Ann Robbins' Will

Megan Shore
MICROSOFT [Company address]
ANN ROBBINS’ LAST WILL
AND TESTAMENT

Megan Shore
Ann Robbins’ Will
1 Initial Here: _____
LAST WILL AND TESTAMENT
OF
ANN MARIE ROBBINS
I, ANN MARIE ROBBINS, a resident of the City of Chicago, County of Cook, and State of
Illinois, being of sound mind and memory, do hereby make, publish, and declare this my last
Will and Testament, hereby revoking all prior Wills and Codicils.
ARTICLE I
INTRODUCTION
1.1 IDENTIFICATION. I, ANNE MARIE ROBBINS was born on October 31, 1941 and I
am divorced from Benjamin Robbins. I have two living children,
CHRISTINA ROBBINS, born January 1, 1974 and ANTHONY ROBBINS, born February 14,
1986. I have no deceased children, and I have not adopted any children.
ARTICLE II
EXECUTOR AND EXECUTOR POWERS
2.1 I nominate and appoint DON JOHNSON as Executor of my last Will and Testament. If
my Executor should, for any reason, fail to qualify, or unable to act in such capacity, or
predecease me, I then nominate and appoint CHRISTOPHER TOMCZAK to my Executor; as
successor; upon like terms.
2.2 WAIVER OF SURETY. I do not require my Executor to post a bond of provide security
or surety to act as executor.
2.3 POWER OF EXECUTOR. I give my Executor the following powers, without
authorization of any court:
(a) To retain, sell, lease for any term, mortgage, pledge, donate or otherwise deal for
any purpose with the property, real or personal, of my estate on any terms that my
Executor shall determine;
(b) To borrow money from an individual, bank or other source;
(c) To invest in any property, and to hold any property in the name of a nominee or in
bearer form;
(d) To employ and pay the compensation of such agents as accountant, and counsel
(legal or investment);

Megan Shore
Ann Robbins’ Will
(e) To execute documents of any kind, including written documents containing
covenants and warranties binding upon and creating a charge against my estate and
containing provisions excluding personal liability; and
(f) To make distributions from my estate in cash or in kind, or partly in each and to
value any property for that purpose; and to allocate shares of property among the
beneficiaries.
2.4 ADMINISTRATION OF ESTATE. I authorize my Executor to administer my estate as
is necessary. If, under applicable state law, administration of my estate may be conducted
without court supervision, then my Executor should do so, as long doing so would not be
inconsistent with the best interests of the beneficiaries as determined by the Executor.
ARTICLE III
3.1 PAYMENTS. My Executor shall make the following payments:
(a) ESTATE TAXES. All of my estate taxes.
(b) EXPENSES. All of my last illness, costs of safeguarding and delivering personal
property, and estate administration expenses.
(c) DEBTS. All of my legally enforceable debts, other than debts secured by life
insurance, by an interest in a land trust or cooperative, or by real property.
3.2 SOURCE OF PAYMENTS GENERALLY. My Executor shall make all payments
required under Article 3, from my estate prior to distributing any gifts or bequests to my
beneficiaries.
(a) I authorize my Executor to use any and all stocks purchased in my name as a way
to pay any and all taxes, expenses, and debts.
(b) I authorize my Executor to use any and all Bank Accounts in my name as a way
to pay any and all taxes, expenses, and debts, if any and all stocks purchased in my name
do not pay any and all taxes, expenses, and debts.

