AUTHORIZATION FOR THE TRANSFER OF PERSONAL PROPERTY FROM APARTMENT UPON DEATH OR INCAPACITATION; WAIVER AND RELEASE OF LIABILITY New Life, Inc Clawson Manor 255 W 14 Mile Rd. Clawson, MI 48017 Resident Name: Resident Address: Telephone Number: I understand that if I should die or become legally incapacitated while a resident at Clawson Manor, that it is the landlord's policy to require Power of Attorney Papers, Guardian Papers, and/or Probate Papers identifying my Personal Representative as the only person authorized to enter and remove personal property located in my apartment. I have reviewed this policy with my family, heirs and/or attorney and have decided that for the sole purpose of removing the contents of my apartment upon my death or incapacitation, my landlord allow the Appointee access to my apartment to remove all the personal property without the necessity of any court order. Name of Appointee: _____________________________________________________________ Address of Appointee: __________________________________________________________ Telephone Number of Appointee: _________________________________________________ I waive and release my landlord, its owners, management agents, employees, agents, successors, assigns or landlord attorney [hereinafter collectively referred to as Landlord] from any and all claims that could be brought as a result of this transfer and I bind my estate through this waiver and release and order my estate to hold Landlord harmless for complying with my wishes. My intent is that my Personal Representative or Estate deal directly with the Appointee named above with regards to the disposition of the personal property. By transferring the personal property to the Appointee, neither my estate nor any heir has or is to have any claim resulting from the transfer against the Landlord. I direct the Appointee to accomplish this task within 30-days of my death, or give 30 days written vacate notice to my Landlord (form is available at the office) upon my incapacitation, and to pay the landlord any rent due as of the date the keys are returned. I understand that this Authorization may be revoked or changed during my residency and that until written notice of said change is received and acknowledged by the landlord this Authorization shall remain in full force and effect and any person acting pursuant to this release are hereby absolved and held harmless from any liability while acting in the absence of a court order. ** One of the following Instructions Must Be Marked** ____ Upon my death or incapacitation the any member of my family may freely come and go, in which event the Landlord will have absolutely no liability should anyone aside from the Appointee remove personal property from the apartment. ____ Upon my death or incapacitation a lockout to the apartment be placed on the door by the Landlord and only the above referenced Appointee shall be allowed to have access to my apartment to remove burial items and/or to remove the personal property from my apartment. ____ Upon my death, I request that my Landlord disposed of the contents of my apartment in any way they see fit. I acknowledge that my family has no legal claim to any of the contents of my apartment. In the event there is anything of cash value, it will be turned over to the State of Michigan as required by law. I have been advised that I may seek the advice and guidance of legal counsel before signing this legal document that will be binding on my family, heirs, personal representative and/or estate. I am further advised that Legal Aid may be available to review the document in the event I am unable to afford an attorney. Knowing this, I have voluntarily elected to execute this document in the presence of a Notary Public. Dated: __________________________________________ Resident Signature _____________________________________________________________ Notary - Resident's Signature (Cannot be the Appointee) ________________________ (Resident name), personally known to me or verified by me, appeared before me this __ day of___________________________, 2o______, and appearing to be of sound mind, attested that this is his/her intent, which is being knowingly and freely made and executed the document in my presence. Notary Public ___________________________________________________________________ My Commission Expires _______ _ (stamp required) County ______________________________________ ******************************************** I accept full responsibility and liability to the above named individual's family, heirs, personal representatives, estate or attorney with respect to all items of personal property I remove from the apartment and assume all liability with regards to the disposition of any property transferred to my care and custody in accordance with the Probate Laws of the State of Michigan. I further agree to remove all the property within 30 days of the resident's death, to return the keys to the management, and to pay the landlord any rent due through the date that I return the keys. I understand that should I fail to do so, that the landlord may seek legal action against me to regain possession of the apartment, which apartment I will be assumed to be in control of as of the date of the resident's death. Dated: _________________________________________ Appointee Signature: ______________________________________ Address: ________________________________________________________________________________________ Telephone Number: __________________________________________ _ Notary—Appointee Signature (Cannot be the resident) ________________________ (Appointee name), personally known to me or verified by me, appeared before me this __ day of______________, 20____, signed this document in my presence and attested that this is the Appointee's intent, which is being freely and knowingly made, and acknowledged that s/he has been advised of the right to seek legal counsel before acknowledging this document and either waives the right or wishes to proceed after consulting with legal counsel. _______________________________________________________________________Notary Public County ______________________________________ My commission expires: ______________ (stamp required) THIS FORM MUST BE COMPLETED, SIGNED BY RESIDENT AND APPOINTEE, NOTARIZED AND RETURNED TO THE MANAGEMENT OFFICE WITHIN 7 DAYS OF MOVE-IN.