Resolución Incapacidad

Filing # 23752243 E-Filed 02/13/2015 02:11:28 PM
IN THE CIRCUIT COURT OF THE

11TH JUDICIAL CIRCUIT IN AND FOR
MIAMI-DADE COUNTY, FLORIDA
MENTAL HEALTH DIVISION
CASE NO. 13-2001 MH 05
IN RE: INCAPACITY OF
CARLOS ALBERTO MUNOZ SEMSCH,
Ward.
________________________________________________/
CARLOS MUNOZ MILBERG, and ADVERSARY PROCEEDING

IGNACIO MUNOZ MILBERG, ADVERSARY CASE NO:
Petitioners,
v.
TERESA KOETZLE DALY, as Purported

Attorney-in Fact, and MARIA ELENA MUNOZ
MULANOVICH, as Purported Health Care Surrogate,
Respondents.
________________________________________________/
NOTICE OF FILING
DECLARATION THAT PROCEEDING IS ADVERSARY
Respondents, Carlos Munoz Milberg and Ignacio Jose Munoz Milberg, by and through
their undersigned counsel, allege as follows:
1. There is now pending proceeding against the Respondents Teresa Koetzle Daly
and Maria Elena Munoz Mulanovich, in the form of Carlos Munoz Milberg and Ignacio Munoz
Milbergs Petition to Terminate Durable Power of Attorney and Designation of Healthcare
Surrogate, attached hereto as Exhibit A.

2. Pursuant to Florida Probate Rule 5.025(b), the undersigned hereby declare the
Proceeding to be adversary.
3. Hereafter all proceedings relating hereto, as nearly as practicable, shall be
conducted similar to suit of a civil nature, and the Florida Rules of Civil Procedure shall govern.
WHEREFORE, Respondents, Carlos Munoz Milberg and Ignacio Jose Munoz Milberg,
by and through their undersigned counsel, declare this action is an adversary proceeding.
Dated: February 13, 2015.
Respectfully submitted,
WEINER & CUMMINGS, P.A. COFFEY BURLINGTON, P.L.

1428 Brickell Avenue, Suite 400 2601 S. Bayshore Drive, Penthouse
Miami, Florida 33131 Miami, Florida 33133
Tel. 305- 371-7800 Tel. 305-858-2900
Fax. 305-858-5261
By: /s/ Paul M. Cummings By: /s/ Fernando L. Tamayo

Paul M. Cummings FBN 161271 Fernando L. Tamayo FBN 28530
paul@wcvlaw.com David A. Freedman FBN 161817
ftamano@coffeyburlington.com
Lmaclaren@coffeyburlington.com
service@coffeyburlington.com
Counsel for Petitioners
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CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by
the Florida Courts eFiling Portal pursuant to Fla. R. Jud. Admin. 2.516(b)(1), and by U.S. Mail
as indicated below, on this 13th day of February, 2015:
Candis Trusty VIA U.S. MAIL

Joshua H. Rosenberg Gerald W. Pierre
Robert C. Segear 12394 S.W. 82nd Avenue
Markowitz, Ringel, Trusty & Hartog, P.A. Pinecrest, Florida 33156
9130 S. Dadeland Boulevard, Suite 1800 Tel. 305-233-9066
Miami, Florida 33156 Fax. 866-389-2760
Tel. 305-670-5000 gpierre@vasallosloane.com
Fax. 305-670-5011 Certified Mail Return Receipt Requested
ctrusty@mrthlaw.com No. 7013 1090 0001 7981 2162
jrosenberg@mrthlaw.com
rsegear@mrthlaw.com
Counsel for Teresa Koetzle-Daly & Maria
Elena Munoz de Mulanovich
Certified Mail Return Receipt Requested
No. 7013 1090 0001 7981 2155
VIA U.S. MAIL VIA U.S. MAIL

Hortensia Munoz Semsch de Sobrevilla Maria Luz Munoz Semsch
Avenida Conquistadores 828-830 Al. San Juan Buena Vista 348, Casa 11
Lima 27 Urbanizacion La Encantada
PERU Lina 9
PERU
VIA U.S. MAIL

Maria Soledad Munoz Semsch de
Ortiz de Zevallos
9b Los Canarios Urbanizacion La Pradera
Lina 12
PERU
By: /s/ Fernando L. Tamayo

Fernando L. Tamayo
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Exhibit A
IN THE CIRCUIT COURT OF THE
11TH JUDICIAL CIRCUIT IN AND FOR
MIAMI-DADE COUNTY, FLORIDA
CASE NO. 13-2001 MH 05
Ward.
________________________________________________/
CARLOS MUNOZ MILBERG, and ADVERSARY PROCEEDING

IGNACIO MUNOZ MILBERG, ADVERSARY CASE NO:
Petitioners,
v.
TERESA KOETZLE DALY, as Purported

Attorney-in Fact, and MARIA ELENA MUNOZ
MULANOVICH, as Purported Health Care Surrogate,
Respondents.
________________________________________________/
CARLOS MUNOZ MILBERG AND IGNACIO MUNOZ MILBERGS PETITION TO

TERMINATE DURABLE POWER OF ATTORNEY AND DESIGNATION OF
HEALTHCARE SURROGATE
COME NOW, Carlos Munoz Milberg (Carlos Munoz Jr.) and Ignacio Jose Munoz
Milberg (Ignacio Munoz), Petitioners and sons of Carlos Alberto Munoz Semsch (the
Ward), by and through undersigned counsel, and pursuant to Florida Statutes 709.2116(d)
and 765.105, hereby file this Petition to Terminate the Durable Power of Attorney naming Teresa
Koetzle Daly (Koetzle) as the Wards attorney-in-fact, and the Designation of Health Care
Surrogate naming Maria Elena Munoz Mulanovich (Mulanovich) surrogate of the Ward, and
the addendum, granting surrogate powers to Koetzle, and allege:

INTRODUCTION
1. Petitioners are the sons and only children of the Ward. They have standing to
bring this action under Floridas Power of Attorney statute, 709.2116(d), as persons interested
in the welfare of the Ward who have a good faith belief that the Courts intervention is necessary
to protect the welfare of the Ward. Petitioners also have standing pursuant to Floridas Health
Care Surrogate statute, 765.105.
2. On October 2, 2014, this Court entered an order declaring the Ward incompetent,
and temporarily permitting the use of the Simple Durable Power of Attorney (Power of
Attorney) and the Designation of Healthcare Surrogate the Ward signed on January 7, 2013 and
May 20, 2014, respectively. (Composite Exhibit 1 hereto). The Power of Attorney designates
Respondent Teresa Koetzle Daly (Koetzle) as attorney-in-fact and the Designation of Health
Care Surrogate designates Respondent Maria Elena Munoz Mulanovich (Mulanovich) as the
Wards surrogate. Additionally, Mulanovich purportedly assigned Health Care Surrogate power
to Koetzle on July 13, 2014. (See Exhibit 2, attached hereto). The Simple Durable Power of
Attorney designates the Wards longtime friend Juan Duany as the successor attorney-in-fact to
Koetzle.
3. The nature of the Ward's incapacity is that he has an impaired executive function
and suffers from Alzheimer's disease and/or dementia. (See Examining Committee Reports,
attached hereto as Exhibit 3.)
4. Florida Statute 709.2116 allows a court to construe or enforce a power of
attorney, review the agents conduct, terminate the agents authority, remove the agent, and grant
other appropriate relief. Petitioners, sons of the Ward, are interested in the welfare of the Ward
and have a good faith belief that the Courts intervention is necessary.
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5. Florida Statute 765.105 allows a patients family member(s) to seek judicial
intervention if that person believes that the surrogate or proxy was improperly designated or
appointed, the surrogate or proxy has failed to discharge his or her duties, or the surrogate or
proxy has abused his or her powers.
GENERAL ALLEGATIONS
6. Petitioners are the Wards only children. Carlos Munoz Jr. is a medical physician
in Worcester, MA. He received his undergraduate degree from The University of Miami and his
medical degree from New York Medical College. He currently works as an anesthesiologist at
The University of Massachusetts Medical Center in Worcester. Ignacio Munoz is a
businessperson in Lima, Peru. He received his undergraduate degree in Business Administrations
at the University of Miami. He received his MBA from the Wharton School of Business. Both
of the Petitioners are United States citizens.
7. In or about mid-2011, Petitioners and other family, friends and associates of the
Ward noticed that the Ward was behaving erratically. This erratic behavior included, but was not
limited to: the Wards disorientation as to where he resides; forgetting simple and routine
matters; having difficulty driving (the Ward used to be a race car driver); frequently repeating
himself; abruptly leaving business meetings with no explanation; missing appointments, getting
lost in his office; forgetting to pay his taxes; showing difficulty following along in business
meetings; and making unusual misrepresentations and statements. The Wards family finally
convinced him, after much resistance, to visit a neurologist at the Cleveland Clinic, Dr. Nestor
Galvez. After several examinations of the Ward, Dr. Galvez concluded that the Ward was
suffering from early-onset Alzheimers Disease. The Ward was also brought to see Dr. Alec
Roth, a neuropsychiatric specialist at Palmwood Center in Sunrise, FL, who also diagnosed the
Ward with early-onset Alzheimers Disease.
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8. It was just prior to this period of time that the Ward met Koetzle. At the time of
their meeting, the Ward was married to Ana Ines Munoz, the Petitioners mother. Koetzle was
married to Jose Luis Daly. Koetzle first approached the Ward seeking his investment in an
energy drink company, New World Products, Inc., that she was involved in, along with her
husband and others.
9. On or around April, 2012, the Ward moved out of his home that he resided in with
Ana Ines Munoz, due to his relationship with Koetzle. Shortly thereafter, the Ward and his wife
began divorce proceedings in Peru. Juan Duany, the designated successor attorney-in-fact in the
Power of Attorney, mediated the divorce settlement agreement in Peru. Koetzle, whom by this
point completely dominated most aspects of the Wards life, inserted herself into the divorce
proceedings and attempted to negotiate on behalf of the Ward and influence the outcome of the
settlement negotiations.
10. Around this same time, in October 2012, Koetzle unduly influenced the Ward,
whom she knew had been diagnosed with Alzheimers Disease, to transfer by deed 50% of his
interest in his Miami condominium, located at 60 Edgwater Dr. PH2A, Coral Gables, FL 33133
(the Edgewater Condo) to Koetzle. At that time, Koetzle was still married to Daly.
11. Once the Wards divorce from Ana Ines Munoz was finalized in November of
2012, Koetzle and her husband, Jose Luis Daly (Daly) moved into the Wards homes in Lima
and Miami. Prior to moving in to the Wards homes, Koetzle and her husband Daly lived in a
rental apartment in Lima, Peru. Understandably, the Petitioners were concerned that Koetzles
husband moved into their fathers home. Petitioners were also very concerned about their
fathers deteriorating health, and were actively attempting to get him medical assistance.
12. Petitioners and the Wards sisters initially sought to develop a good relationship
with Koetzle so they could work collaboratively with her to get the Ward the proper medical
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treatment. Petitioners openly discussed the Wards deteriorating condition with Koetzle, and
expressed their concerns directly to her. Rather than assist the Ward in obtaining treatment for
his disease, Koetzle fully rejected the diagnoses that the Ward suffered from Alzheimers
Disease and/or dementia. Koetzle constantly attempted to explain away the Wards erratic
behavior as being anything other than symptoms of Alzheimers disease or dementia. On several
occasions, Koetzle claimed that the Ward had actually been cured of Alzheimers Disease, and
stopped his medical treatment for Alzheimers Disease or dementia.
13. Koetzle also claimed that the Wards cognitive issues were caused by his
consumption of alcohol and Xanax, and that what he needed was a regimen of yoga, dance and a
healthy diet in order to improve his health. Koetzle wrote this in a series of e-mails to the Wards
sisters, Mulanovich and Maria Luz Munoz Semsch in October of 2012 (see Exhibit 4 hereto).
Koetzle also verbally communicated this to many people, including the Wards sisters and
friends of the Ward. Koetzles denial of the Wards true medical condition was part of her
scheme to assume control of the Wards finances and misappropriate his funds and assets for her
own benefit.
14. As a result of Koetzles denial that the Ward needed proper medical care, the
Petitioners and the Wards sisters, Hortensia Munoz Semsch de Sobrevilla, Maria Luz Munoz
Semch, and Maria Soledad Munoz Semsch de Ortiz de Zevallos, became very concerned with
the way Koetzle was managing or refusing to address the Wards healthcare needs, and
expressed their concerns to Koetzle. As a result, Koetzle isolated the Ward and prevented the
Petitioners, the Wards sisters, and other friends and associates who expressed concern about the
Wards health, from contacting or communicating in any manner with the Ward. On most
occasions, Koetzle would refuse to permit these family members and friends to speak to the
Ward on the phone, or to visit him at his home. On the few occasions that Koetzle did allow
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Petitioners or other family members to visit or contact the Ward, she insisted on being present
during the communications, and she always controlled the nature and time of such
communications. Meanwhile, Koetzle continued to reside with her husband and the Ward at his
Edgewater Condo and condo in Lima, Peru, and continued to deny that the Ward was suffering
from a mental health disease. Meanwhile, Petitioners, firmly believing that the Ward was not
well, with a worsening condition, and under the control of Koetzle, the Petitioners began to
explore legal options to protect their father from Koetzles undue influence.
15. During this process of isolating the Ward from his family and friends who
expressed concerned about his health or inquired about his healthcare treatment, Koetzle cut off
the Wards contact with these persons, because she believed that they posed a threat to her plan
to isolate the Ward and convert his assets for her own use. A list of persons that Koetzle
excluded from the Wards life includes, but is not limited to:
a. The Petitioners;
b. The Wards sisters Maria Luz Munoz Semsch, Maria Soledad Munoz Semsch de
Ortiz de Zevallos, and Hortensia Munoz Semsch de Sobrevilla;
c. The Wards brother-in-law and confidant Raul Ortiz de Zevallos
d. The Wards longtime attorney Alcides Avila of Avila, Rodriguez Mena and Ferri,
LP;
e. The Wards longtime cardiologist, Dr. Cesar Conde;
f. The Wards longtime urologist, Dr. Luis Maggiolo;
g. The Wards longtime friend and colleague Ted Miller;
h. The Wards longtime friend and business associate Fernando Montero;
i. The Wards longtime friends Walter and Teri Shikany;
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16. Some of the concerns expressed by these and other persons since 2012 include,
but are not limited to, the following:
a. Leonardo Perez, the Wards longtime handyman, reported to the Petitioners on
several occasions that the Ward was behaving erratically, such as walking around the
home naked, showering with clothes on, and asking Mr. Perez if he could take the
Ward home with him. (See Affidavit of Leonardo Perez, attached hereto as Exhibit
5). Mr. Perez also reported to Petitioners that the Wards mental health progressively
deteriorated from the time of the Wards initial diagnosis through the time that Perez
ceased to work for the Ward approximately a two and a half year period. Perez
resigned after the Ward was moved to the palace and after he filed an affidavit in
support of the Petitioners.
b. Juan Duany, the Wards longtime friend, who is named as successor attorney-in-fact
to Koetzle in the Durable Power of Attorney, also served as mediator in the divorce
between the Ward and his ex-wife. Mr. Duany reported to the Petitioners that Koetzle
was present at multiple divorce settlement meetings, and she was fully controlling the
Ward throughout the divorce process, including negotiating on the Wards behalf.
See Affidavit of Juan Duany, attached hereto as Exhibit 6.) He also reported that the
Ward behaved erratically during the settlement negotiations Id.
c. Alcides Avila, the Wards longtime attorney, and the attorney whose office prepared
the Power of Attorney, reported to the Petitioners that Koetzle seemed to be
controlling the Ward, whom he said was behaving oddly, and, according to his
assistants, she verbally abused the Ward in the lobby of Avilas law office.
d. Cyntia H. Garcia, Alcides Avilas assistant, reported to Mr. Avila and the Petitioners
that Koetzle was verbally abusive and insulting to the Ward while at the offices of
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Mr. Avila. (See Declaration of Cyntia H. Garcia, attached hereto as Exhibit 7).
Additionally, Koetzle frequently attempted to speak for the Ward, and consistently
and incessantly called Mr. Avila to discuss the Wards legal matters. Ms. Garcia-
Perez also received unusual e-mails from the Wards email account, which she
believes were written by Koetzle, not the Ward.
17. Having successfully isolated the Petitioners and the Wards family and friends
from the Ward, and with the Wards deteriorating mental condition, Koetzle began converting
the Wards funds and assets for her own benefit.
18. Koetzle wrongfully induced the Ward to execute a quit claim deed which
transferred title to her and the Ward as joint tenants with right of survivorship in the Edgewater
Condo. (See Exhibit 8 hereto). Koetzle then later influenced the Ward to transfer his remaining
interest in the Edgewater Condo, to her. (See Exhibit 9 hereto). Koetzle also wrongfully induced
the Ward to sell his Lima, Peru condominium, which he had owned for less than one year.
19. Additionally, Koetzle wrongfully induced the Ward to convert his bank accounts
into joint accounts with her. Once this was accomplished, upon information and belief, Koetzle
began to transfer funds from these joint accounts into her own accounts, or accounts of her
family members. Koetzle also wrongfully induced the Ward to purchase luxury vehicles under
his name, even though he could no longer drive due to his mental health disease, and/or his
weakened state. Koetzle then used the vehicles for her own personal benefit, including a
Masserati that she now drives.
COUNT I: TERMINATION OF SIMPLE DURABLE POWER OF ATTORNEY
Petitioners repeat and reallege the allegations in paragraphs 1 through 19 above as if fully
set forth herein, and further state as follows:
8
20. This Court has power to construe or enforce a power of attorney, review the
agents conduct, terminate the agents authority, remove the agent, and grant other appropriate
relief pursuant to Floridas Power of Attorney statute, Fla. Stat. 709.2116. Under Fla. Stat.
709.2116(d). Petitioners have standing to bring an action under this statute, because they are
the Wards sons and are interested in his well-being.
21. Koetzle has violated her duties as the Wards attorney-in-fact under 709.2116(4).
Koetzles violations, include, but are not limited to, the following:
a. Koetzle failed to act solely in the interest of the Ward. Rather, she has exercised the
power of attorney to convert the Wards assets and funds to her and for her familys
benefit. Koetzle has taken advantage of, and exerted undue influence on the Ward,
who at all relevant times has been either mentally disabled or in a weakened mental
state, in order to serve her personal interests.
b. Koetzle has not acted in good faith in the Wards best interest, as detailed herein.
22. Based on the foregoing, the Court should remove Koetzle as the Wards attorney-
in-fact and terminate the Durable Power of Attorney.
WHERFORE, Petitioners request that the Court find that Koetzle violated her duties as
the Wards attorney-in-fact under 709.2116(4), remove her as the Wards attorney-in-fact and
terminate the Simple Durable Power of Attorney.
COUNT II: TERMINATION OF DESIGNATION OF HEALTH CARE SURROGATE
Petitioners repeat and reallege the allegations in paragraphs 1 through 19 above as if fully
set forth herein, and further state as follows:
23. Mulanovich is the primary designated healthcare surrogate of the Ward. The
Ward lacked the mental capacity, or was unduly influenced by Koetzle, to sign the Designation
of Healthcare Surrogate. Mulanovich has abused her powers as the Wards healthcare surrogate
9
by: preventing the Ward from receiving proper medication for his condition(s), not allowing the
Ward to see the proper doctors to treat his medical condition, abandoning the Ward, and
generally providing ineffective assistance as healthcare surrogate.
24. Additionally, Mulanovich is not a U.S. resident, and is unavailable to exercise
powers for the Ward under the Healthcare Surrogate. In fact, in 2013, she was physically present
in the United States for less than ten percent of the year, and in 2014, she was physically present
in the United States for less than twenty percent of the year. Notwithstanding Mulanovichs
abuse of her surrogate powers, Mulanovich cannot properly manage the health care needs of the
Ward if she is not physically present in Miami for even twenty percent of the year.
25. Koetzle was purportedly granted healthcare surrogate power of the Ward by
Mulanovich. Mulanovichs assignment of surrogate power to Koetzle is highly irregular and
illegitimate. Mulanovich does not have the legal power to effectuate a transfer of healthcare
surrogate power. Moreover, the Ward did not consent to the assignment of surrogate power to
Koetzle, and the Ward did not have capacity to consent such assignment.
26. Even if the assignment of healthcare power to Koetzle was effective, Koetzle has
abused her powers as the Wards healthcare surrogate by: preventing the Ward from receiving
proper medication for his condition(s), not allowing the Ward to see the proper doctors to treat
his medical condition, abandoning the Ward, and generally providing ineffective assistance as
healthcare surrogate.
27. Additionally, neither Mulanovich nor Koetzle possess any formal medical training
or knowledge of the U.S. healthcare system. Mulanovich does not even reside in the United
States, and in fact, spent less than twenty percent of 2014, and less than ten percent of 2013, in
the United States.
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WHERFORE, Petitioners request that the Court find that Koetzles assignment of
surrogacy of the Ward was illegitimate, and that Mulanovich and Koetzle have abused their
powers as healthcare surrogate, remove them as the Wards healthcare surrogates, and terminate
the Designation of Healthcare Surrogate.
COFFEY BURLINGTON, P.L.