Megan Shore
Ann Robbins’ Will
ARTICLE IV
SPECIFIC GIFTS
4.1 SPECIFIC GIFTS. I make the following specific bequests of personal property to be
dispersed as set forth in this section, following the rule of ademption:
(a) I give, devise, and bequeath my Great Grandmother’s two (2) carat Diamond Ring
to Christina Robbins, my daughter, if she is living thirty (30) days after my death. If she does
not survive me, I give, devise, & bequeath my Great Grandmother’s two (2) carat Diamond Ring
to Anthony Robbins, my son, per capita.
(b) I give, devise, and bequeath my house at 5411 N. Belmont, Chicago, IL 60658 to
Christina Robbins, my daughter, if she is living thirty (30) days after my death. If she does not
survive me, I give, devise, & bequeath my house located at 5411 N. Belmont, Chicago, IL 60658
to Anthony Robbins, my son, per capita.
(c) I give, devise, and bequeath my ruby Cufflinks, given to me by my father, to
Anthony Robbins, my son, if he is living thirty (30) days after my death. If he does not survive
me, I give, devise, & bequeath my ruby Cufflinks, given to me by my father, to Christina
Robbins, my daughter, per capita.
(d) I give, devise, and bequeath my 2010 Cadillac SUV to Anthony Robins, my son,
if he survives me, if he is living thirty (30) days after my death. If he does not survive me, I
give, devise, & bequeath my 2010 Cadillac SUV to Christina Robbins, my daughter, per capita.
ARTICLE V
GENERAL GIFTS
5.1 GENERAL GIFTS. I make the following general bequest of personal property to be
(a) I give, devise, and bequeath $5000.00 to Wilbur Wright College.
(b) I give, devise, and bequeath $10,000.00 to Jane McNiven, my good friend, if she
is living thirty (30) days after my death. If she does not survive me, I give, devise, & bequeath
the $10,000.00 to my residual estate.

Megan Shore
Ann Robbins’ Will
ARTICLE VI
RESIDUAL ESTATE
6.1 RESIDUAL ESTATE. I make the following general bequest of residual property to be
(a) I give, devise, and bequeath the residuary of my estate equally to Christina
Robbins, my daughter, and Anthony Robbins, my son.
ARTICLE VII
DEFINITIONS:
7.1 ADEMPTION. “Ademption” of a bequest is the extinction, alienation, withdrawal or
satisfaction of a bequest by some act of the testator by which an intention to revoke is indicated.
7.2 CHILD. A “Child” is born naturally of the testator.
7.3 ESTATE TAX. “Estate tax” includes all estate, transfer, inheritance, and other
succession taxes (including penalties and interest) imposed by reason of death.
7.4 EXECUTOR. “Executor” is the selected individual who administers the estate and
carries out the terms of the will.
7.5 INCAPACITY. An individual will be considered “Incapacitated”
(a) If under the legal age of 18.
(b) Legally disabled.
(c) Determined by a physician or a Court of Law that a person is lacking the ability to
understand one's actions.
7.6 PERSONAL PROPERTY. “Personal Property” property that is movable and touchable,
including chattel, household goods, and money. Personal property includes tangible and
intangible items.
7.7 RESIDUARY ESTATE. “Residuary Estate” means:
(a) The remaining assets after all expenses and debts are satisfied.
(b) The remaining assets not provided for in this Last Will and Testament after all
gifts are fulfilled.
ARTICLE VIII

Megan Shore
Ann Robbins’ Will
SEVERABILITY
8.1 If any portion of my Last Will and Testament shall be held illegal, invalid or otherwise
inoperative, it is my intention that all of the other provisions of this Last Will and Testament
shall continue to be fully effective and operative as far as is possible and reasonable.
I, ANN MARIE ROBBINS, being of sound and disposing mind and memory, do hereby make,
publish, and declare this Last Will and Testament consisting of five (5) typewritten pages, the
next two (2) pages, and on all pages of which I have placed my initials for security and
identification.
_____________________________ day of __________________________________, 2015.
Signed: __________________________________________
ANN MARIED ROBBINS

Megan Shore
Ann Robbins’ Will
Signed, published and declared by the above-named testator, ANN MARIE ROBBINS,
as and for her Last Will and Testament, in the presence of us who at the testator’s request, in her
presence and in the presence of each other have herunto subscribed out names as witnesses:
WITNESS: ADDRESS OF WITNESS:
Signed: __________________________ ______________________________
Printed: __________________________ ______________________________
Dated: ___________________________
Signed: _________________________ ______________________________
Printed: _________________________ ______________________________
Dated: __________________________

