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Filing # 189824429 E-Filed 01/16/2024 01:45:46 PM
IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT
IN AND FOR LEON COUNTY, FLORIDA
Case No.: 2024 CA 000101
BELINDA KEISER, in her capacity as co-
agent/attorney-in-fact under the Durable Power
of Attorney for Dr. Belen Collantes Mills,
Petitioner,
V.
ROGER MILLS, SR., in his capacity as co-
agent/attorney-in-fact under the Durable Power
of Attorney for Dr. Belen Collantes Mills,
Respondent.
/
PETITIONER’S PETITION FOR AN ACCOUNTING
PURSUANT TO FLA. STAT. § 709.2116 AND FLA. STAT. § 709.2114(6)
Petitioner, BELINDA KEISER, in her capacity as co-agent/attorney-in-fact for Dr. Belen
Collantes Mills, pursuant to Florida Statutes §§ 709.2116 and 709.2114(6), hereby files this
Petition for An Accounting against Respondent, ROGER MILLS, SR. in his capacity as co-
agent/attorney-in-fact for Dr. Belen Collantes Mills, and in support thereof, states as follows:
INTRODUCTION
I Jurisdiction, Parties, and Venue
1 This court has jurisdiction pursuant to Fla. Stat. § 26.012(2)(b)-(c), Fla. Stat. §
709.2114(6), and Fla. Stat. § 709.2116 and the amount in controversy exceeds $50,000.00
exclusive of fees and costs.
2. Petitioner, Belinda Keiser (“Petitioner”) is an individual who at all times relevant
hereto resides in Broward County, Florida.
COLE, SCOTT & KISSANE, P.A.
ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX
3 Roger Mills, Sr. (“Respondent”) is an individual who at all times relevant hereto
resides in Leon County, Florida.
4 Venue for this action is proper in Leon County, Florida because Respondent resides
and this cause of action arose in Leon County, Florida.
MATERIAL FACTS
Il. Power of Attorney on behalf of Dr. Belen Collantes Mills
5 Dr. Belen Collantes Mills (“Dr. Mills”) is 93 years and has been diagnosed with
dementia. See Hartsfield Evaluation, at Exhibit 1; Evaluation Notes and Letter from Dr. Fountain,
at Composite Exhibit 2; letter from Dr. Ouslander, at Exhibit 3.
6 Dr. Mills can no longer provide informed consent and is totally dependent on others
for her activities of daily living and independent/instrumental activities of daily living.
7 Dr. Mills is a vulnerable adult pursuant to § 415.102(28), Fla. Stat.
Dr. Mills is the mother of Petitioner and Respondent.
Both Petitioner and Respondent are the only living next-of-kin to Dr. Mills and her
heirs.
10. During her life, Dr. Mills accumulated a portfolio of real estate, investment, and
liquid assets.
11. On July 29, 2022, Dr. Mills executed a Durable Power of Attorney (“Power of
Attorney”). See Power of Attorney, attached as Exhibit 4, p. 9.
12. The Power of Attorney appointed Petitioner and Respondent as joint attorneys-in-
fact to jointly make decisions for Dr. Mills for and in her name. See Power of Attorney, Exhibit
4, p. 8.
2
COLE, SCOTT & KISSANE, P.A.
ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX,
13. The Power of Attorney granted Petitioner and Respondent numerous powers on
behalf of Dr. Mills, including but not limited to, the ability to exercise powers of collection and
payment, to acquire, sell, mortgage, or grant security interests, to execute contracts, to exercise
stock or bond powers with the authority with respect to securities held by financial institutions, to
purchase United States Treasury Bonds, and to conduct banking transactions. See Power of
Attorney, Exhibit 4.
14. Since its execution of the Power of Attorney, Respondent has served exclusively as
agent controlling Dr. Mills’ finances.
15. On March 3, 2023, Dr. Mills appointed Petitioner her sole Health Care Surrogate
and delegated the full authority to make decisions for Dr. Mills regarding her health care. See
Durable Power of Attorney of Health Care, attached as Exhibit 5.
16. Petitioner is unaware of the full state of Dr. Mills’ finances and has paid a
substantial amount of Dr. Mills’ health care needs herself, including but limited to living expenses
for caregivers, physicians, and case managers.
iil. Petitioner’s Request for and Accounting from Respondent
17. On August 8, 2023 at 11:32 AM, counsel for Petitioner sent a formal request for a
complete accounting of Dr. Mills’ assets and liabilities to Respondent, including requesting “a list
of Dr. Mills real estate holdings, investment accounts, bank accounts, stocks, bonds and any other
assets for which she holds any interests.” See Email Thread with Roger Mills, Sr., attached as
Exhibit 6.
18. Respondent replied the same day, on August, 8, 2023, at 2:01 PM stating, “I do not
have authorization to share that information, My mother is still alive and is still making her own
financial decisions.” See Exhibit 6.
3
COLE, SCOTT & KISSANE, P.A.
ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX,
19. On August 11, 2023, counsel for Petitioner emailed Respondent stating, “Your
mother has told Belinda that she would like an accounting of her assets — I am just following so
that the same takes place. Making sure that all of your mother’s finances are in order is prudent.”
See Exhibit 6.
20. Unfortunately, the Federal Tax Returns for the years 2020, 2021, and 2022 were
delayed and were not brought current until the Petitioner and Dr. Mills’ accountant informed the
Respondent of the missing financial information required in order to complete the tax returns. See
Email Thread with Devlin Saley, CPA, attached as Exhibit 7.
21. To date, the only accounting materials provided by Respondent have been Dr.
Mills’ Federal Tax Returns from the years 2020, 2021, and 2022 which was provided on December
12, 2023. See Email Confirming Tax Returns, attached as Exhibit 8.
22. Petitioner recently learned that Respondent failed to comply with Dr. Mills’
accountant’s request for documentation, which resulted in Dr. Mills’ federal tax returns being filed
extremely late. Further, upon review, the tax returns appear potentially incomplete. In short, Dr.
Mills’ federal tax returns raised more questions than answers.
23. Respondent refused to provide any other financial information concerning Dr.
Mills’ assets, liabilities, and asset sales.
24. Respondent has also indicated that he needs to sell one of Dr. Mills’ properties —
implying there is not enough money to support Dr. Mills’ needs.
25. Given Respondent’s refusal to provide a full accounting to Petitioner, Petitioner is
concerned that Respondent is dissipating Dr. Mills’ assets for his own benefit.
26. Petitioner seeks this accounting in good faith for the purpose of ensuring there is
no impropriety and Dr. Mills’ assets are being preserved for her benefit.
4
COLE, SCOTT & KISSANE, P.A.
ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX,
COUNT 1 - ACCOUNTING
27. Petitioner realleges and reavers Paragraphs | through 26 as if restated herein.
28. This is an action for an accounting pursuant to Fla. Stat. § 709.2114 and § 709.2116.
29. An agent “[m]ust keep a record of all receipts, disbursements, and transactions
made on behalf
of the principal.” Fla. Stat. § 709.2114(1)(c).
30. Upon the request, “an agent must disclose receipts, disbursements, and transactions
conducted on behalf
of the principal.” Fla. Stat. § 709.2114(6).
31. Pursuant to the Power of Attorney, Respondent is an agent of Dr. Mills. See Power
of Attorney, Exhibit 4.
32. Respondent has a duty to provide a full accounting of Dr. Mills’ assets and
liabilities when formally requested by Petitioner within 60 days of a formal request or request
additional time to comply with the request. Fla. Stat. § 709.2114(6).
33. Petitioner, through her counsel, has requested an accounting of Dr. Mills’ assets
and liabilities on two previous occasions, to wit: August 8, 2023 and August 11, 2023. See Exhibit
3
34. On August 8, 2023 and August 11, 2023, Respondent refused and ignored,
respectively, Petitioner’s full accounting requests. See Exhibit 6; see also Fla. Stat. §
709.2114(1)(a)(1)-(3); Fla. Stat. § 709.2114(6).
35. On information and belief, Respondent is not acting in Dr. Mills’ best interest but
acting in his own self-interest. Fla. Stat. § 709.2114(1)(a)(3)-(4).
36. On information and belief, Respondent is not preserving Dr. Mills’ property and
her foreseeable obligations and need for maintenance. Fla. Stat. § 709.2114(1)(a)(3)-(4).
5
COLE, SCOTT & KISSANE, P.A.
ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX,
WHEREFORE, Petitioner requests this Honorable Court provide the following relief
pursuant to Fla. Stat. § 709.2114(6) and § 709.2116:
1 Enter an order requiring Respondent to provide a full accounting of Dr. Mills’
assets and liabilities pursuant to Fla. Stat. § 709.2114(6);
2. Award reasonable attorneys’ fees accrued in pursuit of this Petition to receive a
proper accounting pursuant to Fla. Stat. § 709.2114(6) and Fla. Stat. § 709.2116; and
3 Other such relief the Court finds just and proper.
Dated: January 16, 2024 Respectfully submitted,
COLE SCOTT & KISSANE, P.A.
222 Lakeview Avenue Suite 120
West Palm Beach, FL 33401
Tel: (561) 383-9200
Fax: (561) 683-8977
Barry.Postman@csklegal.com
/s/ Barry Postman
BARRY POSTMAN
FBN: 991856
6
COLE, SCOTT & KISSANE, P.A.
ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX,
EXHIBIT 1
CONFIDENTIAL MEDICAL RECORDS — MOTION TO
DETERMINE CONFIDENTIALITY TO BE FILED
CONTEMPORANEOUSLY
COMPOSITE
EXHIBIT 2
CONFIDENTIAL MEDICAL RECORDS — MOTION TO
DETERMINE CONFIDENTIALITY TO BE FILED
CONTEMPORANEOUSLY
EXHIBIT 3
CONFIDENTIAL MEDICAL RECORDS — MOTION TO
DETERMINE CONFIDENTIALITY TO BE FILED
CONTEMPORANEOUSLY
EXHIBIT 4
DURABLE POWER OF ATTORNEY
Clorida Statutes, Sections 709.2101-709.2402)
KNOW ALL MEN BY THESE PRESENTS, that I, BELEN C. MILLS, of Gadsten County,
Florida, do hereby nominate, constitute and appoint my son, ROGER A. MILLS, of Tallahassee,
Florida, and my daughter BELINDA M. KEISER, of Parkland, Florida, to serve jointly as my
attorneys-in-fact and to jointly make decisions for me and in my name, place and stead, and for my
use and benefit and to perform the acts set forth below in this instrument; provided, however, that
if only one of them is available or able to participate in said decisions or said matters on my behalf,
then and in that event the designated agent shall serve as my designated attomey-in-fact for my use
and benefit and to perform the acts set forth in this instrument.
1. General Grant of Power. To exercise or perform any act, power, duty, right or obligation
whatsoever that I now have or may hereafter acquire, relating to any person, matter, transaction or
property, real or personal, tangible or intangible, now owned or hereafter acquired by me, including,
without limitation, the following specifically enumerated powers. I grant to my agent full power and
authority to do everything necessary in exercising any of the powers herein granted as fully as I
might or could do if personally present, with full power of substitution or revocation, hereby
ratifying and confirming all that my agent shall lawfully do or cause to be done by virtue of this
Power and the powers herein granted.
2. Powers of Collection and Payment. To forgive, request, demand, sue for, recover, collect,
receive, hold all such sums of money, debts, dues, commercial paper, checks, drafts, accounts,
deposits, legacies, bequests, devises, notes, interests, stock certificates, bonds, dividends, certificates
of deposit, annuities, pension, profit sharing, retirement, social security, insurance and other
contractual benefits and proceeds, all documents oftitle, all property, real or personal, intangible and
tangible property and property rights, and demands whatsoever, liquidated or unliquidated, now or
hereafter owned by or due, payable or belonging to me, or in which I have or may hereafter acquire
an interest; to have, use, and take all lawful means and equitable and legal remedies and proceedings
in my name for the collection and recovery thereof, and to adjust, sell, compromise and agree for the
same, and to execute and deliver for me, on my behalf and in my name, all endorsements, releases,
receipts or other sufficient discharges for the same;
3. Power to Acquire. Sell. Mortgage or Grant Security Interests. To acquire, purchase,
exchange, mortgage, grant security interests in, grant options to sell, and sell and convey real or
personal property (including sale of my homestead - see provisions of Par. 20, if married), tangible
or intangible, or interests therein, on such terms and conditions as my agent shall deem proper;
4. Management Powers. To maintain, repair, improve, invest, manage, insure, rent, lease,
encumber, and in any manner deal with any real or personal property, tangible or intangible, or any
interest therein, that I now own or may hereafter acquire, in my name and for my benefit, upon such
terms and conditions as my agent shall deem proper;
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5. Power to Execute Contracts. To make, receive, sign, endorse, execute, acknowledge, deliver,
and possess such applications, contracts, agreements, options, covenants, conveyances, deeds, trust
deeds, security agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills of
lading, warehouse receipts, documents of title, bills, bonds, debentures, checks, drafts, bills of
exchange, letters of credit, notes, stock certificates, proxies, warrants, commercial paper, withdrawal
receipts, or other receipts and deposit instruments related to accounts or deposits in, or certificates
of deposit of banks, savings and loans, or other institutions or associations, proofs of loss, evidence
of debts, releases, satisfaction of mortgages, liens, judgments, other debts and obligations, and such
other instruments, in writing of whatever kind and nature as may be necessary or proper in the
exercise of the rights and powers granted herein.
6. Stock or Bond Powers: Authority with Respect to Securities Held by Financial Institutions.
To éxecute stock or bond powers, or similar documents on my behalf and to delegate to a transfer
agent or similar person the authority to register any stocks, bonds, or other securities into or out of
my name or nominee's name. Further, my attorney-in-fact shall have authority to conduct investment
transactions as provided in Section 709.2208(2), Florida Statutes, or any amendmentto such statute
subsequently adopted.
7. Treasury Bonds. To purchase United States Treasury Bonds and other United States obligations
redeemable at par for the payment of estate taxes.
8. Authority to Conduct Banking Transactions. To make, receive and endorse checks and drafts,
deposit and withdraw funds, acquire and redeem certificates of deposit in banks, savings and loan
associations and other institutions, execute or release such deeds of trust or other security agreements
as may be necessary or proper in the exercise of the rights and powers herein granted. Further, my
attorney-in-fact shall have authority to conduct all banking transactions as provided in Section
709.2208(1), Florida Statutes, or any amendment to such statute subsequently adopted.
9. Motor Vehicles. To apply for a Certificate of Title upon, and endorse and transfer title thereto,
for any automobile, truck, pickup, van, motorcycle or other motor vehicle and to represent in such
transfer assignment that the title to said motor vehicle is free and clear ofall liens and encumbrances,
except those specifically set forth in such transfer assignment;
10. Business Interests. To conduct or participate in any lawful business of whatever nature for me
and in my name; execute parinership agreements and amendments thereto; incorporate, reorganize,
merge, consolidate, recapitalize, sell, liquidate or dissolve any business; elect or employ officers,
directors and agents, carry out the provisions of any agreement for the sale of any business interest
or the stock therein; exercise voting rights with respect to stock, either in person or by proxy, and
exercise stock options;
11. Safe Deposit Boxes. To have access at any time or times to any safe deposit box rented by me,
wheresoever located, and to remove all or any part of the contents thereof, and to surrender or
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relinquish said safe deposit box, and any institution in which any such safe deposit box may be
located shall not incur any liability to me or my estate as a result of permitting my agent to exercise
this Power.
12. Revocable Trust. To transfer and convey any of my property to the trustee or trustees, then
acting under any revocable trust agreement executed by me (regardless of whether such trust
agreement was executed or amended prior to or subsequent to the date hereof, and regardless of
whether, by virtue of the terms of such trust agreement, the property transferred to the trustee(s) of
such trust will, upon my death, be distributed pursuant to the provisions of such trust agreement
instead of being made a part of my probate estate and thus being ultimately distributedin accordance
with the provisions of my will or pursuant to laws of descent and distribution). This shall include
the power to transfer the same into the names of any nominee or nominees, as such trustee or trustees
shall direct (even into the names of persons or firms which would not cause the ownership of public
record to appear as being in the name of such trust). Further, the power to withdraw any assets
and/or income from any such revocable trust executed by me.
13. Power to Disclaim, Renounce, Release, Abandon or Waive Property Interests. To renounce,
disclaim and waive any property or interest in property or powers to which for any reason and by any
means I may become entitled, whether by gift, testate or intestate succession; to release or abandon
any property or interest in property or powers which I may now or hereafter own, including any
interests in or rights over trusts (including the right to alter, amend, revoke or terminate) and to
exercise (or not exercise) any right to claim an elective share in any estate or under any will, and in
exercising such discretion, my Agent may take into account such matters as shall include but shall
not be limited to any reduction in estate or inheritance taxes on my estate, and the effect of such
renunciation or disclaimer upon persons interested in my estate and persons who would receive the
renounced or disclaimed property. [The following elections are mandated by Section 709.2202
Fla. Stat., Laws of Florida (2011)]
A. Authority of my attorney-in-fact to waive my right to be a beneficiary of a joint
and survivor annuity, including a survivor benefit under a retirement plan. [Initial (1) or (2)
below, but not both]. [Section 709.2202(1)(f), Fla. Stat.] Initial those specific provisions below
reflecting the withholding or granting authority to your agent; initial those provisions you wish
to apply; cross out and initial those you do not want to apply.]
vw x (D.
My attorney-in-fact SHALL HAVE authority to waive my right to bea
beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement
plan.
a! Mt @). My attorney-in-fact SHALL NOT HAVE authority to waive my right to
be a beneficiary of a joint and survivor annuity, including a survivor benefit under a
retirement plan.
B. Authority of my attorney-in-fact to disclaim property and powers of
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appointment. [Initial (1) or (2) below, but not both]. [Section 709.2202(1)(g), Fla. Stat.]
br _X My attorney-in-fact SHALL HAVE the authority to disclaim property
and powers of appointment as set forth in this Paragraph 13.
i {V0 (2). _ My attorney-in-fact SHALL NOT HAVE the authority to disclaim
property and powers of appointment as set forth in this Paragraph 13.