2601 S. Bayshore Drive, Penthouse
Miami, Florida 33133
Tel. 305-858-2900
Fax. 305-858-5261
By: /s/ Fernando L. Tamayo

Fernando L. Tamayo FBN 28530
David A. Freedman FBN 161817
ftamayo@coffeyburlington.com
Lmaclaren@coffeyburlington.com
service@coffeyburlington.com
11
COMPOSITE
EXHIBIT 1
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\ IN THE ELEVENTH JUDICIAL CIRCUIT COURT
, IN MIAMI-DADE COUNTY, FLORIDA II
MENTAL HEALTH DIVISION Ii
CASE NO, 13-2001 MH 05
Alleged Incapacitated Person.

____________________________________1
AGREED ORDER ON OCTOBER 2, 2014 INCAPACITY HEA
THIS CASE came before the Court on October 2, 2014, on the Petition
I0 Re-Determine
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Incapacity, filed by Carlos Munoz Milberg and Ignacio Jose Munoz Milberg, , II parties having
agreed to the entry of this Order, the Court having reviewed the file, and bej~g otherwise fully
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advised, it is:
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1. The Parties to this matter are Carlos Alberto Munoz Semsch. alleged
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incapacitated person; Carlos Munoz Milberg and Ignacio Jose Munoz Milber ' , petitioners and
sons of Carlos Alberto Munoz Semsch; and Maria Elena Munoz de Mula :ovich. interested
person and sister of Carlos Alberto Munoz Semsch, and Teresa Koetzle-Daly, interested person
and companion of Carlos Alberto Munoz Semsch ("Parties").
2. The Parties do not object to the examining committee reports submitted by Dr.
Neda Picuric, Dr. David Echavarria, and Dr. Enrique Suarez.
3. For the reasons stated in the Order Determining Incapacity, th'~ Court finds that
Carlos Alberto Munoz Semsch is completely incapacitated.
4. On January 7, 2013. Carlos Alberto Munoz Semsch executed . Simple Durable
Power of Attorney naming Teresa Koetzle-Daly as his attorney-in-fact, and J ' n Manuel Duany
I
Pazos as the ~uccessor attorney in-fact if Ms. Koetzle-Daly is unable or till 'illing to serve as
attorney-in-fact.
5. On May 20, 2014, Carlos Alberto Munoz Semsch executed ,n Designation of
Healthcare Surrogate naming Maria Elena MWloz de Mulanovich as his heal th ,are surrogate,
6. Carlos Munoz Milberg and Ignacio Jose Munoz Milberg, sons 1of Carlos Alberto
Munoz Semsch, reserve the right to contest the validity of the Simple ~urabl e Power Of
ATRUE COpy
CERTIFICATION ON LAST PAGE
HARVEY RlJVIN, CLERK
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Case No. 13-2001 MH 05
, Incapacity of Carlos Alberto Munoz Semsch
II.I
Agreed Order On October 2, 2014 Incapacity Hearing I!
Attorney, Designation Of Healthcare Surrogate, and Living Will Declarati#n of Carlos A.
Munoz, signed on May 27,2014, which shall remain in effect pending this Cout.t' s determination
of whether to use the advanced directives or appoint a guardian.
7. Without waiving their strenuous objections to the Durable Po ;er of Attorney,
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Designation of Healthcare Surrogate and Living Will Declaration, Carlos Mu oz Milberg and
Jgnacio Jose Munoz Milberg agree that Teresa Koetz]e-Daly shall serve as all , rney-i n-fact and
Maria Elena Munoz de Mulanovich shall serve as healthcare surrogate pen ,ing this Court's
determination of whether to use the advanced directives or appoint a guardian. :
8. Teresa Koetzle-Daly, as currently agreed attorney-in-fact, . ~lal l use Carlos
Alberto Munoz Semsch's assets exclusively for the healthcare, mai ntenanc~~1 and support of
Carlos Alberto Munoz Semsch pending this Court's determination of wh Ither to use the
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advanced directives or a.ppoint a g~ardian. . I

9. Gerald Pierre, Esqmre shall remam as counsel for Carlos Albert? Munoz Semsch
,
pending further order of this court. 1
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DONE and ORDERED in Miami-Dade County, Florida on October 2,2 1:14.
BfJ<NAFW S, SH/,Yif\O
cc: Gerald Pierre, Esquire,
Paul Cummings Esquire,
David Freedman, Esquire
Fernando Tamayo, Esquire
Candis Trusty, Esquire STATE OF FLORIDA C
Robert C. Segear, Esquire IItEREDy CEmlT')' UI81lho fi' ?UNTY OF MIAMI-DAD ;:
Original CX1 fiIo III UII3 offlQ) o~n{)O no 19.a fnl91lnd COIroc~CUjly oj)
HARVEYRUVIN C,~E'~+M"
, u:RK' ~d County. I
Depuly C/IU& ourt
-- -, ("et-7
67~
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Filing # 18701626 Electronically Filed 09/26/2014 11 :05 : 14 AM
IN THE ELEVENTH JUDICIAL CIRCUIT COURT

IN MIAMI-DADE COUNTY, FLORIDA
CASE NO. 13-2001 MH 05
Ward.
_______________________________ 1
SIMPLE DURABLE POWER OF ATTORNEY AND DESIGNATION OF HEALTH

CARE SURROGATE~NOTICE OF FILING
Teresa Koetzle-Daly and Maria Elena Mufioz de Mulanovich, as interested patties in this
matter, hereby file the Simple Durable Power of Attorney and Designation of Health Care
Surrogate for Carlos A. Mufioz.
Signed on September 26,2014.
MARKOWITZ, RINGEL, TRUSTY + HARTOG, P.A.