Megan Shore
Ann Robbins’ Will
Self–Proving Affidavit
Signed, published and declared by the above-named testator, ANN MARIE ROBBINS, as and
for her Last Will and Testament, in the presence of us who at the testator’s request, in her
presence and in the presence of each other have herunto subscribed out names as witnesses:
WITNESS: ADDRESS OF WITNESS:
Signed: __________________________ ______________________________
Printed: __________________________ ______________________________
Dated: ___________________________
Signed: _________________________ ______________________________
Printed: _________________________ ______________________________
Dated: __________________________
Subscribed and sworn to before me this ______ day of ___________________, 2015.
____________________________________
Notary Public
My Commission Expires: ______________

Megan Shore
Ann Robbins’ Will
ILLINOIS STATUTORY SHORT FORM
POWER OF ATTORNEY FOR PROPERTY
1. I, ANN MARIE ROBBINS of 5411 N. BELMONT CHICAGO, IL 60658 hereby revoke
all prior powers of attorney for property executed by me and appoint: ANTHONY ROBBINS,
my son as my attorney-in-fact (my "agent") to act for me and in my name (in any way I could act
in person) with respect to the following powers, but subject to any limitations on or additions to
the specified powers inserted in paragraph 2 or 3 below:
(NOTE: You must strike out any one or more of the following categories of powers you do not
want your agent to have. Failure to strike the title of any category will cause the powers
described in that category to be granted to the agent. To strike out a category you must draw a
line through the title of that category.)
(a) Real estate transactions.
(b) Financial institution transactions.
(c) Stock and bond transactions.
(d) Tangible personal property transactions.
(e) Safe deposit box transactions.
(f) Insurance and annuity transaction.
(g) Retirement plan transactions.
(h) Social Security, employment and military service benefits.
(i) Tax matters.
(j) Claims and litigation.
(k) Commodity and option transactions.
(l) Business operations.
(m) Borrowing transactions.
(n) Estate transactions.
(o) All other property transactions.
2. The powers granted above shall not include the following powers or shall be modified or
limited in the following particulars:
(NOTE: Here you may include any specific limitations you deem appropriate, such as a
prohibition or conditions on the sale of particular stock or real estate or special rules on
borrowing by the agent.)
At no time will my agent be allowed to sell my real property at 5411 N. BELMONT,
CHICAGO IL, 60658 location.

Megan Shore
Ann Robbins’ Will
3. In addition to the powers granted above, I grant my agent the following powers:
(NOTE: Here you may add any other delegable powers including, without limitation, power to
make gifts, exercise powers of appointment, name or change beneficiaries or joint tenants or
revoke or amend any trust specifically referred to below.)
My Agent is welcome to rent or lease my real property at 5411 N. BELMONT, CHICAGO IL,
60658.
(NOTE: Your agent will have authority to employ other persons as necessary to enable the agent
to properly exercise the powers granted in this form, but your agent will have to make all
discretionary decisions. If you want to give your agent the right to delegate discretionary
decision-making powers to others, you should keep paragraph 4, otherwise it should be struck
out.)
4. My agent shall have the right by written instrument to delegate any or all of the foregoing
powers involving discretionary decision-making to any person or persons whom my agent may
select, but such delegation may be amended or revoked by any agent (including any successor)
named by me who is acting under this power of attorney at the time of reference.
(NOTE: Your agent will be entitled to reimbursement for all reasonable expenses incurred in
acting under this power of attorney. Strike out paragraph 5 if you do not want your agent to also
be entitled to reasonable compensation for services as agent.)
5. My agent shall be entitled to reasonable compensation for services rendered as agent under
this power of attorney
(NOTE: This power of attorney may be amended or revoked by you at any time and in any
manner. Absent amendment or revocation, the authority granted in this power of attorney will
become effective at the time this power is signed and will continue until your death, unless a
limitation on the beginning date or duration is made by choosing and completing one or both of
paragraphs 6 and 7 :)
6. (X) This power of attorney shall become effective on the day my physician deems me
incapacitated through written determination.
7. (X) This power of attorney shall terminate on the day of my death.