14. Power to Make Gifts. To make gifts or conveyances of my property or interests in my property,
to any one or more members of my family (limited to my children, grandchildren and lineal
descendants), and/or to any inter vivos trust agreement created by me or for my benefit, so as
implement any estate and income tax planning for the benefit of my family; to execute any and all
related documents needed to implement such planning; to withdraw cash or other assets from any
trust created by me if necessary or advisable to complete any gifts which are authorized hereunder
provided Ihave retained the power to withdraw funds from said trust. No such gifts or conveyances
shall, without prior approval from a court of competent jurisdiction, be made in an amount per donee
which exceed the annual dollar limits of the federal gift tax exclusion under 26 U.S.C. 2503(6), as
amended, without regard to whether the federal gift tax exclusion applies to the gift, or ifmy spouse
(if any) agrees to consent to a split gift pursuant to 26 U.S.C. 2513, as amended, in an amount per
donee which exceeds twice the annual federal gift tax exclusion limit. Notwithstanding the
foregoing power and notwithstanding anything to the contrary contained herein or otherwise, no such
gifts or conveyances shall be permitted hereunder if such action would be detrimental to my
economic welfare. Further, pursuant to Section 2513 of the Internal Revenue Code, my attorney-in-
fact shall have the authority to consent to the splitting of a gift made by my spouse in an amount not
to exceed the aggregate annual gift tax exclusions for both spouses.
Authority of my attorney-in-fact to make gifts. [The following elections are mandated
by Section 709.2202(1)(c), (3), Fla. Stat., Laws of Florida (2011)]. Initial those specific
provisions below reflecting the withholding or granting authority to your agent; initial those
provisions you wish to apply; cross out and initial those you do not want to apply.]
ph x (1). Power to Make Annual Exclusion Gifts. I authorize my attomey-in-fact to
make gifts of my property or interests in my property and to split gifts with my spouse, if applicable,
as specificyin the provisions of this Paragraph 14 set forth above.
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——. (2) Power to Make Additional Gifts. 1 further authorize my attorney-in-fact to
male gifts (outright, in trust, or otherwise) of any of my property up to the entirety thereof to, or pay
amounts on behalf of, any one or more of my descendants (including my agent, if my agent isa
descendant of mine) or to any charitable organization to which deductible gifts may be made under
the income and gift tax provisions of the Intemal Revenue Code of 1986, as amended. Such gifts
or amounts paid to my descendants shall include those which are excludible under Section 25 (03(b)
or Section 2503(e) of the Internal Revenue Code of 1986, as amended, or those to which the split
gift provisions of Section 2513 of the Internal Revenue Code of 1986, as amended, are expected to
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apply. Nothing herein shall be construed to require any court action whatsoever prior to making such
gifts, nor to restrict such gifts to a situation in which it must be determined that I will remain
incapacitated for the remainder of my lifetime.
ye x _(3) Power to Make Gifts to Qualify for Public Benefits. If my attorney-in-fact
in his or her sole discretion has determined that I need nursing home or other long-term medical care
and that I will receive proper medical care whether I privately pay for such care or if I am the
recipient of Title XIX (Medicaid) or other public benefits, then my agent shall have the power: (1)
to take any and all steps necessary, in my agent’s judgment, to obtain and maintain my eligibility for
any and all public benefits and entitlement programs, including if necessary, signing a deed with a
retained life estate (also known as a “Lady Bird Deed”) as well as creating and funding a qualified
income trust or special needs trust for me or a disabled child, if any: (4i) to transfer with or without
consideration my assets to my descendants (if any), or to my natural heirs at law or to the persons
named as beneficiaries under my last will and testament or a revocable living trust which Imay have
established, including my agent; and (iii) to enter into a personal services contract for my benefit
including entering into such contract with my agent, even if doing so maybe considered self-dealing.
Such public benefits and entitlement programs shall include, but are not limited to Social Security,
Supplemental Security Income, Medicare, Medicaid and Veterans’ benefits.
7 NO (4) NoAuthority to Make Gifts. I do not authorize my attorney-in-fact to make
gift s of my property or interests in my property, nor do I authorize my agent to split gifts with myis
spouse, if applicable, as specified in the provisions of this Paragraph 14 set forth above. [If this
selected and initialed, strike through Paragraph 14, above and the prior gifting options].
15. Income or Gift Tax Returns. To file income or gift tax returns for any years for which I have
not filed such returns and consent to any gifts made, even though such action subjects my estate to
additional liabilities.
16. Federal. State, Local, Income. Gift and Other Tax Matters. To prepare, sign and file federal,
state, income, gift or other tax returns of all kinds, claims forrefund, amendments to retums, requests
for extensions of time, petitions to the Tax Court or other courts regarding tax matters and any and
all other tax related documents, including, without limitation to, receipts, offers, waivers, consents
(including, but not limited to, consents and agreements under Intemal Revenue Code Section 2032A,
or any successor section thereto), powers of attorney, closing agreements; to exercise any elections
I may have under federal, state or local tax law; and generallyto act in my behalf on all tax matters
of all kinds and for all periods before all persons representing the Internal Revenue Service and any
other taxing authority, including receipt of confidential information and the posting of bonds.
17. Power to Nominate Conservator or Guardian. To nominate and/or petition for the
appointment of my Agent or any person my Agent deems appropriate as primary, successor or
alternate guardian, guardian ad litem or conservator or to any fiduciary office (all of such offices of
guardian, et al. being hereinafter referred to as "Personal Representative") representing me or any
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interest of mine or any person for whom I may have a right or duty to nominate or petition for such
appointment; to grant any such Personal Representative all of the powers under applicable law that
Iam permitted to grant; to waive any bond requirement for such Personal Representative that I am
permitted by law to waive.
18. Health Care Decisions. To make health care decisions for me which he or she believes that
I would have made under the circumstances, had I been capable of making such decision, and to give
or withdraw consent to or from any and all types of medical care, treatment, surgical or diagnostic
procedure, medication or other procedures including the power to sign revocations, waivers,
consents, authorizations and releases pertaining to my health care and treatment which shall include
the power to retain, hire, or terminate physicians and other medical persons or practitioners of the
health arts; to obtain, review, and release to other persons any and all medical records to which Imay
be privy; and, to consent to or withhold consent from the cessation of any life prolonging procedure
pursuant to the Life Prolonging Procedures Act of Florida or under a similar act in any other
jurisdiction (including the right to terminate nutrition and hydration); provided, however, ifpursuant
to the Life Prolonging Procedures Act of Florida or a similar act in any other jurisdiction I have
executed a living will which remains in force, then I direct my attorney-in-fact to enforce the
provisions of the living will in accordance with its terms and provisions.
19, Interpretation and Governing Law. This instrument is to be construed and interpreted as a
Durable Power of Attorney. The enumeration of specific powers herein is not intended to, nor does
it limit or restrict the general powers herein granted to my agent. This instrument is executed and
delivered in the State of Florida, and the laws of the State of Florida shall govern all questions as to
the validity of this Power and the construction of its provisions.
20. Limitations on Powers: Notwithstanding the foregoing, if lam married, my attorney-in-fact
shall not mortgage or convey homestead property without the joinder of my spouse (which joinder
may be accomplished by the exercise of authority in a durable power of attorney executed by my
spouse) or my spouse’s legal guardian. [Section 709.2201 (2)(b), Fla. Stat.] Further, notwithstanding
the foregoing, my attorney-in-fact shall not: (1) perform duties under a contract that requires the
exercise of personal services by me; (2) make any affidavit as to my personal knowledge; (3) vote
in any public election on my behalf; (4) execute or revoke any will or codicil for me; or (5) exercise
any powers or authority granted to me as trustee or as a court-appointed fiduciary. [Section
709.2201(3), Fla. Stat.]. Furthermore, if my named attomey-in-fact is not an ancestor, spouse or
descendant of mine, said attomey-in-fact shall not exercise authority to create in himselfor herself,
or in any individual to whom said agent owes a legal obligation of support, any interest in my
property by means of this Durable Power of Attorney, whether by gift, right of survivorship,
beneficiary designation, disclaimer or otherwise. [Section 709.2202(2), Fla. Stat].
21. Ss €} arate Signed Enumeration of Specific Powers Pursuant to Section 709.2202, Florida
Statutes. [The following elections are mandated by Section 709.2202(1), Fla. Stat., Laws of
Florida (2011). Initial those specific provisions below reflecting the withholding or granting
authority to your agent; initial those provisions you wish to apply; cross out and initial those
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you do not want to apply.]
Authority of my attorney-in-fact to create, amend, modify, or revoke any document
(including a revocable trust) or other disposition effective at my death.