Primary Service E-Mail: probateservice@mrthlaw.com
Attorneys for Teresa Koetzle-Daly & Maria Elena Mufioz
de Mulanovich
Isl Robert C. Segear, Esquire

By: ______~~--~----------------__
CANDIS TRUSTY
Florida Bar No. 335101
ctrusty@!ruthlaw.com
JOSHUA H. ROSENBERG
jrosenbel'g@mlthlaw.c011l
ROBERT C. SEGEAR
rsegeal'@mltblaw.com

9130 South Dadeland Boulevard, Suite 1800, Miami, Florida 33156 t: 305.670.5000 f: 305.670-5011 w: www.mrthlaw.com
CASE NO. 13-2001 MH 05
IN RE: Incapacity of Carlos Alberto Munoz Semsch
Notice of Filing
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that hue and correct copies of the Notice of Filing were sent on
September 26, 2014, via Florida Courts E-Filing POltal, pursuant to Florida Supreme COUlt
Administrative Order No. AOSC13-19 to: Paul M. Cummings, Esquire, paul@wcvlaw.com;
David Freedman, Esquire dfrcedman@coffeyburl1ngton.com; Gerald Pierre, Esquire,
gpierre@vtlsallosloane.com; Ms. Maria Elena Munoz de Mulanovich, malena@malena-
opportunity. com; and Ms. Teresa Koetzle-Daly at teresa.koetzle@mykaptive.com.
lsi Robert C. Segeal', Esquire
CANDIS TRUSTY
JOSHUA H. ROSENBERG
ROBERT C. SEGEAR

9130 South Dadeland Boulevard, Suite 1800, Miami, Florida 33156 t: 305.670.5000 f: 305.670-50 II w: www.lnl1hlnw.colu
504685 I.DOe
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SIMPLE DURABLE POWER OF ATTORNEY
I, CARLOS Mu~oz, as of this January 7, 2013, hereby appoint and empower TERESA
KOBTZLE-DALY as my true and lawful attorney-in-fact (limy Agent"), to act for me and in my name
and on my behalf to exercise the powers listed in this DUl'able Power of Attorney. If my Agent is
unable or unwilling to serve I designate JUAN MANUEL DUANY PAZOS as my Agent.
..
Third Parties. Any third pruty to whom this Durable Power of Attorney is presented may
rely upon an affidavit by my Agent stating, to the best of my Agent's knowledge and belief, that
this power has not been revoked, tbat I am then living, and that no proceedings have been initiated
to determine my incapacity.
A TllRD PARTY WHO IMPROPERLY REFUSES TO ACCEPT TIDS POWER

. O,F ,.~TI.oRNEY WILL BE LIABLE FOR DAMAGES, INCLUDING REASONABLE
. ATTORNEY'S. FEES AND COSTS, INCURRED IN ANY ACTION OR PROCEEDING
THAT CONFIRMS THE VALIDITY OF THIS POWER OF ATTORNEY.
Durable Power. This Durable Power of Attorney will not be affected by my subsequent
incapacity except as provided in Chapter 709 of the Florida Statutes. It is my specific intent that
the power conferred on my Agent will be exercisable from the date of this Durable Power of
Attorney, . and will remain effective thereafter, notwithstanding my subsequent disability or
. incapacity, except as otherwise specifically provided by statute.
My Agent will have 'the following powers and dutie~:
GENERAL AUTHORITY
1. To -manage all assets and properties belonging to me or in which I have any interest, and to
expend whatever funds my Agent deems proper for the preservation, maintenance, or
improvement of those assets or properties.
2. To exercise all powers even though my Agent may also be acting individually or on behalf
of any other person or entity interested in the same matters (as more fully set forth in the
Additional Provisions seCtion).
3. To seek on my behalf the assistance of a court or other governmental agency to carry out an
act authorized in this power of attorney and to enforce the exercise of these powers granted
to my Agent.
4. To exercise any authority reasonably necessary to give effect to an express grant of specific
authority in this power of attorney.
5. To the extent not limited under the law of the jurisdiction in which this power of attorney is
presented, to take all other actions as may be necessary or appropriate for my personal
well-being and the management of my affairs, as fully and as effectively as if made or done
by me personally.
000789l2.RTF v.l
I
..,
"
SPECIFIC POWERS
6. To manage and conserve any real property, Of any interest or incidents in real property, on
my behalf, including the authority to receive, buy, sell, exchange, lease, encumber, and
convey such property. Such property and incidents in property include any interest in
homestead property, mineral rights, cooperative apartments, and any property lawn as
joint tenants with right of survivorship or as tenants by the entireties.
7. To manage and conserve any tangible personal property, or any interest in tangible
personal property, including exempt property, on my behalf, including the authority to
receive, buy, sell, exchange, lease, encumber, and convey such property.
8. To operate, insure, license and register with any state or government agency, any and all
vehicles of which I am the registered or legal owner.
9. To conduct investment transactions as provided in Fla. Stat. 709.2208(2).
10. To collect, receive, and receipt for any and all sums of money or payments due or to
become due to me.
11. To pay any and all bills, accounts, claims, and demands now or hereafter payable by me,
including a judgment, award, order or settlement made in connection with a claim or
litigation.
12. To conduct banking transactions as provided in Fla. Stat. 709.2208(1).
13. Except as otherwise provided under Fla. Stat. 709.2201(3) relating to contracts for
personal services, to contract with any person or Entity for any purpose (including
contracts between me and my Agent), and to perform that contract; to agree to any
termination, release, rescission or modification of any contract or agreement.
14. To the extent not limited in the Special Transactions section, to act for me regarding any
trust, probate estate, guardianship, conservatorship, escrow, custodianship or fund in
which I may have a right or beneficial interest.
15. To sue in my name and behalf for the recovery of any and all sums of money or other things
of value, payments due or to become due to me, or damages I have sustained or will
sustain; to seek an attachment, garnishment, order of arrest, or other preliminary,
provisional, or intermediate relief and use an available procedure to effect or satisfy a
judgment, order, or decree; and to collect, hold and disburse any property received in
satisfaction of judgments.
16. To act for me with respect to any bankruptcy or insolvency concerning me or some other
person, or with respect to a reorganization or receivership which affects my interest in any
property.
00078912.RTFv.l .2
17. To demand, obtain, review, and release to others medical records, documents, or
communications protected by the patient-physician privilege, attorney-client privilege, or
any similar privilege, including all records subject to, and protected by, the Health
Insurance Portability and Accountability Act of 1996, as amended ("HIPAA"). I
designate my Agent as my personal representative under HIPAA. My Agent may also
enforce any or all of the privileges listed above.
18. To nominate on my behalf a person (including an Agent) or entity to be appointed by a

court of appropriate jurisdiction as guardian of my person or property, or both, or as
custodian for my property during the pendency of any proceedings to determine my legal
capacity.
19. To receive and open my mail, change my mailing address, and otherwise represent me in
any matter concerning the U.S. Postal Service.
20. To hire and compensate attorneys, accountants, advisors, financial consultants, managers,
agents, and assistants (including any individual or entity who provides investment advisory
or management services, or who furnishes professional assistance in making investments)
without liability for any act of those persons, if they are selected and retained with
reasonable care. An Agent may serve in one or more of these capacities and be
compensated separately for the services in each.
21. To discharge (with or without cause) any person hired by me (or on my behalf), by my
Agent, or by any prior Agent, including but not limited to, the categories of persons named
above, and physicians, nurses, care-givers, and domestics.
22. To act for me with respect to benefits or actions from or relating to any branch or
department of the United States government, any state government, or any foreign
government, whether or not recognized by the United States, including without limitation,
the Social Security Administration, the Department of Veterans Affairs, the Internal
Revenue Service, Medicare or Medicaid, and any government department providing
payments or grants.
23 . To create, fund, and maintain an Income Trust pursuant to 42 USC 1396(d)(4)(B) in order
to qualify me or retain my eligibility for Medicaid or any other public assistance benefits.
24. To represent me before any office of the Internal Revenue Service or any state agency; to
receive confidential information regarding all tax matters for all periods, whether before or
after the execution of this instrument; to prepare, sign and file any tax return on my behalf;
to pay taxes due, collect refunds, post bonds, receive confidential information, and contest
assessments, deficiencies, fines, or penalties determined by the Internal Revenue Service
or any other taxing authority; and to make any tax elections on my behalf.
SPECIAL TRANSACTIONS
Certain transactions under this power of attorney may profoundly affect my existing estate plan
00078912.RTFv.l .3
-
and therefore require a separate authorization for my Agent to engage in them. By initialing next
to any items within the respective numbered paragraphs in this Special Transactions section, I
grant my Agent the authority stated in that paragraph with respect to the item initialed. If I have
not initialed an item, my Agent is not authorized to take that action. Reference to my "wife"
means any person or persons whom I later marry.
25. W" Gifts. I authorize my Agent to make gifts of my property outright to, or for
the benefit of, members of my family or charitable organizations my Agent believes I have
supported or would support. For these purposes, a gift "for the benefit of" a person
includes a gift to a trust in which that person is a beneficiary, to a custodial account under a
state version of the Uniform Transfers (or Gifts) to Minors Act, and to a tuition savings
account or prepaid tuition plan as defined under Internal Revenue Code 529.
26. k1? Trusts. I authorize my Agent to create an inter vivos trust, whether revocable
or irrevocable, in which I am a beneficiary; to amend, revoke, or terminate a trust of which
I am a beneficiary, or transfer the assets of such a trust into another trust under which I am
a beneficiary; to create, amend, or revoke trusts for the benefit of others; and to participate
in either judicial or nonjudicial modification of a trust as permitted in Fla, Stat, Chapter
736,
27. ~ SUl'vlvorship and Other Designations. I authorize my Agent to create or

change rights of survivorship in accounts or other assets in which I have an interest; to
change a beneficiary designation for any accounts or financial instruments, including life
insurance policies, annuities, or retirement accounts of any nature; and to waive my right to
be a beneficiary of a joint and survivor annuity, including a survivor benefit under a
retirement plan of any nature,
28. ~ Disclaimers. I authorize my Agent to disclaim: any interest in property I