Megan Shore
Ann Robbins’ Will
(NOTE: If you wish to name one or more successor agents, insert the name and address of each
successor agent in paragraph 8.)
8. If any agent named by me shall die, become incompetent, resign or refuse to accept the
office of agent, I name the following (each to act alone and successively, in the order named) as
successor(s) to such agent:
Christina Robbins, my daughter
For purposes of this paragraph 8, a person shall be considered to be incompetent if and while the
person is a minor or an adjudicated incompetent or a person with a disability or the person is
unable to give prompt and intelligent consideration to business matters, as certified by a licensed
physician.
9. If a guardian of my estate (my property) is to be appointed, I nominate the agent acting
under this power of attorney as such guardian, to serve without bond or security.
10. I am fully informed as to all the contents of this form and understand the full import of this
grant of powers to my agent.
(NOTE: This form does not authorize your agent to appear in court for you as an attorney-at-law
or otherwise to engage in the practice of law unless he or she is a licensed attorney who is
authorized to practice law in Illinois.)
11. The Notice to Agent is incorporated by reference and included as part of this form.
Dated: ______________________________
Signed: ____________________________________________________
(Ann Robbins)

Megan Shore
Ann Robbins’ Will
The undersigned witnesses certifies that ANN MARIE ROBBINS, know to me to be the same
person whose name is subscribed as principal to the foregoing power of attorney, appeared
before me and the notary public and acknowledged signing and delivering the instrument as the
free and voluntary act of the principal, for the uses and purposes therein set forth. I believe her
to be of sound mind and memory. The undersigned witness also certifies that the witness is not:
(a) the attending physician or mental health service provider or relative of the physician or
provider; (b) an owner, operator, or relative on an owner or operator of a health care facility in
which the principal is a patient or resident; (c) a parent, sibling, descendant, or any spouse of
such parent, sibling or descendant of either the principal or any agent or successor agent under
the foregoing power of attorney, whether such relationship is by bloom, marriage, or adoption;
(d) an agent or successor agent under the foregoing power of attorney.
Dated: ______________________________
Printed Name: _______________________________________________________
Signature: ___________________________________________________________
(Witness)
Dated: ___________________________________
Printed Name: ________________________________________________________
Signature: ____________________________________________________________
(Second Witness)

Megan Shore
Ann Robbins’ Will
State of Illinois )
) SS.
County of Cook )
The undersigned, a notary public in and for the above county and state, certifies that
ANN MARIE ROBBINS, know to me to be the same person whose name is subscribed as
principal to the foregoing power of attorney, appeared before me and the witness (es)
__________________________________ (and ____________________________) in person
and acknowledged signing and delivering the instrument as the free and voluntary act of the
principal, for the uses and purposes therein set forth (and certified to the correctness of the
signature(s) of the agent(s)).
Dated: _____________________________
___________________________________
Notary Public
Signature of agent (and successors). I certify that the signatures of my
Agents (and successors) are correct.
_____________________________________ ____________________________________
Anthony Robbins Ann Robbins
______________________________________ ____________________________________
Christina Robbins Ann Robbins
_______________________________________ ____________________________________
(Successor Agent) Ann Robbins