(NB a). Limitations on Authority of Agent. My attorney-in-fact shall not have the
authority to create, amend, modify or revoke any document (including any revocable trust) or other
disposition effective at my death, (provided, however, that this limitation of authority does not
preclude my attorney-in-fact from transferring assets to or withdrawing assets from any existing
revocable trust as specifically authorized in Paragraph 12 above).
te X @, Create an Intervivos Trust. Grant to my agent the power to create for me
one or more revocable trusts (referred to as a “grantor trust”) of which I am an income beneficiary
and with such person or persons as my agent shall select as the trustee or co-trustees (including my
agent, or a bank having trust powers or a trust company either of which must have, alone or when
combined with its parent organization and affiliates, assets beneficially owned by others under its
management with a value in excess of $100,000,000. (U.S.)), without bond or other security, and
with such other terms and provisions as my agent shall deed appropriate, including, but not limited
to, provisions to minimize or eliminate any death or transfer taxes which may be imposed on my
estate, any grantor trust, any beneficiary of my estate or any beneficiary of any grantor trust, and to
grant to the trustee or co-trustees of any grantor trust any one or more of the powers granted to a
trustee under the governing law of the trust; provided, however, such trust agreement shall provide
that I retain the power to revoke any such grantor trust, in whole or in part at any time, or that I have
a general power of appointment over the assets of such grantor trust; and further provided that at my
death the assets of any such grantor trust shall pass in a manner which is consistent with any existing
estate plan which I may have previously instituted including dispositions of my property by will,
trust, beneficiary designation, or otherwise, and including the apportionment of taxes and other
expenses, or if there is no person named in such grantor trust to whom such assets shall pass, then
such assets shave be delivered to the personal representative of my estate. It is not my intention in
granting the powers enumerated in this paragraph to allow my agent to change in any way the
persons who will be receiving the property of my estate or the overall scheme of my estate plan;
rather I am attempting to facilitate my agent’s ability to save taxes or otherwise reduce the costs of
administering my estate.
x 6). Authority to Amend, Modify, Revoke or Terminate a Trust Created by
Me or on My Behalf. If] have already established a grantor trust, or if my agent creates a grantor
trust for me, my agent shall have the power and authority to alter, amend or modify such grantor trust
in a manner which is consistent with the provisions contained therein; and in addition, any such
grantor trust created by me or by my agent may be revoked by my agent as long as such revocation
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results in a disposition of my estate which is consistent with my existing estate plan. Further, my
agent shall have the power to transfer all or any part of the interest I may own in any real property,
stocks, bonds, accounts with financial institutions, insurance or other property to the trustee of such
grantor trust.
A to). My attorney-in-fact SHALL HAVE THE AUTHORITY to change rights
of survivorship;
Wb (5). My attorney-in-fact SHALL HAVE THE AUTHORITY to change a
Ve beneficiary designation.
22. Third-Party Reliance. Third parties may rely upon the representations of my agent as to all
matters relating to any power granted to my agent, and no person who may act in reliance upon the
representations of my agent, or the authority granted to my agent, shall incur any liability to me or
my estate as a result of permitting my agent to exercise any power.
23. Ratification of ent's Acts. I hereby ratify and confirm all that my agent shall do or cause to
be done by virtue of this Power. I specifically direct that my agent shall not be subject to any
liability by reason of my agent's decisions, acts or failures to act, all of which shall be conclusive and
binding upon me, my estate and my heirs. Furthermore, I agree to indemnify my agent and hold my
agent harmless from all claims which may be made against my agent as a result of serving hereunder,
and I agree to reimburse my agent in the amount of any damages, costs and expenses which may be
incurred as a result of any such claim.
24. Disability of Principal. This durable power of attorney shall not be affected by my disability,
except as provided by statute.
25. Effective Date. The powers granted in this instrument are effective immediately.
I intend to create a Durable Power of Attorney (hereinafter referred to as "this Power"),
pursuant to Sections 709.2101-709.2402, Florida Statutes (2022).
My attorney-in-fact shall use the following form when signing on my behalf pursuant to this
Power:
“BELEN C. MILLS, by ROGER A. MILLS, her attorney-in-fact;”
“BELEN C.MILLS, by BELINDA M. KEISER, her attorney-in-fact”
Signed, sealed and delivered
in the presence of:
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BELEN C. MILLS
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ACKNOWLEDGMENT
STATE OF FLORIDA
COUNTY OF Evy)
The foregoing Durable Power of Attomey was acknowledged before me onthe 24 day
of ae 2022, by physical presence or online notarization by BELEN C.
MILLS who ‘perso: ly knownto who has produced a Florida Driver's
License as identificatio
NOTARY PUBLIC
My Commission Expires:
ROBERT S. HIGHTOWER
MY COMMISSION # HH 031403
EXPIRES: October 10, 2024
SS" Bonded Thru Nolary Public Unerutiors
Prepared by:
Robert S. Hightower, Esq.
PO Box 4165
Tallahassee, FL 32315
EXHIBIT 5
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
I, BELEN C. MILLS, of Gadsden County, pursuant to the authority granted in Sections
765.201 - 765.205, Florida Statutes (2022), and other applicable laws, hereby intend to create a
durable power of attorney for health care purposes.
A. Designation of Health Care Agent and Alternate.
I hereby nominate and appoint my daughter, BELINDA M. KEISER, of Parkland, Florida,
to serve as my attorney in fact and to make decisions for me and in my name, place and stead, and
for my use and benefit and to perform acts set forth in this instrument. In the event my daughter,
BELINDA M. KEISER, is unable or unwilling to serve, I nominate and appoint my son, ROGER
A. MILLS, of Tallahassee, Florida, to serve as my attorney in fact and to make decisions for me and
in my name, place and stead, and for my use and benefit and to perform acts set forth in this
instrument.
B. Effective Date and Duration.
This Durable Power of Attorney for Health Care shall be effective immediately, but lrequest
that it be used only during any period of incapacity in which, in the opinion of my Agent and
attending physician, ] am unable to make or communicate a choice regarding a particular health care
decision.
Cc. Power and Authority of Agent.
I grant to my Agent full authority to make decisions for me regarding my health care. In
exercising this authority, my Agent shall follow my desires as stated in this document or otherwise
known to my Agent. In making any decision, my Agent shall attempt to discuss the proposed
decision with me to determine my desires if I am able to communicate in any way. If my Agent
cannot determine the choice I would want made, my Agent shall make a choice for me based upon
what my Agent believes to be in my best interests. My Agent's authority to interpret my desires is
intended to be as broad as possible. Accordingly, unless specifically limited by Section D of this
Durable Power of Attorney for Health Care, my Agent is authorized as follows:
1 To consent, refuse, or withdraw consent to any and all types of medical care,
treatment, surgical procedures, diagnostic procedures, medication, and the use of mechanical or other
procedures that affect any bodily function including, but not limited to, artificial respiration,
nutritional support and hydration, and cardiopulmonary resuscitation.
2. To have access to medical records and information to the same extent that I am
entitled to, including the right to disclose the contents to others.
3 To authorize my admission to or discharge (even against medical advice) from any
hospital, nursing home, residential care, assisted living or similar facility or service.
4 To contract on my behalf for any health care related service or facility on my behalf,
without my Agent incurring personal financial liability for such contracts.
5 To hire and fire medical, social service and other support personnel responsible for
my care.
6 To authorize, or refuse to authorize, any medication or procedure intended to relieve
pain, even though such use may lead to physical damage, addiction or hasten the moment of (but not
intentionally cause) my death.
1
To take any other action necessary to do what I authorize in this document, including,
but not limited to, granting any waiver or release from liability required by any hospital, physician
or other health care provider; signing any documents relating to refusals of treatment or the leaving
of a facility against medical advice, and pursuing any legal action in my name, and at the expense
of my estate to force compliance with my wishes as determined by my Agent, or to seek actual or
punitive damages for the failure to comply.
D Statement of Desires, Special Provisions and Limitations.
With respect to any life-sustaining treatment, on this date, I have completed and attached to
this document: a Living Will. I specifically direct my Agent to follow these directives and any
other health care declaration or living will executed by me after this date.
E. Protection of Third Parties Relying on Agent.
No person who relies in good faith upon any representations by my Agent shall be liable to
me, my estate, personal representatives, heirs, devises or assigns for recognizing the Agent's
authority.
FE. Guardian of Person.
If a guardian of my person should for any reason be required, I nominate my Agent as
guardian. If my Agent dies, becomes legally disabled, resigns, refuses to act or is unavailable, I
nominate my Alternate Agent as guardian.
G HIPAA Disclosure and Release Authority.
lintend for my Healthcare Surrogate (including any successor Healthcare Surrogate serving
from time to time) to be treated as I would be with respect to my rights regarding the use and
disclosure of my individually identifiable health information or other medical records. This release
authority applies to any information governed by the Health Insurance Portability and Accountability
Act of 1996 (referred to as "HIPAA"), 42 U.S.C. 1320d and 45 CFR 160-164. My Healthcare
Surrogate shall be my "Personal Representative" as that term is defined under, and for purposes of
compliance with Federal HIPAA Laws and Regulations (which term may have a different meaning
and use under such laws and regulations than the term "personal representative" as defined under
applicable state probate laws). I authorize any physician, healthcare professional, pharmacist, dentist,
health plan, hospital, clinic, laboratory, health care facility, pharmacy, or other covered health care
provider, any insurance company, other third-party payors, and the Medical Information Bureau, Inc.
or other healthcare clearing house that has provided treatment or services to me or that is seeking
payment from me for such services, to give, disclose and release to my Healthcare Surrogate, without
restriction, all of my individually identifiable health information and medical records regarding any
past, present, or future medical or mental health condition. My Healthcare Surrogate is expressly
authorized to execute releases of such confidential information on my behalf and in my place and
stead; and all persons and entities designated above are directed to comply with any request for
information by my Healthcare Surrogate and shall accept any releases executed by my Healthcare
Surrogate. I expressly and specifically direct that applicable Florida law concerning durable powers
of attorney and healthcare surrogates shall supersede any provisions under the Federal HIPAA Laws
and Regulations related to disclosure of medical information that would restrict or limit access by
my Healthcare Surrogate to my medical information and decision making. The authority granted to
my Healthcare Surrogate hereunder shall supersede any prior agreement that I may have made with
my health care providers to restrict access to or disclosure of my individually identifiable health
information. The authority granted to my Healthcare Surrogate hereunder has no expiration date and
shall expire only in the event that I revoke this authority in writing and deliver it to my health care
provider.