might otherwJse receive, either outright or in tJ.ust; any powers I have over property or as a
beneficiary of any trusts (excluding any powers I possess in a fiduciary capacity); and any
powers of appointment I have or may acquire, excluding any testamentary power of
appointment that I currently exercise in my Last Will and Testament.
ADDITIONAL PROVISIONS .
Protection for Agent. I understand, acknowledge and anticipate that many of my Agent's
actions taken pursuant to specific grants of authority in this instrument could involve her in
conflicts of interest (created either by me or by my Agent), or call into question my Agent's
apparent loyalty to me, or both. This might result from the totality of the circumstances facing the
Agent at that time, or by virtue of the Agent's specific actions that might create the conflict of
interest. I want my Agent to be free to act in my interest without concern over questionable
lawsuits. Therefore, so long as my Agent acts in good faith, she will be protected as follows:
a, My Agent does-not have an affirmative-duty to act under this power of attorney and will
not be liable for any claim or demand arising out of her good faith acts or omissions, except for
00078912,RTP v.l .4
actions or omISSIOns resulting from my Agent's dishonesty, improper motive, or reckless
indifference to the purposes of this power of attorney or my best interests.
b. My Agent may have competing interests for herself or her affiliates, and r waive any
express duty of loyalty imposed under Fla. Stat. 709.2114(2).
c. My Agent may have a conflict of interest as provided in Fla. Stat. 709.2116. Despite
that section, my Agent may undertake a transaction on my behalf even if another party to that
transaction is: (i) a business or trust controlled by my Agent, or of which my Agent, or any
director, officer, or employee of a Corporate Agent, is also a director, officer, or employee; (ii) an
affiliate or business associate of my Agent; or (iii) my Agent acting individually. This exception
also extends to any relative of such a party.
d. I fully indemnify my Agent out of my assets and my estate for any actions brought
against her, and damages she sustains, including attorneys' fees and costs, that have as a basis my
Agent's actions or inactions resulting in both a claim for breach of fiduciary duty and actual
damages to me or my estate, but this protection does not extend to actions or omissions resulting
from my Agent's dishonesty, improper motive, or reckless indifference to the purposes of this
power of attorney or my best interests. If my Agent ceases to serve, these provisions for
inderrmification may be enforced against me or a successor Agent. This right of indemnification
extends to the estate, personal representatives, legal successors and assigns of my Agent.
e. My Agent will not be liable for any actions or omissions by a predecessor agent if the
Agent does not participate in or conceal the action or omission. My Agent is not required to
review the actions of a predecessor agent, absent actual knowledge by the Agent of wrongdoing.
If, however, my Agent has actual knowledge of a breach or imminent breach of fiduciary duty by
another agent, including a predecessor agent, my Agent must take action reasonably appropriate in
the circumstances to safeguard my best interests. If my Agent in good faith believes that I am not
incapacitated, giving notice to me is a sufficient action.
Compensation and Expenses. My Agent will be entitled to reasonable compensation

and reimbursement for all expenses reasonably incurred by her on my behalf.
Delegation of Powers. My Agent may not delegate the powers given under this Durable
Power of Attorney except as follows: to grant a transfer agent or similar person the authority to
register securities in my name or the name of a nominee; for investment management purposes as
provided in Fla. Stat. 518.112; or to any other person, as may be permitted under the law of
another jurisdiction in which this instrument is presented.
Suspension of Rights and Duties. All powers granted to my Agent will be suspended
immediately if my Agent is determined to be incapacitated by a court having jurisdiction.
Partial Invalidity. If any part of this power of attorney is declared invalid or

unenforceable, that decision will not affect the validity of the remaining parts.
LlmJtation on actions of Agent. My Agent may not participate in an action to the extent
that a payment or distribution pursuant to that action would discharge a legal support obligation of
00078912.RTPv.l .5
my Agent. If my Agent is the insured of any insurance policy that I own, my Agent may not
exercise any rights or have any incidents of ownership with respect to the policy, including the
power to change the beneficiary, to surrender or cancel the policy, to assign the policy, to revoke
any assignment, to pledge the policy for a loan, or to obtain from the insurer a loan against the
surrender value of the policy.
In witness whereof, I have executed this Durable Power of Attorney as of the date first
written above.
Signed in the presence of:
/l-il
Print Name: Mt"-"1'" (lj~c
~~
Two witnesses as to
Carlos Mufioz
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The foregoing instrument was acknowledged before me on January 7, 2013, by Carlos

Munoz.
~?~&#i!ad-O
I
Notary Public--State of Florida
Porson.Uy Known ....,----.J<~'--_ _ __ Print Notary Name: -------........
Produced IdelUlfioation _ _ _ _ __ My Commission Number Is: -c;:::
Type of Identltlcntlon _ _ _ __ _ My Commission Expires: _ __ _ __ _ _ __
::.~~~ MARIA P,ILAR S~-GAO<?::'

~'j' ,.to; MV COMMISSION ~ EEt2~
~ EXPIRES Auguat 27. 201i.
FIOrldaNo!a ..... I<t:oom. ,
000789J2,RTFv,l .6
DESIGNATION OF HEALTH CARE SURROGATE FOR
CARLOS A. MUNOZ
In the event that I have been determined, in the opinion of my attending physician and a
second physician, to be incapacitated and therefore unable to provide infonned consent for
medical treatment and surgical and diagnostic procedures, I, CARLOS A. MUNOZ, residing at
2627 S. Bayshore Dr., Apt. 1404, Coconut Grove, FL 33133, designate MARIA ELENA
MUNOZ de MULANOVICH, as my Health Care Surrogate ("Health Care Surrogate").
If my Health Care Surrogate is unwilling or unable to perform such duties, I wish to
designate MARIA ELENA MULANOVICH MUNOZ, as my Health Care Surrogate.
I grant to my Health Care Surrogate full authority to make decisions for me regarding my
health care, including the authority to make decisions regarding mental health treatment, and any
reference herein to health care shall include mental health care. In exercising this authority, my
Health Care Surrogate shall follow my desires as set forth in this document or as may be
otherwise known to my Health Care Surrogate and my Health Care Surrogate shall attempt to
reach the decision that I would make if capable. If my Health Care Surrogate cannot determine
the choice I would have made, then my Health Care Surrogate is authorized to act for me based
upon what my Health Care Surrogate believes to be in my best interests. In exercising such
powers, my Health Care Surrogate shall attempt to discuss with me the specifics of any proposed
health care decision if I am able to communicate in any manner, and is authorized to consult with
other health care consultants or health care providers in reaching such decisions. My
Health Care Surrogate shall have full power and authority to execute all instruments, and to do
everything appropriate and necessary to be done for me and in my name regarding my health
care. My Health Care Surrogate is hereby authorized as follows:
1. To have final authority to act for me and to make health care decisions, as
defined in Chapter 765 of the Florida Statutes, as amended, for me in matters regarding my
health care during my incapacity;
2. To consult with appropriate health care providers to provide informed
consent in my best interests and to make health care decisions for me which my
Health Care Surrogate believes that I would have made under the circumstances, had I been
capable of making such decisions;
3. To consent, refuse to consent, or withdraw consent to any and all types of
medical care, treatment, surgical procedure, diagnostic procedures, medication and to the
initiation or use of mechanical or other procedures that replace any bodily function including the
administration or withdrawal of nutrition and hydration, by using the appropriate consent forms;
4. To serve as my legally authorized personal representative under the
relevant state law and for all purposes of the Health Insurance Portability and Accountability Act
of 1996, (Pub. L. 104-191 "IDPAA"), including for purposes of the provisions of 45 Code of
Federal Regulations ("CFR"), Sections 160 through 164, and to obtain and have access to all of
my medical information and protected health information maintained by any health care
provider, health plan, or other "covered entity" as that term is defined in the HIP AA privacy rule;
and such health care providers, health plans, and other covered entities are hereby directed to
release all of my medical infonnation and protected health information in their possession to my
Health Care Surrogate and/or any Patient Advocate appointed by my Health Care Surrogate;
5. To execute any and all releases, authorizations, and other documents
necessary to obtain or authorize disclosure of all of my medical records and protected health
information, whether privileged or confidential, regarding my personal affairs or my physical or
mental health, as permitted or required under HIPAA and any other relevant state or federal law;
6. To appoint any person, including my Health Care Surrogate, to act as my
Patient Advocate, who shall have the same power and authority as my Health Care Surrogate;
7. To apply for public benefits, such as Medicare and Medicaid, for me, to
submit on my behalf any claims or documentation required to any private insurance company
with which I may have an effective policy for medical care benefits, and to have access to
infonnation regarding my income and assets to the extent required to make such application;
provided that a health care provider may not, however, make such application a condition of
continued care ifI, if capable, would have refused to apply;
8. To employ and discharge medical personnel including physicians,
psychiatrists, and oral surgeons, nurses, and therapists as deemed necessary and to pay them (or
cause them to be paid) a reasonable compensation.
9. To exercise my right of privacy and my right to participate in decisions
regarding any of my medical care even if the exercise of such rights might hasten my death.
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MILHAUSER LAW FIRM, P.L.
10. To take any action not specifically described above necessary to carry out
the intent of this docwnent.
11. To authorize or refuse to authorize any pain-killing medication or surgical
or medical procedures of any kind helpful, even though such medications or procedures may lead
to pennanent damage, addiction, or hasten my death.
12. To make arrangements for the treatment of my terminal illness under the
auspices of a hospice, if I should qualify for such care. I understand that acceptance into hospice
care entails foregoing curative treatment and life-sustaining procedures, such as the
administration of nutrition and hydration (food and water) through a feeding tube or resuscitation
in case of cardiac arrest, and that foregoing such procedures might hasten my dying. I hereby
consent to hospice care under such conditions, and direct my Health Care Surrogate to make any
and all necessary arrangements for me to receive such care, including the signing of such consent
forms as may be required by the hospice, any third party payor, and the Federal Government.
13. To contract on my behalf for any health care related service or with any
health care related facility, without my Health Care Surrogate waiving personal financial
liabilities for such contracts.
14. To sue third parties at the expense of my estate as fully as I might for their
failure reasonably to comply with instructions given by my Health Care Surrogate, to compel
compliance with my wishes as determined by my Health Care Surrogate, or to seek damages
(including punitive damages) for the failure to comply.
15. To authorize my transfer and admission to or from a health care facility.
This Designation can be revoked in writing or by designation of a successor
Health Care Surrogate.
The power of my Health Care Surrogate to act on my behalf under this Designation may
be revoked at my request if my attending physician and a second physician deem that I have
regained the capacity to make health care decisions or provide informed consent. If my spouse is
my Health Care Surrogate, this Designation will be revoked upon the dissolution or annulment of
my marriage.
My Health Care Surrogate shall not be entitled to compensation for services perfonned
under this Designation, but shall be entitled to reimbursement for all reasonable expenses
incurred as a result of carrying out any provision of this Designation.
-3-
Any persons dealing with my Health Care Surrogate under this Designation are
completely absolved of any liability by me, my estate, my heirs or assigns, for recognizing my
Health Care Surrogate's authority if they rely upon a photocopy of the original of this
Designation.
This Designation shall be valid in any jurisdiction in. which it is presented, and the
powers delegated under this Designation shall be separable; the invalidity of one or more powers
shall not affect any others.
I fully understand that this Designation will permit my Health Care Surrogate to make
health care decisions and to provide, withhold, or withdraw consent on my behalf; to apply for
public benefits to defray the cost of health care; and to authorize my admission to or transfer
from a health care facility.
I further affirm that this Designation is not being made as a condition of treatment or
admission to a health care facility.
Unless revoked, this Designation shall remain in effect indefinitely, even though a
guardian or otber representative shall be appointed to act on my behalf.
I will furnish an exact copy of this Designation to my Health Care Surrogate.
I understand the purpose and effect of this Designation and sign it after careful
deliberation, being both emotionally and mentally competent, on :( ' ',IJC J J 1,..)
~ I
[BALANCE LEFT INTENTIONALLY BLANK]
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MILHAUSER LAW FIRM, P .L.
Executed in the presence of:
CA~~NOZ. Principal
Signature bfWitness
Name of Witness
~
Sigriatul'e of Witness
TWO WITNESSES ARE REQUIRED AND AT LEAST ONE WITNESS MUST NOT
BE A SPOUSE OR BLOOD RELATIVE NOR SHOULD EITHER WITNESS BE A PARTY
ENTITLED TO ANY PORTION OF THE DESIGNATOR'S ESTATE OR THE
DESIGNATOR'S HEALTH CARE PROVIDER OR EMPLOYEE OF SUCH.
-5-
STATE OF _\\I RANYor\~ )
) SS
COUNTY OF~0.hlYC d-: )
The foregoing instrument was acknowledged before me on 90 ~%\Lt ' by