Megan Shore
Ann Robbins’ Will
NOTICE TO AGENT
When you accept the authority granted under this power of attorney a special legal relationship,
known as agency, is created between you and the principal. Agency imposes upon you duties
that continue until you resign or the power of attorney is terminated or revoked.
As agent you must:
(1) Do what you know the principal reasonably expects you to do with the principal’s
property;
(2) Act in good faith for the best interest of the principal, using due care, competence, and
diligence;
(3) Keep a complete and detailed record of all receipts, disbursements, and significate actions
conducted for the principal;
(4) Attempt to preserve the principal’s estate plan, to the extent actually known by the agent,
if preserving the plan is consistent with the principal’s best interest; and
(5) Cooperate with a person who has authority to make health care decisions for the principal
to carry out the principal’s reasonable expectations to the extent actually in the principal’s best
interest.
As agent you must not do any of the following:
(1) Act so as to create a conflict of interest that is inconsistent with the other principles in
this Notice to Agent;
(2) Do any act beyond the authority granted in this power of attorney;
(3) Commingle the principal’s funds with your funds;
(4) Borrow funds or other property from the principal, unless otherwise authorized;
(5) Continue acting on behalf on the principal if you learn of any event that terminates this
power of attorney or your authority under this power of attorney, such as the death of principal,
your legal separation from the principal, or the dissolution of your marriage to the principal.
If you have special skills or expertise, you must use those special skills and expertise when
acting for the principal. You must disclose your identity as an agent whenever you act for the
principal by writing or printing the name of the principal and signing your own name “as Agent”
in the following manner:
“(Principal’s Name) by (Your Name) as Agent”
If you violate your duties as agent or act outside the authority granted to you, you may be liable
for any damages, including attorney’s fees and costs, cause by your violation.
If there is anything about this document or your duties that you do not understand, you should
seek legal advice from an attorney.

Megan Shore
Ann Robbins’ Will
AGENT’S CERTIFICATION AND ACCEPTANCE OF AUTHORITY
I, ANTHONY ROBBINS, certify that the attached is a true copy of a power of attorney
naming the undersigned as agent or successor agent for ANN MARIE ROBBINS.
I certify that to the best of my knowledge the principal had the capacity to execute the
power of attorney, is alive, and has not revoked the power of attorney; that my powers as agent
have not been altered or terminated; and that the power of attorney remains in full force and
effect.
I accept appointment as agent under this power of attorney.
Dated: ________________________________________
_______________________________________________
(Anthony Robbins Signature)
_______________________________________________
(Print Anthony Robbins Name)
831 W. Oakdale Ave., Chicago, IL 60657
(Anthony Robbins Address)

Megan Shore
Ann Robbins’ Will
MY POWER OF ATTORNEY FOR HEALTH CARE
THIS POWER OF ATTORNEY REVOKES ALL PREVIOUS POWERS OF ATTORNEY
FOR HEALTH CARE. (You must sign this form and a witness must also sign it before it is
valid)
Principal Name: ANN MARIE ROBBINS
My address: 5411 N. Belmont, Chicago, IL 60658
I WANT THE FOLLOWING PERSON TO BE MY HEALTH CARE AGENT
(An agent is your personal representative under state and federal law):
Agent Name: Anthony Robbins Relationship: Son
Agent address: 831 W. Oakdale Ave., Chicago, IL 60657
Agent phone number: 773-545-9785
MY AGENT CAN MAKE HEALTH CARE DECISIONS FOR ME, INCLUDING:
(i) Deciding to accept, withdraw or decline treatment
For any physical or mental condition of mine, including life-and-death decisions.
(ii) Agreeing to admit me to or discharge me from any
hospital, home, or other institution, including a mental health facility.
(iii) Having complete access to my medical and mental
health records and sharing them with others as needed, including after I die.
(iv) Carrying out the plans I have already made, or,
if I have not done so, making decisions about my body or remains, including organ, tissue
or whole body donation, autopsy, cremation, and burial.
The above grant of power is intended to be as broad as possible so that my agent will have the
authority to make any decision I could make to obtain or terminate any type of health care,
including withdrawal of nutrition and hydration and other life-sustaining measures.
I AUTHORIZE MY AGENT TO (please check any one box):
X Make decisions for me only when I cannot make them for myself. The physician(s) taking
care of me will determine when I lack this ability.
(If no box is checked, then the box above shall be implemented) OR
___ Make decisions for me starting now and continuing after I am no longer able to make them
for myself. While I am still able to make my own decisions, I can still do so if I want to.