H Miscellaneous Provisions.
1 I revoke any prior power of attorney for health care.
2. This Durable Power of Attorney for Health Care:
Is not affected by subsequent incapacity that I may suffer except as
provided in Sections 765.201 - 765.205 of the Florida Statutes.
Shall be nondelegable.
Is intended to be valid and exercisable in any jurisdiction in which it is
presented.
d Shall remain in full force and effect until I die, revoke this power in
writing or am adjudic
Preview
Filing # 189824429 E-Filed 01/16/2024 01:45:46 PM IN THE CIRCUIT COURT OF THE SECOND JUDICIAL CIRCUIT IN AND FOR LEON COUNTY, FLORIDA Case No.: 2024 CA 000101 BELINDA KEISER, in her capacity as co- agent/attorney-in-fact under the Durable Power of Attorney for Dr. Belen Collantes Mills, Petitioner, V. ROGER MILLS, SR., in his capacity as co- agent/attorney-in-fact under the Durable Power of Attorney for Dr. Belen Collantes Mills, Respondent. / PETITIONER’S PETITION FOR AN ACCOUNTING PURSUANT TO FLA. STAT. § 709.2116 AND FLA. STAT. § 709.2114(6) Petitioner, BELINDA KEISER, in her capacity as co-agent/attorney-in-fact for Dr. Belen Collantes Mills, pursuant to Florida Statutes §§ 709.2116 and 709.2114(6), hereby files this Petition for An Accounting against Respondent, ROGER MILLS, SR. in his capacity as co- agent/attorney-in-fact for Dr. Belen Collantes Mills, and in support thereof, states as follows: INTRODUCTION I Jurisdiction, Parties, and Venue 1 This court has jurisdiction pursuant to Fla. Stat. § 26.012(2)(b)-(c), Fla. Stat. § 709.2114(6), and Fla. Stat. § 709.2116 and the amount in controversy exceeds $50,000.00 exclusive of fees and costs. 2. Petitioner, Belinda Keiser (“Petitioner”) is an individual who at all times relevant hereto resides in Broward County, Florida. COLE, SCOTT & KISSANE, P.A. ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX 3 Roger Mills, Sr. (“Respondent”) is an individual who at all times relevant hereto resides in Leon County, Florida. 4 Venue for this action is proper in Leon County, Florida because Respondent resides and this cause of action arose in Leon County, Florida. MATERIAL FACTS Il. Power of Attorney on behalf of Dr. Belen Collantes Mills 5 Dr. Belen Collantes Mills (“Dr. Mills”) is 93 years and has been diagnosed with dementia. See Hartsfield Evaluation, at Exhibit 1; Evaluation Notes and Letter from Dr. Fountain, at Composite Exhibit 2; letter from Dr. Ouslander, at Exhibit 3. 6 Dr. Mills can no longer provide informed consent and is totally dependent on others for her activities of daily living and independent/instrumental activities of daily living. 7 Dr. Mills is a vulnerable adult pursuant to § 415.102(28), Fla. Stat. Dr. Mills is the mother of Petitioner and Respondent. Both Petitioner and Respondent are the only living next-of-kin to Dr. Mills and her heirs. 10. During her life, Dr. Mills accumulated a portfolio of real estate, investment, and liquid assets. 11. On July 29, 2022, Dr. Mills executed a Durable Power of Attorney (“Power of Attorney”). See Power of Attorney, attached as Exhibit 4, p. 9. 12. The Power of Attorney appointed Petitioner and Respondent as joint attorneys-in- fact to jointly make decisions for Dr. Mills for and in her name. See Power of Attorney, Exhibit 4, p. 8. 2 COLE, SCOTT & KISSANE, P.A. ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX, 13. The Power of Attorney granted Petitioner and Respondent numerous powers on behalf of Dr. Mills, including but not limited to, the ability to exercise powers of collection and payment, to acquire, sell, mortgage, or grant security interests, to execute contracts, to exercise stock or bond powers with the authority with respect to securities held by financial institutions, to purchase United States Treasury Bonds, and to conduct banking transactions. See Power of Attorney, Exhibit 4. 14. Since its execution of the Power of Attorney, Respondent has served exclusively as agent controlling Dr. Mills’ finances. 15. On March 3, 2023, Dr. Mills appointed Petitioner her sole Health Care Surrogate and delegated the full authority to make decisions for Dr. Mills regarding her health care. See Durable Power of Attorney of Health Care, attached as Exhibit 5. 16. Petitioner is unaware of the full state of Dr. Mills’ finances and has paid a substantial amount of Dr. Mills’ health care needs herself, including but limited to living expenses for caregivers, physicians, and case managers. iil. Petitioner’s Request for and Accounting from Respondent 17. On August 8, 2023 at 11:32 AM, counsel for Petitioner sent a formal request for a complete accounting of Dr. Mills’ assets and liabilities to Respondent, including requesting “a list of Dr. Mills real estate holdings, investment accounts, bank accounts, stocks, bonds and any other assets for which she holds any interests.” See Email Thread with Roger Mills, Sr., attached as Exhibit 6. 18. Respondent replied the same day, on August, 8, 2023, at 2:01 PM stating, “I do not have authorization to share that information, My mother is still alive and is still making her own financial decisions.” See Exhibit 6. 3 COLE, SCOTT & KISSANE, P.A. ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX, 19. On August 11, 2023, counsel for Petitioner emailed Respondent stating, “Your mother has told Belinda that she would like an accounting of her assets — I am just following so that the same takes place. Making sure that all of your mother’s finances are in order is prudent.” See Exhibit 6. 20. Unfortunately, the Federal Tax Returns for the years 2020, 2021, and 2022 were delayed and were not brought current until the Petitioner and Dr. Mills’ accountant informed the Respondent of the missing financial information required in order to complete the tax returns. See Email Thread with Devlin Saley, CPA, attached as Exhibit 7. 21. To date, the only accounting materials provided by Respondent have been Dr. Mills’ Federal Tax Returns from the years 2020, 2021, and 2022 which was provided on December 12, 2023. See Email Confirming Tax Returns, attached as Exhibit 8. 22. Petitioner recently learned that Respondent failed to comply with Dr. Mills’ accountant’s request for documentation, which resulted in Dr. Mills’ federal tax returns being filed extremely late. Further, upon review, the tax returns appear potentially incomplete. In short, Dr. Mills’ federal tax returns raised more questions than answers. 23. Respondent refused to provide any other financial information concerning Dr. Mills’ assets, liabilities, and asset sales. 24. Respondent has also indicated that he needs to sell one of Dr. Mills’ properties — implying there is not enough money to support Dr. Mills’ needs. 25. Given Respondent’s refusal to provide a full accounting to Petitioner, Petitioner is concerned that Respondent is dissipating Dr. Mills’ assets for his own benefit. 26. Petitioner seeks this accounting in good faith for the purpose of ensuring there is no impropriety and Dr. Mills’ assets are being preserved for her benefit. 4 COLE, SCOTT & KISSANE, P.A. ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX, COUNT 1 - ACCOUNTING 27. Petitioner realleges and reavers Paragraphs | through 26 as if restated herein. 28. This is an action for an accounting pursuant to Fla. Stat. § 709.2114 and § 709.2116. 29. An agent “[m]ust keep a record of all receipts, disbursements, and transactions made on behalf of the principal.” Fla. Stat. § 709.2114(1)(c). 30. Upon the request, “an agent must disclose receipts, disbursements, and transactions conducted on behalf of the principal.” Fla. Stat. § 709.2114(6). 31. Pursuant to the Power of Attorney, Respondent is an agent of Dr. Mills. See Power of Attorney, Exhibit 4. 32. Respondent has a duty to provide a full accounting of Dr. Mills’ assets and liabilities when formally requested by Petitioner within 60 days of a formal request or request additional time to comply with the request. Fla. Stat. § 709.2114(6). 33. Petitioner, through her counsel, has requested an accounting of Dr. Mills’ assets and liabilities on two previous occasions, to wit: August 8, 2023 and August 11, 2023. See Exhibit 3 34. On August 8, 2023 and August 11, 2023, Respondent refused and ignored, respectively, Petitioner’s full accounting requests. See Exhibit 6; see also Fla. Stat. § 709.2114(1)(a)(1)-(3); Fla. Stat. § 709.2114(6). 35. On information and belief, Respondent is not acting in Dr. Mills’ best interest but acting in his own self-interest. Fla. Stat. § 709.2114(1)(a)(3)-(4). 36. On information and belief, Respondent is not preserving Dr. Mills’ property and her foreseeable obligations and need for maintenance. Fla. Stat. § 709.2114(1)(a)(3)-(4). 5 COLE, SCOTT & KISSANE, P.A. ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX, WHEREFORE, Petitioner requests this Honorable Court provide the following relief pursuant to Fla. Stat. § 709.2114(6) and § 709.2116: 1 Enter an order requiring Respondent to provide a full accounting of Dr. Mills’ assets and liabilities pursuant to Fla. Stat. § 709.2114(6); 2. Award reasonable attorneys’ fees accrued in pursuit of this Petition to receive a proper accounting pursuant to Fla. Stat. § 709.2114(6) and Fla. Stat. § 709.2116; and 3 Other such relief the Court finds just and proper. Dated: January 16, 2024 Respectfully submitted, COLE SCOTT & KISSANE, P.A. 222 Lakeview Avenue Suite 120 West Palm Beach, FL 33401 Tel: (561) 383-9200 Fax: (561) 683-8977 Barry.Postman@csklegal.com /s/ Barry Postman BARRY POSTMAN FBN: 991856 6 COLE, SCOTT & KISSANE, P.A. ESPERANTE BUILDING - 222 LAKEVIEW AVENUE, SUITE 120 - WEST PALM BEACH, FLORIDA 33401 (S61) 383-9200 - (561) 683-8977 FAX, EXHIBIT 1 CONFIDENTIAL MEDICAL RECORDS — MOTION TO DETERMINE CONFIDENTIALITY TO BE FILED CONTEMPORANEOUSLY COMPOSITE EXHIBIT 2 CONFIDENTIAL MEDICAL RECORDS — MOTION TO DETERMINE CONFIDENTIALITY TO BE FILED CONTEMPORANEOUSLY EXHIBIT 3 CONFIDENTIAL MEDICAL RECORDS — MOTION TO DETERMINE CONFIDENTIALITY TO BE FILED CONTEMPORANEOUSLY EXHIBIT 4 DURABLE POWER OF ATTORNEY Clorida Statutes, Sections 709.2101-709.2402) KNOW ALL MEN BY THESE PRESENTS, that I, BELEN C. MILLS, of Gadsten County, Florida, do hereby nominate, constitute and appoint my son, ROGER A. MILLS, of Tallahassee, Florida, and my daughter BELINDA M. KEISER, of Parkland, Florida, to serve jointly as my attorneys-in-fact and to jointly make decisions for me and in my name, place and stead, and for my use and benefit and to perform the acts set forth below in this instrument; provided, however, that if only one of them is available or able to participate in said decisions or said matters on my behalf, then and in that event the designated agent shall serve as my designated attomey-in-fact for my use and benefit and to perform the acts set forth in this instrument. 