Authorization to Enter Premises

Which community is this form for? *

Resident Name *

City of Residence *

County *

Person Authorized to Enter the Apartment *

That Person’s City *

Second Person Authorized to Enter (optional) *

That Person’s City (optional) *

Apartment Address *

AUTHORIZATION TO ENTER PREMISES

The undersigned __________, residing in the City of __________, __________ County, Michigan, hereby represents and warrants that upon my death or incapacity, I hereby designate __________, of __________, and/or __________, of __________ as the person(s) having the authority to enter the apartment, located at __________ to remove my personal belongings therefrom or otherwise arrange for the disposition of my assets.

I hereby indemnify and hold harmless American House, its agents and employees, from any liabilities or actions resulting from the providing of access to my apartment to the above-mentioned person(s) upon my death or incapacity.

If the authorized persons do not remove all items within 30 days after my death, I authorize American House to enter my apartment, remove any remaining items and dispose of them.

This authorization shall be binding upon and inure to the benefit of my heirs, personal representatives, administrators, assigns and successors.

Resident and/or Responsible Party Signature *Sign with your mouse, finger, or stylus.