Megan Shore
Ann Robbins’ Will
The subject of life-sustaining treatment is of particular importance. Life-sustaining
treatments may include tube feedings or fluids through a tube, breathing machines, and CPR. In
general, in making decisions concerning life-sustaining treatment, your agent is instructed to
consider the relief of suffering, the quality as well as the possible extension of your life, and your
previously expressed wishes. Your agent will weigh the burdens versus benefits of proposed
treatments in making decisions on your behalf.
Additional statements concerning the withholding or removal of life-sustaining treatment are
described below. These can serve as a guide for your agent when making decisions for you. Ask
your physician or health care provider if you have any questions about these statements.
SELECT ONLY ONE STATEMENT BELOW THAT BEST EXPRESSES YOUR
WISHES (optional):
X The quality of my life is more important than the length of my life. If I am unconscious and
my attending physician believes, in accordance with reasonable medical standards, that I will not
wake up or recover my ability to think, communicate with my family and friends, and experience
my surroundings, I do not want treatments to prolong my life or delay my death, but I do want
treatment or care to make me comfortable and to relieve me of pain.
___Staying alive is more important to me, no matter how sick I am, how much I am suffering,
the cost of the procedures, or how unlikely my chances for recovery are. I want my life to be
prolonged to the greatest extent possible in accordance with reasonable medical standards.
SUCCESSOR HEALTH CARE AGENT(S) (optional):
If the agent I selected is unable or done not want to make health care decisions for me,
then I request the person I name below to be my successor health care agent.
Christina Robbins, Daughter, 406 Sherman Ave, Park Forest, IL 60466; 708-748-5039
(Successor agents #1, relationship, address, and phone number)
SPECIFIC LIMITATIONS TO MY AGENT'S DECISION-MAKING AUTHORITY:
The above grant of power is intended to be as broad as possible so that your agent will have
the authority to make any decision you could make to obtain or terminate any type of health care.
If you wish to limit the scope of your agent's powers or prescribe special rules or limit the
power to authorize autopsy or dispose of remains, you may do so specifically in this form.
I would like to be buried at Mt. Greenwood Cemetery. Located at 2900 W 111th Street,
Chicago, IL 60655. I do not own a plot; however if possible, I would like to be buried next to
my parents, Elisa and Robert Alberts. I have already paid for my funeral at Kosary Funeral
Home located at 9837 S. Kedzie, Evergreen Park, IL 60805. The relating documents to my pre-
paid funeral are located in my safe located at my home, 5411 N. Belmont Chicago, IL 60658.
If a guardian of my person is to be appointed, I nominate the agent acting under this power of
attorney as such guardian, to serve without bond or security.
My signature: _________________________________________________________________
Today's date: _________________________________________________________________

Megan Shore
Ann Robbins’ Will
HAVE YOUR WITNESS AGREE TO WHAT IS WRITTEN BELOW, AND THEN
COMPLETE THE SIGNATURE PORTION:
I am at least 18 years old. (Check the options below that apply):
___ I saw the principal sign this document, or
___ The principal told me that the signature or mark on the principal signature line is hers.
___ I am not the agent or successor agent(s) named in this document. I am not related to the
principal, the agent, or the successor agent(s) by blood, marriage, or adoption. I am not the
principal's physician, mental health service provider, or a relative of one of those individuals. I
am not an owner or operator (or the relative of an owner or operator) of the health care facility
where the principal is a patient or resident.
Witness printed name: ________________________________________
Witness address: _____________________________________________
Witness signature: ____________________________________________
Today's date: _____________________
HAVE YOUR WITNESS AGREE TO WHAT IS WRITTEN BELOW, AND THEN
COMPLETE THE SIGNATURE PORTION:
I am at least 18 years old. (Check the options below that apply):
___ I saw the principal sign this document, or
___ The principal told me that the signature or mark on the principal signature line is hers.
___ I am not the agent or successor agent(s) named in this document. I am not related to the
principal, the agent, or the successor agent(s) by blood, marriage, or adoption. I am not the
principal's physician, mental health service provider, or a relative of one of those individuals. I
am not an owner or operator (or the relative of an owner or operator) of the health care facility
where the principal is a patient or resident.
Witness #2 printed name: ______________________________________
Witness #2 address: ___________________________________________
Witness #2 Signature: __________________________________________
Today’s date: _____________________