1. General Grant of Power. To exercise or perform any act, power, duty, right or obligation whatsoever that I now have or may hereafter acquire, relating to any person, matter, transaction or property, real or personal, tangible or intangible, now owned or hereafter acquired by me, including, without limitation, the following specifically enumerated powers. I grant to my agent full power and authority to do everything necessary in exercising any of the powers herein granted as fully as I might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that my agent shall lawfully do or cause to be done by virtue of this Power and the powers herein granted. 2. Powers of Collection and Payment. To forgive, request, demand, sue for, recover, collect, receive, hold all such sums of money, debts, dues, commercial paper, checks, drafts, accounts, deposits, legacies, bequests, devises, notes, interests, stock certificates, bonds, dividends, certificates of deposit, annuities, pension, profit sharing, retirement, social security, insurance and other contractual benefits and proceeds, all documents oftitle, all property, real or personal, intangible and tangible property and property rights, and demands whatsoever, liquidated or unliquidated, now or hereafter owned by or due, payable or belonging to me, or in which I have or may hereafter acquire an interest; to have, use, and take all lawful means and equitable and legal remedies and proceedings in my name for the collection and recovery thereof, and to adjust, sell, compromise and agree for the same, and to execute and deliver for me, on my behalf and in my name, all endorsements, releases, receipts or other sufficient discharges for the same; 3. Power to Acquire. Sell. Mortgage or Grant Security Interests. To acquire, purchase, exchange, mortgage, grant security interests in, grant options to sell, and sell and convey real or personal property (including sale of my homestead - see provisions of Par. 20, if married), tangible or intangible, or interests therein, on such terms and conditions as my agent shall deem proper; 4. Management Powers. To maintain, repair, improve, invest, manage, insure, rent, lease, encumber, and in any manner deal with any real or personal property, tangible or intangible, or any interest therein, that I now own or may hereafter acquire, in my name and for my benefit, upon such terms and conditions as my agent shall deem proper; fe 5. Power to Execute Contracts. To make, receive, sign, endorse, execute, acknowledge, deliver, and possess such applications, contracts, agreements, options, covenants, conveyances, deeds, trust deeds, security agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills of lading, warehouse receipts, documents of title, bills, bonds, debentures, checks, drafts, bills of exchange, letters of credit, notes, stock certificates, proxies, warrants, commercial paper, withdrawal receipts, or other receipts and deposit instruments related to accounts or deposits in, or certificates of deposit of banks, savings and loans, or other institutions or associations, proofs of loss, evidence of debts, releases, satisfaction of mortgages, liens, judgments, other debts and obligations, and such other instruments, in writing of whatever kind and nature as may be necessary or proper in the exercise of the rights and powers granted herein. 6. Stock or Bond Powers: Authority with Respect to Securities Held by Financial Institutions. To éxecute stock or bond powers, or similar documents on my behalf and to delegate to a transfer agent or similar person the authority to register any stocks, bonds, or other securities into or out of my name or nominee's name. Further, my attorney-in-fact shall have authority to conduct investment transactions as provided in Section 709.2208(2), Florida Statutes, or any amendmentto such statute subsequently adopted. 7. Treasury Bonds. To purchase United States Treasury Bonds and other United States obligations redeemable at par for the payment of estate taxes. 8. Authority to Conduct Banking Transactions. To make, receive and endorse checks and drafts, deposit and withdraw funds, acquire and redeem certificates of deposit in banks, savings and loan associations and other institutions, execute or release such deeds of trust or other security agreements as may be necessary or proper in the exercise of the rights and powers herein granted. Further, my attorney-in-fact shall have authority to conduct all banking transactions as provided in Section 709.2208(1), Florida Statutes, or any amendment to such statute subsequently adopted. 9. Motor Vehicles. To apply for a Certificate of Title upon, and endorse and transfer title thereto, for any automobile, truck, pickup, van, motorcycle or other motor vehicle and to represent in such transfer assignment that the title to said motor vehicle is free and clear ofall liens and encumbrances, except those specifically set forth in such transfer assignment; 10. Business Interests. To conduct or participate in any lawful business of whatever nature for me and in my name; execute parinership agreements and amendments thereto; incorporate, reorganize, merge, consolidate, recapitalize, sell, liquidate or dissolve any business; elect or employ officers, directors and agents, carry out the provisions of any agreement for the sale of any business interest or the stock therein; exercise voting rights with respect to stock, either in person or by proxy, and exercise stock options; 11. Safe Deposit Boxes. To have access at any time or times to any safe deposit box rented by me, wheresoever located, and to remove all or any part of the contents thereof, and to surrender or tl iv pr relinquish said safe deposit box, and any institution in which any such safe deposit box may be located shall not incur any liability to me or my estate as a result of permitting my agent to exercise this Power. 12. Revocable Trust. To transfer and convey any of my property to the trustee or trustees, then acting under any revocable trust agreement executed by me (regardless of whether such trust agreement was executed or amended prior to or subsequent to the date hereof, and regardless of whether, by virtue of the terms of such trust agreement, the property transferred to the trustee(s) of such trust will, upon my death, be distributed pursuant to the provisions of such trust agreement instead of being made a part of my probate estate and thus being ultimately distributedin accordance with the provisions of my will or pursuant to laws of descent and distribution). This shall include the power to transfer the same into the names of any nominee or nominees, as such trustee or trustees shall direct (even into the names of persons or firms which would not cause the ownership of public record to appear as being in the name of such trust). Further, the power to withdraw any assets and/or income from any such revocable trust executed by me. 13. Power to Disclaim, Renounce, Release, Abandon or Waive Property Interests. To renounce, disclaim and waive any property or interest in property or powers to which for any reason and by any means I may become entitled, whether by gift, testate or intestate succession; to release or abandon any property or interest in property or powers which I may now or hereafter own, including any interests in or rights over trusts (including the right to alter, amend, revoke or terminate) and to exercise (or not exercise) any right to claim an elective share in any estate or under any will, and in exercising such discretion, my Agent may take into account such matters as shall include but shall not be limited to any reduction in estate or inheritance taxes on my estate, and the effect of such renunciation or disclaimer upon persons interested in my estate and persons who would receive the renounced or disclaimed property. [The following elections are mandated by Section 709.2202 Fla. Stat., Laws of Florida (2011)] A. Authority of my attorney-in-fact to waive my right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan. [Initial (1) or (2) below, but not both]. [Section 709.2202(1)(f), Fla. Stat.] Initial those specific provisions below reflecting the withholding or granting authority to your agent; initial those provisions you wish to apply; cross out and initial those you do not want to apply.] vw x (D. My attorney-in-fact SHALL HAVE authority to waive my right to bea beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan. a! Mt @). My attorney-in-fact SHALL NOT HAVE authority to waive my right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan. B. Authority of my attorney-in-fact to disclaim property and powers of yo appointment. [Initial (1) or (2) below, but not both]. [Section 709.2202(1)(g), Fla. Stat.] br _X My attorney-in-fact SHALL HAVE the authority to disclaim property and powers of appointment as set forth in this Paragraph 13. i {V0 (2). _ My attorney-in-fact SHALL NOT HAVE the authority to disclaim property and powers of appointment as set forth in this Paragraph 13. 14. Power to Make Gifts. To make gifts or conveyances of my property or interests in my property, to any one or more members of my family (limited to my children, grandchildren and lineal descendants), and/or to any inter vivos trust agreement created by me or for my benefit, so as implement any estate and income tax planning for the benefit of my family; to execute any and all related documents needed to implement such planning; to withdraw cash or other assets from any trust created by me if necessary or advisable to complete any gifts which are authorized hereunder provided Ihave retained the power to withdraw funds from said trust. No such gifts or conveyances shall, without prior approval from a court of competent jurisdiction, be made in an amount per donee which exceed the annual dollar limits of the federal gift tax exclusion under 26 U.S.C. 2503(6), as amended, without regard to whether the federal gift tax exclusion applies to the gift, or ifmy spouse (if any) agrees to consent to a split gift pursuant to 26 U.S.C. 2513, as amended, in an amount per donee which exceeds twice the annual federal gift tax exclusion limit. Notwithstanding the foregoing power and notwithstanding anything to the contrary contained herein or otherwise, no such gifts or conveyances shall be permitted hereunder if such action would be detrimental to my economic welfare. Further, pursuant to Section 2513 of the Internal Revenue Code, my attorney-in- fact shall have the authority to consent to the splitting of a gift made by my spouse in an amount not to exceed the aggregate annual gift tax exclusions for both spouses. Authority of my attorney-in-fact to make gifts. [The following elections are mandated by Section 709.2202(1)(c), (3), Fla. Stat., Laws of Florida (2011)]. Initial those specific provisions below reflecting the withholding or granting authority to your agent; initial those provisions you wish to apply; cross out and initial those you do not want to apply.] ph x (1). Power to Make Annual Exclusion Gifts. I authorize my attomey-in-fact to make gifts of my property or interests in my property and to split gifts with my spouse, if applicable, as specificyin the provisions of this Paragraph 14 set forth above. c kK ——. (2) Power to Make Additional Gifts. 