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Affidavit Of Medical Doctor As To Incapacity Of Person To Manage Property (Florida) POA-FL 100 - Legal Forms

Affidavit Of Medical Doctor As To Incapacity Of Person To Manage Property (Florida) Form. This is a Legal Forms form and can be used in General Power Of Attorney .
 Fillable word Last Modified 7/16/2009
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Affidavit of Medical Doctor as to Incapacity of Person to Manage Property pursuant to Section 709.08(4)(d), Florida Statute BEFORE ME, the undersigned Notary Public, appeared (name of physician) , , (hereinafter "Affiant"), who has personal knowledge of the facts and matters set forth herein and being duly sworn, deposes and states: 1. Affiant is a physician licensed to practice medicine in (name of state, territory or foreign country). 2. Affiant is the primary physician who has responsibility for the treatment and care of (principal's name). 3. To the best of Affiant's knowledge after reasonable inquiry, Affiant believes that the principal lacks the capacity to manage property, including taking those actions necessary to obtain, administer, and dispose of real and personal property, intangible property, business property, benefits, and income. 4. Affiant further states that he/they are familiar with the nature of an oath, and with the penalties as provided by the laws of the State of Florida for falsely swearing to statements made in an instrument of this nature. Signature of Affiant Printed Name STATE OF FLORIDA COUNTY OF of Sworn to and subscribed before me, a Notary Public, this , 20 , by day . (Signature of Notary Public) (Print, Type or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification Type of Identification Produced American LegalNet, Inc. ©
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