, or by virtue of the Agent's specific actions that might create the
conflict of interest. I want my Agent to be free to act in my interest without concern over
questionable lawsuits. Therefore, so long as my Agent acts in good faith, he will be protected as
follows:
a. My Agent does not have an affirmative duty to act under this power of attorney and
will not be liable for any claim or demand arising out of his good faith acts or omissions, except
for actions or omissions resulting from my Agent's dishonesty, improper motive, or reckless
indifference to the purposes of this power of attorney or my best interests.
b. My Agent may have competing interests for himself or his affiliates, and I waive any
express duty of loyalty imposed under Fla. Stat. §709.2114(2).
c. My Agent may have a conflict of interest as provided in Fla. Stat. §709.2116.
Despite that section, my Agent may undertake a transaction on my behalf even if another party to
that transaction is: (i) a business or trust controlled by my Agent, or of which my Agent, or any
director, officer, or employee of a Corporate Agent, is also a director, officer, or employee; (ii)
an affiliate or business associate of my Agent; or (iii) my Agent acting individually. This
exception also extends to any relative of such a party.
d. I fully indemnify my Agent out of my assets and my estate for any actions brought
against him, and damages he sustains, including attorneys' fees and costs, that have as a basis my
Agent's actions or inactions resulting in both a claim for breach of fiduciary duty and actual
damages to me or my estate, but this protection does not extend to actions or omissions resulting
from my Agent's dishonesty, improper motive, or reckless indifference to the purposes of this
power of attorney, or my best interests. If my Agent ceases to serve, these provisions for
indemnification may be enforced against me or a successor Agent. This right of indemnification
extends to the estate, personal representatives, legal successors and assigns of my Agent.
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e. My Agent will not be liable for any actions or omissions by a predecessor agent if the
Agent does not participate in or conceal the action or omission. My Agent is not required to
review the actions of a predecessor agent, absent actual knowledge by the Agent of wrongdoing.
If, however,my Agent has actual knowledge of a breach or imminent breach of fiduciary duty by
another agent, including a predecessor agent, my Agent must take action reasonably appropriate
in the circumstances to safeguard my best interests. If my Agent in good faith believes that I am
not incapacitated, giving notice to me is a sufficient action.
Compensation and Expenses. My Agent will be entitled to reasonable compensation
and reimbursement for all expenses reasonably incurred by him on my behalf.
Foreign Accounts. Despite any power granted to my Agent in this instrument or under
law, my Agent may not exercise any power over, or transact any business with respect to, an
account in a foreign country, as defined in 31 CFR 1010.350(c) and 1010.350(d), unless my
Agent expressly and specifically accepts such authority in writing.
Delegation of Powers. My Agent may not delegate the powers given to him as my
attorney-in-fact, except as follows:
a. To grant a transfer agent or similar person the authority to register securities in my
name or the name of a nominee.
b. For investment management purposes as provided in Fla. Stat. §518.112.
c. To any other person, as may be permitted under the law of another jurisdiction in
which this instrument is presented.
Suspension of Rights and Duties. All powers granted to my Agent will be suspended
immediately if he becomes disabled, i.e., unable to carry out his duties under this Durable Power
of Attorney because of a mental or physical impairment (whether temporary or permanent in
nature). For these purposes,that disability is determined as follows:
a. My Agent's capacity or disability can be determined by a court having jurisdiction,
which will supersede any other determination under this section.
b. In the absence of a judicial determination, if my Agent is disabled, as confirmed by
my Agent's physician or a board certified medical doctor hired at my expense, all powers of my
Agent as my attorney-in-fact will be suspended until his legal capacity is determined by a court,
or until the physician consulted determines my Agent is no longer disabled.
Use of Copies. As provided in Fla. Stat. §709.2106, a photocopy or electronic copy of
this power is sufficient for its exercise.
Partial Invalidity. If any part of this power of attorney is declared invalid or
unenforceable, that decision will not affect the validity of the remaining parts.
Limitation on actions of Agent. No Agent may participate in an action to the extent
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that a payment or distribution pursuant to that action would discharge a legal support obligation
of that Agent. No Agent who is the insured of any insurance policy that I own may exercise any
rights or have any incidents of ownership with respect to the policy, including the power to
change the beneficiary, to surrender or cancel the policy, to assign the policy, to revoke any
assignment, to pledge the policy for a loan, or to obtain from the insurer a loan against the
surrender value of the policy. All such power is to be exercised solely by another Agent, if any.
In witness whereof, I have executed this Durable Power of Attorney as of the date first
written above.
Signed in the presence of:
W&. oi�i�:Fitzgerak.4' Jr. oxanne Perry
Stewart
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me on May 30, 2012, by Roxanne
Perry.
Notary Public--State of Florida
Personally Known Print Notary Name:
Produced Identification My Commission Number is:
Type of Identification My Commission Expires:
PUe��� EiMy SONS
* MY coMMISSiON#DD W629
EXPIRES:February 16,2013
�fArEOF flOP`oe Bonded TW Budget Notary Services
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