CARLOS A. MUNOZ. Said person (CHECK ONE) [ ] is personally known to me, [v1
produced a driver's license (current or issued by a state of the United States within the last five
(5) years) as identification, or [ ] produced other identification, to wit: \(ukt'kJ l)Shw'('(",(A
WITNESS my hand and official seal.
N u lie
VUKIKO USHIJIMA
My Commjssion Expires: feb b~rU>\b Notary Publlol ~Iate of New York
No, 01uS6101566
Qualified In New Y~~~II .
Commission Expires _ V)O I
-6-
LIVING WILL DECLARATION OF
CARLOS A. MUNOZ
I, CARLOS A. MUNOZ, willfully and voluntarily make this declaration on t'\ky 2.::\- ,
2014. I recognize that death is natural and is but a phase in the cycle of Hfe. I do not fear death
as much as I fear the indignity and futility of deterioration, dependence, and hopeless pain. If
there is no reasonable medical expectation of my recovery from a physical or mental disability, I
do not wish to be kept alive by artificial means or heroic measures.
Therefore, if my attending or treating physician and another consulting physician determine that
there is no reasonable medical probability of my recovery from any of the following conditions, I
direct that life-prolonging procedures be withheld or withdrawn when the application of those
procedures would serve only to prolong artificially the process of dying, and that I be permitted to
die naturally with only the administration of medication or the performance of any medical
procedure deemed necessary to provide me with comfort care or to alleviate pain, even if that
hastens my death:
I have a terminal condition caused by injury, disease, or illness from which there
is no reasonable medical probability of recovery and which can be expected to
cause my death if not treated.
I am in an irreversible end-stage condition that is caused by injury, disease, or

illness that has resulted in severe and permanent deterioration, indicated by my
incapacity and complete physical dependency, for which treatment would be
medically ineffective to a reasonable degree of medical certainty.
I am in a persistent vegetative state characterized by permanent and irreversible

unconsciousness in which there is an absence of voluntary .action or cognitive
behavior of any kind by me, with an inability to communicate or interact
purposefully with others in the environment around me.
In any of the situations described above, r direct that the following medical interventions that I
have initialed be considered Hfe-prolonging procedures.
Placement on ventilator or other mechanical devices

Surgical procedures and blood transfusion, except as needed to prevent or
alleviate suffering
Placement in an intensive care unit except as an absolute necessity to relieve
suffering
Chemotherapy or radiation therapy, unless there is a substantial medical
probability my condition will materially improve
Resuscitation efforts in the event of arrest of my heart or breathing
Active treatment of a new reversible condition such as newly-discovered cancer,

heart attack, or pneumonia
Artificial nutrition and hydration (providing food and water through tubes)
1
I request as muoh as possible treatment at home or in a comfortable bed in home-like,
comfortable surroundings.
If I have been determined to be unable to provide express informed consent regarding the
withholding, withdrawal, or continuation of life-prolonging procedures, I designate MARIA
ELENA MUNOZ de MULANOVICH, as my surrogate to carry out the provisions of this
declaration. If MARIA ELENA MUNOZ de MULANOVrCH is unable to serve as my surrogate
for any reason, I designate MARIA ELENA MULANOVICH MUNOZ, as my surrogate to
curry out the provisions of this declaration.
I hereby indemnify and hold harmless my physioian and any other health care providers who
render care or withhold care from me in good faith if they reasonably believe such action is
consistent with my wishes as expressed in this document. I further request that my family and
anyone aoting on my behalf follow my wishes and directives and take whatever steps are
neoessary, including legal action, to insure that my wishes and directives are carried out. I direct
my Attorney-in-Fact or any Trustee holding funds on my behalf to make such funds available to
my surrogate or anyone acting on my behalf to insure that my wishes as expressed here are
carried out.
I authorize my Living Will to be registered by my surrogate, attorney, or Attorney-in-Fact in any
national or regional registry for Living Wills and I authorize my Living Will to be released to any
hospital, physician, or other health care provider that is rendering care or is reasonably expected
to render care to me.
I intend that this declaration be honored by my family and my physicians as the final expression
of my legal right to refuse medical or surgical treatment and to accept the consequences for such
refusal. I understand that my wishes may place a heavy burden upon others, and so I make this
declaration to assume sole responsibility for my decision and to mitigate any feelings of guilt that
my wishes may cause.
r am emotionally and mentally competent to make this declaration, and I understand its
importance.
[BALANCE LEFT INTENTIONALLY BLANK]
2
{1\
CARLOS A.,.MUNOZ
This declaration is witnessed by us in the presence of the declarant.
;:::=-
~ Witness
Address Address
C,.orc?l \ [pehk- s, ,J Jib ~~ 6cJ, (u 'Fe I 33( y~

( :,) &6 '1 . :;., I 13 I , ( 3oS-) be., 7 - Z( F'/
Telephone " >
Telephone
STATE OF ~/..[)flZPA
COUNTY OF DADe:
The foregoing instrument was acknowledged before me on HmGL9' I 2014, by

~~'~6'"1s ~~fC.
M ~ ~O .\ 0 \ . /.l '0 oJ <0 \ 0
Personally'Known Print o tDry Nomc: ~-:--_ _ _ __ _

Produced Identifica-:"
tio- n""""""y.:- - -- My Commission Numbor 18: _ _ _ __ _
Typo of identlllca lion fO e: Ot::t62.S l.r.~ My Commission Expires: _ __ _ _ __
~,~:. ~~#(1) EDGARO ENRIQUEROA, JR.
~
MY COMMISSION' FF006195
~ .. EXPIRES: January 2G, 2018
~ltOfJ\O~.;- 9oI\6oml1l9udgttNOIlIySlrvl~f$
3
MILHAUSER LAW FIRM, PoL.
EXHIBIT 2
- .... _- ... ..... -....._......... -._-- .. ...--._. -._.__ ._ . ._-_.... .- . -..- ..... -~- .---.--...-.- . .......
ttereWith I, Marla .Elena Muftoz de MulanoVich authorize Teresa Koe"tl.la Da:lyto

make..hea.lth care deci.stOllS for my brother Carlos Alberto Munoz whenever needed
al1.dduring my a:bsence..
Miami, July 23rd, 2014
Maria. Blena Mufioz de Mulanovich

EXHIBIT 3
09-19-'14 15:11 FROM- PROBATE SERVICES 305-349-7484 T-704 P0002/0009 F-449
',.' ~ '"
IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT

