DISPOSITION OF ESTATE Revised 4/4/06 0911.
Property Name:__________________________________
Date:__________________________________________
Resident’s Name(s):______________________________________________
Address & Suite #: ______________________________________________
______________________________________________
Please be advised that I/We_________________________________________________ name the following individual(s), are authorized to handle the disposition and removal of my/our personal belongings without court order in suite #____________ in the event of my/our death or disability.
NAME RELATIONSHIP PHONE
____________________________ _____________________________ __________________
____________________________ _____________________________ __________________
____________________________ _____________________________ __________________
Further I/We agree to hold The K&D Group, Inc. and it’s employees harmless of any liability in connection with providing access to my/our apartment to the names(s) listed above in the event of my/our death or disability.
WITNESSES: RESIDENT(S):
____________________________________ ______________________________
Witness Resident’s Signature
____________________________________
Witness
____________________________________ ______________________________
Witness Resident’s Signature
____________________________________
Witness
STATE OF OHIO )
)
)
COUNTY OF____________________)
Before me, a Notary Public, in and for said county and state, personally appeared the above named ___________________________________________________________________, who acknowledged that he/she/they did sign foregoing instruments and that the same is his/her/their free act and deed.
IN TESTIMONY WHEREOF, I have hereunto set my hand and official seal at __________________________________, Ohio this ________ day of _______________________________, 20____.
__________________________________________
Signature of Notary Public