1 further authorize my attorney-in-fact to male gifts (outright, in trust, or otherwise) of any of my property up to the entirety thereof to, or pay amounts on behalf of, any one or more of my descendants (including my agent, if my agent isa descendant of mine) or to any charitable organization to which deductible gifts may be made under the income and gift tax provisions of the Intemal Revenue Code of 1986, as amended. Such gifts or amounts paid to my descendants shall include those which are excludible under Section 25 (03(b) or Section 2503(e) of the Internal Revenue Code of 1986, as amended, or those to which the split gift provisions of Section 2513 of the Internal Revenue Code of 1986, as amended, are expected to yo OW apply. Nothing herein shall be construed to require any court action whatsoever prior to making such gifts, nor to restrict such gifts to a situation in which it must be determined that I will remain incapacitated for the remainder of my lifetime. ye x _(3) Power to Make Gifts to Qualify for Public Benefits. If my attorney-in-fact in his or her sole discretion has determined that I need nursing home or other long-term medical care and that I will receive proper medical care whether I privately pay for such care or if I am the recipient of Title XIX (Medicaid) or other public benefits, then my agent shall have the power: (1) to take any and all steps necessary, in my agent’s judgment, to obtain and maintain my eligibility for any and all public benefits and entitlement programs, including if necessary, signing a deed with a retained life estate (also known as a “Lady Bird Deed”) as well as creating and funding a qualified income trust or special needs trust for me or a disabled child, if any: (4i) to transfer with or without consideration my assets to my descendants (if any), or to my natural heirs at law or to the persons named as beneficiaries under my last will and testament or a revocable living trust which Imay have established, including my agent; and (iii) to enter into a personal services contract for my benefit including entering into such contract with my agent, even if doing so maybe considered self-dealing. Such public benefits and entitlement programs shall include, but are not limited to Social Security, Supplemental Security Income, Medicare, Medicaid and Veterans’ benefits. 7 NO (4) NoAuthority to Make Gifts. I do not authorize my attorney-in-fact to make gift s of my property or interests in my property, nor do I authorize my agent to split gifts with myis spouse, if applicable, as specified in the provisions of this Paragraph 14 set forth above. [If this selected and initialed, strike through Paragraph 14, above and the prior gifting options]. 15. Income or Gift Tax Returns. To file income or gift tax returns for any years for which I have not filed such returns and consent to any gifts made, even though such action subjects my estate to additional liabilities. 16. Federal. State, Local, Income. Gift and Other Tax Matters. To prepare, sign and file federal, state, income, gift or other tax returns of all kinds, claims forrefund, amendments to retums, requests for extensions of time, petitions to the Tax Court or other courts regarding tax matters and any and all other tax related documents, including, without limitation to, receipts, offers, waivers, consents (including, but not limited to, consents and agreements under Intemal Revenue Code Section 2032A, or any successor section thereto), powers of attorney, closing agreements; to exercise any elections I may have under federal, state or local tax law; and generallyto act in my behalf on all tax matters of all kinds and for all periods before all persons representing the Internal Revenue Service and any other taxing authority, including receipt of confidential information and the posting of bonds. 17. Power to Nominate Conservator or Guardian. To nominate and/or petition for the appointment of my Agent or any person my Agent deems appropriate as primary, successor or alternate guardian, guardian ad litem or conservator or to any fiduciary office (all of such offices of guardian, et al. being hereinafter referred to as "Personal Representative") representing me or any pe interest of mine or any person for whom I may have a right or duty to nominate or petition for such appointment; to grant any such Personal Representative all of the powers under applicable law that Iam permitted to grant; to waive any bond requirement for such Personal Representative that I am permitted by law to waive. 18. Health Care Decisions. To make health care decisions for me which he or she believes that I would have made under the circumstances, had I been capable of making such decision, and to give or withdraw consent to or from any and all types of medical care, treatment, surgical or diagnostic procedure, medication or other procedures including the power to sign revocations, waivers, consents, authorizations and releases pertaining to my health care and treatment which shall include the power to retain, hire, or terminate physicians and other medical persons or practitioners of the health arts; to obtain, review, and release to other persons any and all medical records to which Imay be privy; and, to consent to or withhold consent from the cessation of any life prolonging procedure pursuant to the Life Prolonging Procedures Act of Florida or under a similar act in any other jurisdiction (including the right to terminate nutrition and hydration); provided, however, ifpursuant to the Life Prolonging Procedures Act of Florida or a similar act in any other jurisdiction I have executed a living will which remains in force, then I direct my attorney-in-fact to enforce the provisions of the living will in accordance with its terms and provisions. 19, Interpretation and Governing Law. This instrument is to be construed and interpreted as a Durable Power of Attorney. The enumeration of specific powers herein is not intended to, nor does it limit or restrict the general powers herein granted to my agent. This instrument is executed and delivered in the State of Florida, and the laws of the State of Florida shall govern all questions as to the validity of this Power and the construction of its provisions. 20. Limitations on Powers: Notwithstanding the foregoing, if lam married, my attorney-in-fact shall not mortgage or convey homestead property without the joinder of my spouse (which joinder may be accomplished by the exercise of authority in a durable power of attorney executed by my spouse) or my spouse’s legal guardian. [Section 709.2201 (2)(b), Fla. Stat.] Further, notwithstanding the foregoing, my attorney-in-fact shall not: (1) perform duties under a contract that requires the exercise of personal services by me; (2) make any affidavit as to my personal knowledge; (3) vote in any public election on my behalf; (4) execute or revoke any will or codicil for me; or (5) exercise any powers or authority granted to me as trustee or as a court-appointed fiduciary. [Section 709.2201(3), Fla. Stat.]. Furthermore, if my named attomey-in-fact is not an ancestor, spouse or descendant of mine, said attomey-in-fact shall not exercise authority to create in himselfor herself, or in any individual to whom said agent owes a legal obligation of support, any interest in my property by means of this Durable Power of Attorney, whether by gift, right of survivorship, beneficiary designation, disclaimer or otherwise. [Section 709.2202(2), Fla. Stat]. 21. Ss €} arate Signed Enumeration of Specific Powers Pursuant to Section 709.2202, Florida Statutes. [The following elections are mandated by Section 709.2202(1), Fla. Stat., Laws of Florida (2011). Initial those specific provisions below reflecting the withholding or granting authority to your agent; initial those provisions you wish to apply; cross out and initial those feo you do not want to apply.] Authority of my attorney-in-fact to create, amend, modify, or revoke any document (including a revocable trust) or other disposition effective at my death. (NB a). Limitations on Authority of Agent. My attorney-in-fact shall not have the authority to create, amend, modify or revoke any document (including any revocable trust) or other disposition effective at my death, (provided, however, that this limitation of authority does not preclude my attorney-in-fact from transferring assets to or withdrawing assets from any existing revocable trust as specifically authorized in Paragraph 12 above). te X @, Create an Intervivos Trust. Grant to my agent the power to create for me one or more revocable trusts (referred to as a “grantor trust”) of which I am an income beneficiary and with such person or persons as my agent shall select as the trustee or co-trustees (including my agent, or a bank having trust powers or a trust company either of which must have, alone or when combined with its parent organization and affiliates, assets beneficially owned by others under its management with a value in excess of $100,000,000. (U.S.)), without bond or other security, and with such other terms and provisions as my agent shall deed appropriate, including, but not limited to, provisions to minimize or eliminate any death or transfer taxes which may be imposed on my estate, any grantor trust, any beneficiary of my estate or any beneficiary of any grantor trust, and to grant to the trustee or co-trustees of any grantor trust any one or more of the powers granted to a trustee under the governing law of the trust; provided, however, such trust agreement shall provide that I retain the power to revoke any such grantor trust, in whole or in part at any time, or that I have a general power of appointment over the assets of such grantor trust; and further provided that at my death the assets of any such grantor trust shall pass in a manner which is consistent with any existing estate plan which I may have previously instituted including dispositions of my property by will, trust, beneficiary designation, or otherwise, and including the apportionment of taxes and other expenses, or if there is no person named in such grantor trust to whom such assets shall pass, then such assets shave be delivered to the personal representative of my estate. It is not my intention in granting the powers enumerated in this paragraph to allow my agent to change in any way the persons who will be receiving the property of my estate or the overall scheme of my estate plan; rather I am attempting to facilitate my agent’s ability to save taxes or otherwise reduce the costs of administering my estate. x 6). Authority to Amend, Modify, Revoke or Terminate a Trust Created by Me or on My Behalf. If] have already established a grantor trust, or if my agent creates a grantor trust for me, my agent shall have the power and authority to alter, amend or modify such grantor trust in a manner which is consistent with the provisions contained therein; and in addition, any such grantor trust created by me or by my agent may be revoked by my agent as long as such revocation job results in a disposition of my estate which is consistent with my existing estate plan. Further, my agent shall have the power to transfer all or any part of the interest I may own in any real property, stocks, bonds, accounts with financial institutions, insurance or other property to the trustee of such grantor trust. A to). My attorney-in-fact SHALL HAVE THE AUTHORITY to change rights of survivorship; Wb (5). My attorney-in-fact SHALL HAVE THE AUTHORITY to change a Ve beneficiary designation. 