TN AND FOR MIAM1-DADE COUNTY. FLORIDA t'"
REPORT OF EXAMINING COMMITTEE MEMBER

,CvDC
~
PROBA TE CASE NO: 13-2001 DIVISION: 5
IN RE; Carlos Alberto Munoz Semsch
(Insert Name of Alleged Incapacitated Person (AlP

The undersigned, being a member of the duly appointed examining committee, herein reports that ~:
the AlP was examined as directed by the Order Appointing Examining Committee, and a report of the
comprehensive examination is as follows (attach sheets ifnecessal,),):
~ .:,:.
I. GENERAL INFORMA nON ,> r. ~ ' .;" " .
NAME
A. .. ...... ".,.....
,...... OF AlP: Carlos Alberto Munoz Setnsch -.....,......----;-;------:.~.-:".-:-.,:-:-:" S;}
.. .., ..... , ...." .......,..,..,.. ... ." .. ........-.. . ~""'
.... ;:"'
.... -::.. .,.......,
.. ~--;-,
<00 -' , ."
-:.: . <~ '.: iJ' ...
B. ADDRESS_~T~h~euP~a~ I _ _ _ __ ~~--------~:7;~~~
la~~~at~K~~~\~da~II~.~F~ " ----4 ~ .
y:,..... . --,> .;.
C. DATE OF BIRTH =5/~211.!..11w:.9~48,,---_ _ _ _ _ _ _ _ _~_ __ _~. ~ . _~ "(,~.'
......' .:.,..
,>t.. ~
D. LOCATION OF ASSESSMENT above : ;::.l.-
...~
;~
B. DATE AND TIME OF ASSESSMENT ....:.9u:.13l..:;/2:..l<:.O.:..14:...!;I!~i.:.:
lO~:5~7.....
A~M~_ _ _ _ _~_ __
F. NAME ANYONE, OTHER THAN AlP, PRESENT DURING ASSESSMENT (DIRECTLY)
Companion and aide
G, NAME ANYONE IN IMMEDIATE VICINITY DURINCi ASSESSMENT (NOT DIRECTLY)
~ And Gil!lia Covella. admnistrator
n. SOURCES OF INFORMATION
A. TREATING PHYSICIAN Name Dr. Jimenez'----_ _ _ _ _ _ _ _ _ _~~_
Date contacted ___ QJ; ( check one):
Call not returned or Not contacted _if(~Reason no lead

~--
(I) Per medical records

Del]~nti8. and Impaired Executive .FuntiQning
..
Case NO.~ - ? ()O (
"
(2) Per treating physician
(3) Per M.D. or Ph.D. examining committee member (only if different from 1 or 2)
Cognitive Disorder,NOS; DeRression
D. INTCJ\VJOW WlTlJ OTUCJ\ Im.(\LTlIc.\R~ l:'nOVlOl>I\(fJ} ....dminiot .....-to..c_ _ _ _ __
Nam~s) ______________________________------____ ~ ____ ~ ___
_ _ _ _ _ _ _ _ _ Contact (tel #) _ _ _ _....;Relationship to AlP _ _~_ __
C. INTERVIEW WITH FAMILY/OTHERS Name Teresa.._ _ _ _ _ _ _ _ _ _ __
,_ _ _ __ _ Conmct (tel #) _~_ _-'Rel.ationship to AlP _~_ _ ___
D. MEDICAL RECORDSIDOCUMENTS (IDENT1FY RECORDS AND WHO PROVIDED WITH

'TELEPHONE NUMBER) ~C:.=.:hart:::..=a:.:;..t:..:Pal=a~c.:..e____________~__~_________
n.. COMPREHENSIVE EXAMINATION
Please give the results of the comprehensive examination and the committee member's
118sessrnent. Attach extra sheets jf necessary.
A. I. PHYSICAL EXAMlNATION
Not done
A.2 OBSERVATION OF PHYSICAL STATUSIPHYSICAL CAPABILITIES _~~~~~
8. . MENTAL STATUS EXAMINATION
J.:rp, ic: n"p.ntp.~ tn timp. tip.~dt.o;: nfcognitjon' able to provjde basic information'
judgment and oognition impaired: unable describe proverty; replies mostly Udon't know to
guestions 'asked"; unable to concentrate: repeat digits forn:ardi unable to do serials 3'5 or mournl
calculations; preoccupied With glaylilS wIth Apple games. _
'.
(M22S6040;4) 2
Case No._1~ --,~ ,
C. FUNCTIONAL ASSESSMENT
Needs supervision and assistance of APt's; needs help in managing finances and affairs.
If any of the three parts of the comprehensive examination were not indicated or could not be
Qooompli:Jh"d for ~)' toaaon, tho rclloon for the omiooion mur;t be e'Kl'lliinecl b.,low.
Prognosis and likelihood of future restoration 'offlghts:

Guarded.
Treatment recommenda.tions:
Continue with medical care as neede,\! according to Teres!!. he Is being worked up for
"l:reutzreJdWaK00 DIsease or ou)er tOrms 01 aemJ)ua _
IV. . REPORT OF EXAMINING COMMITTEE MEMBER
Legislative intent in adopting the current version of the Florida Guardianship Law is to make
available the least restrictive form of guardianship to assist persons who are only partially incapable of
caring for their needs, with incapacitated persons to be able to participate as fully as possible in aU
decisions affecting them. FGL 744.1012.
Is able to make informed decisions regarding his/her right to: (please state Yes or No)
~o vote NO sue, or assist in the defense of suits
NO personally apply for government
of any nature against himlher.
benefits NO manage property or to make any
gift or disposition of property
NQ have a driver's license or operate a
vehicle. NO detennine hislher residence.
NO travel(accompanied). NO consent to medical treatment.
NQ seek or retain employment. NO have an effect on his/her social
environment. or sooial aspects of
NQ contract. hislher life.
NO marry NO have a license to carry a weapon
and firearm and or own Or possess
a weapon and firearm.
{Mm604O',4} 3
Ca!leNo.~l~-lDO(
~ , ,' \,
In the following blank. Please sunUDarize specific evidence of the person's incapacity to e~rcise
infonned decisions in the categories you have checked above or in any other areas not listed.
Recommendation (Please circle one):
<!Fi~[)tf
Ljmited gUjlrdlaDsblp
No Kuardiansb.ip
The undersigned member of the extlmining committee further states that he/she has
examined the alleged incapacitated person in accordance with Florida Statute
744.331(3)(b) and ( c), perfonned the examination necessary to detennine which, if any,
, " of the rights; which the petitioner ,has requested be removed. the allegedly incapacitated
person can no longer sufficiently nor adequately exercise, and he/she hewby presents to
the Court his/her conclusions, evaluAtions and recommendations. At least one member of
the committee bas knowledge of the type of incapacity alleged in the petition.
NOTE: IF ANY MEMBER OF THE EXAMINING COMMITTEE WISHES TO EXPLAIN HIS OR
HER EVALUATION OR RECOMMENDATIONS AS TO ANY PORTION OF THE FOREGOING
REPORTI SUCH MEMBER MAY ATTACH A SIGNED STATBMENT INCORPORATING SUCH
MATTERS.
Date mailed/faxed to Clerk of CourtJLead Doctor, this __ day of _ _~_ _ _ _-.)
20_ _
(j) ",0 f~-v~~

s{gnature~ ~ Date I I
David Echavarria
Print Name Above
"
(M22S6040;4) 4
08-18-'14 15:12 FROM- PROBATE SERVICES
uv'Vv,
305-348-7484 T-704 POOOS/0008 F-448
-'v'"" "'"u v ...
"''''UI''''''''~ ., .... vv~\J r oJvr oJr r av.., I1VUJ vr ' '"'''' v ~ I oJ ~ VV \1:]1\1 J"J(J
IN THE CIRCUI~ COURT OF ~~ ~LVENTH JUDIC1AL CIRCUlT

IN AND FOI\ MIAMI-CADi! CQUtl~"{, jj'J..Ot<.LLJA
REPORT OF EXAMINING C~I'1''l'EE HE)o!BER - EEMS
DIVISION
~OBATE CASE 00: J.3-2 ,0 01 SJ:CT!ON 5
IN R.I!::
CARLOS ALB8RTO [v!UNOZ SE}.tSC~
(In~ert Nam~ of ~leged Incapacitated Per$on (AlP
Th.e unde:;-s;i.gned, belng a :nember of tl\e ~U1Y

repo~t~ that the AlP was ex~m~nad as cii;:ecte::1
and ('! report of: toe ';;OlT;prehens:'ire examination
(attach sh~et3 if necessary):
I . . GErttAAI:. INFORMA'UON . ','
A. NAM8 OF AlP Carlos Alberto Munoz Semsch '

8. ADDRESS 1 : 355 Sw 8~th Street Miami , FL 33l7~
C. OP.TE OF aIR'rH .-...:...5~12~1:..:./....;4..;;.a_ _ _ _ _ _ __ _ _ __ _ _ _ _~_~_ _ _~_
O. LOCATIot'<l Of ASSESSME:~I'r :'he , palace Renaissance Facili ty (address as Clbove)

