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HomeMy WebLinkAbout1099 This instrument was pr pared bye k/ "'"`"~~a-~ FORM OF AGREEMENT SiGNED BY RESiDENTS ~exter Batea, P.O.Box 668, Davenport, Florida 33637 KNOW ALL MEN BY THESE PRESENTS: +~~~~p - C~ That I, ~A• Phiiifpe- of Fort Pierce . in the County of Saint Lucfe , State of Florida, in consideration of my admission as a resident of Willia~n Crane Gray Inn for Older People, a corporation under the general supervision of the Protestant F.piscopal Diceese of Central Florida, the Protestant ~iscopal Diocese of Southeast Florida and the Protest- ant Episcopal Diocese of Southwest Florida~ and for my future maintenance and support during the time I am a resident of sa~d Inn, and for my buri;~l in a decent manner should I die while such a resident, do hereby give, grant, bargain, sell and convey, assign, trunsfer and set over to said corporation, all mq reai and personal property and estate of whatsoever nature or description wherever located, to have and to hold the same to ~villiam Crane Gray Inn for Otder People, a corporation, and its successors und assigns forever. and absolutely free of any trust; and I hereby covenant and agree that I will from time to time execute and deliver such - further instruments as the said corporation may deem necessary to make effectual this assig~nment and to rest in said corporation the title of the property hereby transferred. Provided also that the responsibility of the carporation for my future maintenance and support shall be terminated at such time as the value of the resources transferred by me to the said oorporation have been re- duced by such an amonnt as the corporation deems sufficient to compensate for the cost of my care and main- tenance, to an amount which would not in itself prerent my being eligible for a public assistance Srant as defined by the rules and regulations of the State of Flarida, Department of Health and Rehabilitative Services, Di~ision of Family Sen~ces. And for the oonsidei~tion aforesaid, I hereby further covenant and agree that in case I shall hereafter acquire any property, real or personal, during my tenure as a resident of sAid Inn whether by gift, inheritance, devise, bequest, or othenvise, I witl convey, assign aud transfer and set over to said Corporation, its saccessors and assigns, absolutely free of any trust, all such property hereafter acquired by me, and all pmpertq so oon- veyed or transferred by me shall be added to and the ~alue thereof inventoried in the schedule hereto annexed. And in case of disagreement as to such vAlue, I hereby agree that the same shall be appraised by three disin- terested persons, one to be chosen by me. one by the said Corporation, and the third by the other two; and that their determination of such ralue shall be final and conclusive. I hereby constitute and appoint tVitliam Crane Gray Inn foi• Older People. a Corporation, my true and la«ful attorney, for me and in my n~me, place, and stead, to sign all papers and exerate and perform all or e~ ery act or thing needful and necessary to be done in connection with my property or affairs, as fully, largelq~ and amply, to all intents and purposes whatsoerer as I might or could do if acting personally. PROVIDED, HOWE~ ER~ and it is hereby e~.-pressly understood and agreed that said Corporation rnay at any time during my lifetime, terminate my residence in said Inn, and discontinue my maintenance and sup- . port, and that I may at any time voluntarily te~cninate my residence therein; and in case of sach termination, «hether by my election or by the election of the Corporation, said Corporation shall deliver over to me all prop- erty heretofore conyeyed or transferred by me to said Corporat.ion, or a sum equal to the value thereof at the date of sucte termination, based upon the pl'operty inventoried upon the annexed schedule, but without interest, and deducting therefrom sach amounts as the said Corporation shall deem sufficient oompensation for my main- tenance, care and support while a resident of said Inn, and deducting also the amount of any special or extra- ordinai~t~ expense incurred 1qy said Corporation in my behalf. AND, I further agree that in event I become cligible for old age or other governmental assistance, I ~~-i11 apply for the same at the request of the William Crane Gray Inn for Older People. Such assistance when received shall be paid to and used by the William Crane Gray Inn for Older People for my support and main- tenance. AND, I further agiee that so long as I shall continue to be a resident of said Inn, I~till abide by atl the rules and regulations of said Inn. I FURTHER AGREE that in event of sickness or accident occurring to me, the ftesident ~lanager of T! R ~.t/'? (uver) ~ '''I•T~~ ~ ~ ~ ~ ~ : ~ ~ t~, ~ ~ * -