22. Third-Party Reliance. Third parties may rely upon the representations of my agent as to all matters relating to any power granted to my agent, and no person who may act in reliance upon the representations of my agent, or the authority granted to my agent, shall incur any liability to me or my estate as a result of permitting my agent to exercise any power. 23. Ratification of ent's Acts. I hereby ratify and confirm all that my agent shall do or cause to be done by virtue of this Power. I specifically direct that my agent shall not be subject to any liability by reason of my agent's decisions, acts or failures to act, all of which shall be conclusive and binding upon me, my estate and my heirs. Furthermore, I agree to indemnify my agent and hold my agent harmless from all claims which may be made against my agent as a result of serving hereunder, and I agree to reimburse my agent in the amount of any damages, costs and expenses which may be incurred as a result of any such claim. 24. Disability of Principal. This durable power of attorney shall not be affected by my disability, except as provided by statute. 25. Effective Date. The powers granted in this instrument are effective immediately. I intend to create a Durable Power of Attorney (hereinafter referred to as "this Power"), pursuant to Sections 709.2101-709.2402, Florida Statutes (2022). My attorney-in-fact shall use the following form when signing on my behalf pursuant to this Power: “BELEN C. MILLS, by ROGER A. MILLS, her attorney-in-fact;” “BELEN C.MILLS, by BELINDA M. KEISER, her attorney-in-fact” Signed, sealed and delivered in the presence of: Du 1 a ¢ ‘witness Lu. BELEN C. MILLS C file fee David Htiglrhoes er print name Ceheqya~—— ‘witness Repent s- lhubtowed print name ACKNOWLEDGMENT STATE OF FLORIDA COUNTY OF Evy) The foregoing Durable Power of Attomey was acknowledged before me onthe 24 day of ae 2022, by physical presence or online notarization by BELEN C. MILLS who ‘perso: ly knownto who has produced a Florida Driver's License as identificatio NOTARY PUBLIC My Commission Expires: ROBERT S. HIGHTOWER MY COMMISSION # HH 031403 EXPIRES: October 10, 2024 SS" Bonded Thru Nolary Public Unerutiors Prepared by: Robert S. Hightower, Esq. PO Box 4165 Tallahassee, FL 32315 EXHIBIT 5 DURABLE POWER OF ATTORNEY FOR HEALTH CARE I, BELEN C. MILLS, of Gadsden County, pursuant to the authority granted in Sections 765.201 - 765.205, Florida Statutes (2022), and other applicable laws, hereby intend to create a durable power of attorney for health care purposes. A. Designation of Health Care Agent and Alternate. I hereby nominate and appoint my daughter, BELINDA M. KEISER, of Parkland, Florida, to serve as my attorney in fact and to make decisions for me and in my name, place and stead, and for my use and benefit and to perform acts set forth in this instrument. In the event my daughter, BELINDA M. KEISER, is unable or unwilling to serve, I nominate and appoint my son, ROGER A. MILLS, of Tallahassee, Florida, to serve as my attorney in fact and to make decisions for me and in my name, place and stead, and for my use and benefit and to perform acts set forth in this instrument. B. Effective Date and Duration. This Durable Power of Attorney for Health Care shall be effective immediately, but lrequest that it be used only during any period of incapacity in which, in the opinion of my Agent and attending physician, ] am unable to make or communicate a choice regarding a particular health care decision. Cc. Power and Authority of Agent. I grant to my Agent full authority to make decisions for me regarding my health care. In exercising this authority, my Agent shall follow my desires as stated in this document or otherwise known to my Agent. In making any decision, my Agent shall attempt to discuss the proposed decision with me to determine my desires if I am able to communicate in any way. If my Agent cannot determine the choice I would want made, my Agent shall make a choice for me based upon what my Agent believes to be in my best interests. My Agent's authority to interpret my desires is intended to be as broad as possible. Accordingly, unless specifically limited by Section D of this Durable Power of Attorney for Health Care, my Agent is authorized as follows: 1 To consent, refuse, or withdraw consent to any and all types of medical care, treatment, surgical procedures, diagnostic procedures, medication, and the use of mechanical or other procedures that affect any bodily function including, but not limited to, artificial respiration, nutritional support and hydration, and cardiopulmonary resuscitation. 2. To have access to medical records and information to the same extent that I am entitled to, including the right to disclose the contents to others. 3 To authorize my admission to or discharge (even against medical advice) from any hospital, nursing home, residential care, assisted living or similar facility or service. 4 To contract on my behalf for any health care related service or facility on my behalf, without my Agent incurring personal financial liability for such contracts. 5 To hire and fire medical, social service and other support personnel responsible for my care. 6 To authorize, or refuse to authorize, any medication or procedure intended to relieve pain, even though such use may lead to physical damage, addiction or hasten the moment of (but not intentionally cause) my death. 1 To take any other action necessary to do what I authorize in this document, including, but not limited to, granting any waiver or release from liability required by any hospital, physician or other health care provider; signing any documents relating to refusals of treatment or the leaving of a facility against medical advice, and pursuing any legal action in my name, and at the expense of my estate to force compliance with my wishes as determined by my Agent, or to seek actual or punitive damages for the failure to comply. D Statement of Desires, Special Provisions and Limitations. With respect to any life-sustaining treatment, on this date, I have completed and attached to this document: a Living Will. I specifically direct my Agent to follow these directives and any other health care declaration or living will executed by me after this date. E. Protection of Third Parties Relying on Agent. No person who relies in good faith upon any representations by my Agent shall be liable to me, my estate, personal representatives, heirs, devises or assigns for recognizing the Agent's authority. FE. Guardian of Person. If a guardian of my person should for any reason be required, I nominate my Agent as guardian. If my Agent dies, becomes legally disabled, resigns, refuses to act or is unavailable, I nominate my Alternate Agent as guardian. G HIPAA Disclosure and Release Authority. lintend for my Healthcare Surrogate (including any successor Healthcare Surrogate serving from time to time) to be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (referred to as "HIPAA"), 42 U.S.C. 1320d and 45 CFR 160-164. My Healthcare Surrogate shall be my "Personal Representative" as that term is defined under, and for purposes of compliance with Federal HIPAA Laws and Regulations (which term may have a different meaning and use under such laws and regulations than the term "personal representative" as defined under applicable state probate laws). I authorize any physician, healthcare professional, pharmacist, dentist, health plan, hospital, clinic, laboratory, health care facility, pharmacy, or other covered health care provider, any insurance company, other third-party payors, and the Medical Information Bureau, Inc. or other healthcare clearing house that has provided treatment or services to me or that is seeking payment from me for such services, to give, disclose and release to my Healthcare Surrogate, without restriction, all of my individually identifiable health information and medical records regarding any past, present, or future medical or mental health condition. My Healthcare Surrogate is expressly authorized to execute releases of such confidential information on my behalf and in my place and stead; and all persons and entities designated above are directed to comply with any request for information by my Healthcare Surrogate and shall accept any releases executed by my Healthcare Surrogate. I expressly and specifically direct that applicable Florida law concerning durable powers of attorney and healthcare surrogates shall supersede any provisions under the Federal HIPAA Laws and Regulations related to disclosure of medical information that would restrict or limit access by my Healthcare Surrogate to my medical information and decision making. The authority granted to my Healthcare Surrogate hereunder shall supersede any prior agreement that I may have made with my health care providers to restrict access to or disclosure of my individually identifiable health information. The authority granted to my Healthcare Surrogate hereunder has no expiration date and shall expire only in the event that I revoke this authority in writing and deliver it to my health care provider. H Miscellaneous Provisions. 1 I revoke any prior power of attorney for health care. 2. This Durable Power of Attorney for Health Care: Is not affected by subsequent incapacity that I may suffer except as provided in Sections 765.201 - 765.205 of the Florida Statutes. Shall be nondelegable. Is intended to be valid and exercisable in any jurisdiction in which it is presented. d Shall remain in full force and effect until I die, revoke this power in writing or am adjudic