Megan Shore
Ann Robbins’ Will
State of Illinois )
) SS.
County of Cook )
The undersigned, a notary public in and for the above county and state, certifies that
______________________________, know to me to be the same person whose name is
subscribed as principal to the foregoing power of attorney, appeared before me and the witness
(es) __________________________________ (and ____________________________) in
person and acknowledged signing and delivering the instrument as the free and voluntary act of
the principal, for the uses and purposes therein set forth (and certified to the correctness of the
signature(s) of the agent(s)).
Dated: _____________________________
___________________________________
Notary Public

Megan Shore
Ann Robbins’ Will
AGENT’S CERTIFICATION AND ACCEPTANCE OF AUTHORITY
I, Anthony Robbins, certify that the attached is a true copy of a power of attorney
naming the undersigned as agent for Ann Marie Robbins.
I certify that to the best of my knowledge the principal had the capacity to execute the power of
attorney, is a live, and has not revoked the power of attorney; that my powers as agent have not
been altered or terminated; and that the power of attorney remains in full force and effect.
Dated: ___________________________________
__________________________________________
(Anthony Robbins’ Signature)
___________________________________________
(Print Anthony Robbins’ Name)
831 W. Oakdale Ave., Chicago, IL 60657
(Anthony Robbins’ Address)

Megan Shore
Ann Robbins’ Will
AGENT’S CERTIFICATIONAND ACCEPTANCE OF AUTHORITY
I, Christina Robbins, certify that the attached is a true copy of a power of attorney
naming the undersigned as successor agent for Ann Marie Robbins.
I certify that to the best of my knowledge the principal had the capacity to execute the power of
attorney, is a live, and has not revoked the power of attorney; that my powers as agent have not
been altered or terminated; and that the power of attorney remains in full force and effect.
Dated: ___________________________________
__________________________________________
(Christina Robbins’ Signature)
___________________________________________
(Print Christina Robbins’ Name)
406 Sherman Ave, Park Forest, IL 60466
(Christina Robbins’ Address)

Megan Shore
Ann Robbins’ Will
LIVING WILL
DECLARATION
This declaration is made this_________ day of _____________, 20__ (month, year). I, ANN
MARIE ROBBINS, being of sound mind, willfully and voluntarily make known my desires that
my moment of death shall not be artificially postponed.
If at any time I should have an incurable and irreversible injury, disease, or illness judged to
be a terminal condition by my attending physician who has personally examined me and has
determined that my death is imminent except for death delaying procedures, I direct that such
procedures which would only prolong the dying process be withheld or withdrawn, and that I be
permitted to die naturally with only the administration of medication, sustenance, or the
performance of any medical procedure deemed necessary by my attending physician to provide
me with comfort care.
In the absence of my ability to give directions regarding the use of such death delaying
procedures, it is my intention that this declaration shall be honored by my family and physician
as the final expression of my legal right to refuse medical or surgical treatment and accept the
consequences from such refusal.
Signed: ________________________________________________
City, County and State of Residence: City of Chicago, County of Cook and State of Illinois
The declarant is personally known to me and I believe him or her to be of sound mind. I saw
the declarant sign the declaration in my presence (or the declarant acknowledged in my presence
that he or she had signed the declaration) and I signed the declaration as a witness in the presence
of the declarant. I did not sign the declarant's signature above for or at the direction of the
declarant. At the date of this instrument, I am not entitled to any portion of the estate of the
declarant according to the laws of intestate succession or, to the best of my knowledge and
belief, under any will of declarant or other instrument taking effect at declarant's death, or
directly financially responsible for declarant's medical care.
Witness: ______________________________________
Witness: _______________________________________

Ann Robbins' Will

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