Case File
efta-efta00803375DOJ Data Set 9OtherDESIGNATION AND APPOINTMENT OF
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00803375
Pages
2
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
DESIGNATION AND APPOINTMENT OF
JOINT SURROGATES AND HEALTH CARE AGENTS
FOR HEALTH CARE DECISIONS
I, JEFFREY E. EPSTEIN, residing at Little St. James in the United States Virgin Islands, in the event
that I am incapacitated to provide informed consent for medical treatment, surgical diagnostic
procedures and surgical procedures, do hereby designate and appoint as my joint surrogates and
my joint health care agents for all health care decisions regarding such medical treatment,
surgical diagnostic procedures and surgical procedures:
DARREN K. INDYKE, residing at 6030 Le Lac Road, Boca Raton, Florida 33496, Telephone: (561)
419-7668, Mobile: (973) 908-9233, and Work: (561) 781-8238;
and
EVA ANDERSSON DUBIN, residing at 1040 Fifth Avenue, 15'h Floor, New York, New York 10028,
Telephone: (212) 288-4844, Mobile: (646) 388-0059;
Both of them to serve in such capacity and to make all such decisions jointly.
I fully understand that this Designation and Appointment will permit my designated joint
surrogates and health care agents to jointly make all health care decisions and to jointly provide,
withhold, or withdraw consent to medical treatment, surgical diagnostic procedures and/or
surgical procedures, and to jointly authorize my admission to or transfer from any health care
facility; provided, however, to the extent that I have provided express and clear direction as to
any specific health care decisions, medical treatment, surgical diagnostic procedures and/or
surgical procedures and/or treatment at any specific health care facility, such express and clear
direction must be followed by my designated joint surrogates and health care agents, and each
and every treating health care worker and each and every treating health care facility to whom I
have communicated such express and clear direction.
Unless I revoke this Designation and Appointment, or hereafter provide an expiration date or
specify any circumstances under which it shall expire, this Designation and Appointment shall
remain in effect perpetually. I hereby direct my designated joint surrogates and health care
agents to make all health care decisions, including, without limitation, decisions regarding
providing, withholding or withdrawing consent to medical treatment, surgical diagnostic
procedures and surgical procedures, and authorizing admission to or transfer from any health
care facility, in accordance with my wishes as expressed to them from time to time.
I further affirm that this Designation and Appointment is not being made as a condition of
treatment or admission to a health care facility. I will notify and send a copy of this document to
the following person other than my designated joint surrogates and health care agents, so that
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the following person will be aware of the identities and contact information of my designated
joint surrogates and health care agents:
Richard Kahn, 575 Lexington Avenue, 4th Floor, New York, New York 10022 .
IN WITNESS WHEREOF, the undersigned has executed this Designation and Appointment this
day of February, 2019.
JEFFREY E. EPSTEIN
STATEMENT BY WITNESSES:
Each of the undersigned, being 18 years of age or older, declares that Jeffrey E. Epstein is
personally known to the undersigned, appears to be of sound mind and acting of his own free
will, and executed this document in the presence if the undersigned.
Name:
Name:
Address:
Address:
Signature:
Signature:
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EFTA00803376
Technical Artifacts (5)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Phone
(212) 288-4844Phone
(561) 781-8238Phone
(646) 388-0059Phone
(973) 908-9233Phone
419-7668Related Documents (6)
DOJ Data Set 10CorrespondenceUnknown
EFTA Document EFTA01765224
0p
DOJ Data Set 11OtherUnknown
EFTA02328489
1p
DOJ Data Set 10CorrespondenceUnknown
EFTA Document EFTA02125460
0p
DOJ Data Set 9OtherUnknown
From: "Jeffrey E." <[email protected]>
4p
DOJ Data Set 11OtherUnknown
EFTA02489202
1p
DOJ Data Set 10OtherUnknown
EFTA02086739
1p
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