E. DATE Me T:ME OF P.SS~SSMENT --,,9!.L/~2..L/..<!1..:!1I_..!io2;..:.:..<!1'-'li5~P.l:<M"-- _ _ _ _ _ _ _~_ __ _ _ _ _~
[]'. l\AAe ANYONE, OTHEr.. 'rHJ\N J\IP, PRESE:~~ DCJ3H;G ASSESSMEt-lT (DIRr.CTLY)
NIA.
:3. t;AME ANYONE IN Il'\MEDIATE VICINITY DORING Il.$SESS[<1f.mT (NO'[ DIRE,CTLY:
J\IP's caretaker, Don~ (phonetiC)
II. $OVRCES OF INFOEUiAl'J:ON
A. .TREATINC PHYSICIAt)I
Da~e contacted or (check o.r.e):
Call oot returned or Net cQnt~='::ed _~ __ KeaSon '.nUt JUI:" I) ....u'1nulSt:::I W>;:LO;I!
revi~ ~ n his medical
nIA.GNOSES (short surr.mary) cba~t ~t the palace
Rennaisance.
( l) Per ocedical record(s)
Nll<1 COl;n'lUvl;! :JU~dl.LUl'dIL;', t'll~d Itlzheir,1eJ:".3 Dcr;1cnti.::., 9cni!lodia~r.pJ.n~ N. ..I ... It,
D~cr~a~~d
..
Interaotivity,
l.imi tad Eruot :"00a1., Qut.put;.
v90v-9PP-90
09-19-'14 15:13 FROM- PROBATE SERVICES
Y -.",VI,",."V
305-349-7484 T-704 P0007/0009 F-449
p""vr"'",",vw VF "'''' .... .., .. "''"' """n~ .j"'..IU
Of ) . . . . .I .... . ...... h" ! ! P Qj wras "p?Q'ci fI cd
l.L
~a~e{s) ________________________________________________________ ~ ______________
________~_Contact (tel t) 305-27Q-700v Ralationshi~ to AIP Db. Aciministraticn
c. I~TERvrEW WITH fAMIL/OTHrRS
u. MEiDI::;Al, uC6l\M/MeUl-d~Wr.';l (lL}~Wl.'l!'!'i l{!:.t!lJHU~ ANiJ ' WIIU ~L{U~lUbU Wi,Hi I[,Li;PHOtq!
bl 'JM9~P.) N........ "p9wh"laoi.ca1 SlA1 "aT 1 00 lQ~s ~l ~c Both Ii Ma:tl.tu1.!'1, Gravl ;..!a~i..: .. .
provided I"ith the pet.i.tion. )f~dical Re~o:::-ts fx-om Dt:'s. Galvel~J~m.enez & J:'erreira
w~~ Q1O'Qvidli!d by tl\e AI e & Mr- . KOMHe. ,1.\1 P' S me.d1 Gil). r:ha rt'. a.t the Fa l;'l ~e
Rena~ssance was p~ovided by Julia Cove!la lTelephone as abo~e).
III. COMPREHENSIVE E~INA~ION
Please give the results of the ccmpx:el'.ensive ex:aminatlon and th.e commit~ee rn~mber' $
~ssessme~t. Attach e~~ra shee~s ~f necessary.
A,l, PHYS:CAL EXp~INATro~
N/A.
-
A.2 02SERVATION OF P~YSICAL STATUS/~HSrCAL CAPAB1L1Tr~S The AlP i$ ambulatory.
His vision and hearinq are adeq~ate for the ~v~luation. The AlP's atti~e ~nd
hi31'yqiene 1.5 ade(J\:.ate.
B. ME~TpL StATUS EXAMINATION
P~ior t9 er:t~dnC{ the iXlt.~rv ew r99J!1c too

11.1[> !!tood in :he hall :;!nd \m~ipped his t1-:0~IS~rl';,
\~hic his ~~etak.e.:c indicated t :"Iat 1\9 does this ..ih~n he is about to urinate. l!~ was quickly
taken !.Q...~. bp. r@,stroQJ!1,: 'l'he Fl.IE' i;;} fl(ol~k<'l, alel:'t. bl;t ipllttent .lVB . His 5QeeCn is c :. Allr a.nd
f).uent, au':. :"lnpo veri shed. He is oriented to pe~son. pa.t:tially to plaoe, and ctisOT.ip.!Lt~d to
time. }!i~ .mOOd is calm and his aff~~t. 1..,
exoresioolflU. His I".hinlcipg :i~)' oFg2.Q.hed, ,but.
ilq;lover:i.shed, with (:0 delUSional content. nallucinati.oJ'ls are not. reported. Tne An was
unable;! to ~Jlgaqe it: fr.bA intenri~ Rr(1~es fejr mote .that or:.e to ~~o mh\~kS.9 91:. a time. Ite
would stand UF, ~eave the i~tetviaw roo~, only to be bto~qhc back by r.is attendant. On
each of l(i such inst,ances, he ~f~otered.tb!t t'oOC'!\, intr:>duce h'msffl.f. cnR~hD()k U~p.
ur.der~~gned'$ hand as he ~ad done at the s~art of tne :i.n ~ervle~. The ~I~'s short-term and
~Ior:kinq mel(\O;:V are severely impaired, and his I:Qcent and remote m.emory ..RP~ rr.oderately
impaixed. Re ~'as able to do on:'y 1 of 6 simple si:lgle- digit l\'Iath ,c omputations, ana WclS
IJnable to do the serial ;'s or 3'g task. The AlP's fund of geo~ral ~nd 9ractic~l ~nQwi~dge
is inadequate. the AIV :i.~ ~na~are of hi5 medical condition or his prescribeci trea~nent. He
.i.s uMwareof his financial assets aJ'\d r.espoosJ.billties. Hi3 insight:, judgment, and
reality testiLg ability is adequate.
U\lVV{LVVUIo.4 "'''''IIIU''", "ol'(UVUU v .... I':JUI':JI'V:lUc. -nval ov'c-.v v~ ,-;n -ou ljj/\I jJjll
Cll8e No. 13-2001,
Seet:..1on. S
C. ~U~CTIOMAL ASSESSMENT
Th~ AIl! .L::. al\\bulat<H.Y. Th4! AI!.' i~ dcmcl'\~cd, c1[!'\ibi t Lng' f!1om.ory ilupai "'fI\~nt ,
inQttention, con:usion, diaorien~ation ~o ti_m~, and irneaired social pehavio~;
I[ <CIY u[ LILlo: I..h,,IOIli' parts of th~ r.:,'mpr~h"'.n!'tiv,;; ~..{.1mkmti,or\ ~:c:::c not

i.ndl.csted or CO\lld n~t be $t6~c.1tM~cl tor any ~e~!lotl, lilt! l.~d~Un [VI.
the omission must be explained belo~.
1;>1:09:105i5 and likelihood of future re~t.oration of rights ;
On :":'kel,Yl due to s e ve r ity r'} oognitikt e d e cline a nd p r oq r. essi v e flat u );"; :: dernill\t~,a.
Legj,slcl"t.iva in::e'nt in acopting the c\.:..rr~nt. version of the Florida Gual:dia:'l~h:i,'p La.w
is to make available ~he least restrictive f~rn of guardiansh~p to assl~t
persons who are only partially incapable of oar~ng tor tteir oeeds, with inoapacitated
persoM. to be able to participq.te ~a fully as possible ir.. al: decis;J..oflS aftebt':.:\g the:ll.
FGL 744. ::'OL'2,
Is able to make ihformed decisions IegdIdi~g his/her rig~t to: (please state Yes or No;
NQ vote ~ 5~e, or <I:ilsi.st ;i.n the defense of
ar.y oature against h~ne(
NQ personally apply for governmen~ tenefl~~ Nc ' l'tIatla(Je pl:Q~~t: Qr t make any
gift or di.&positien of prOplrty
NQ have a driver'S license O~ o~erate a v~~ile. No detemine hig/heJ: X'e5i~nCEi'.
w!.t:. ap~ll~oval of hh attending' ps.vChi~tr.i.st
'10 travel. No cop...ser.t ~o medical treatment:.
:m seek or; xe';ain empl.oy:nBnt . No have an foIffect on h:i.s/lwr soeia)

en?ironment, or soc~al aspects of
his/her life,
_ tl'j" po , , .....,....... " '""t~. " "'PI'lv,,,
I\.'''? li f l 1
1LIMLJtl dull OL vWII UL lJU:'b>!,' l:' 4
Io'\!!apon and fueam.
!n. the toUoW.lflq blank. ~lease 51llll1\an.z~ !~~,~tfl~ ~"Hl.I!IICJ lH LUIJ .lJY.l.o>UlI b
i11:IlPo.<::ity to cltcrcioc informod dooitlicm6 in ';in" 'iilo\"'i'~... "i.'i'i' Y"" h'l~r.:o. I'n.:o.r,\rp(l 1'lhtWfI or in
nny 9th~r ~r~~~ ~~T lis~~d.
The AIP is de~ent ed and his cognitive imp~ i rrnent5 x2nder hi~ incapable of using
rega roi nq :'13 eeX'e ona 1 , !,~ di ca ~, fi nanci al , c iv:l.c ot' l eqal. a:::~i r s.
v90t>-9Pv-90 Z9JSnS'lO
08-19-'14 15:13 FROM- PROBATE SERVICES 305-348-7484 T-704. . P0008/0008 F-448
.. - - _.' 9 _ .. __
Case No. l3-2001
SOCltion 5
Recommend~tion (Ple~~e circle one::
Hrl. f.luudiaDship
The ~ndersi~ned me~~e r Of the e~am~n~ng committee further st&tes th~t he/$he has
e~a~ined the alleged incapacitated pe~son in accordance with Florida Statute
7~4.331(31 (b) ~nd ( e), pe~=ormed the exa~i~at~Qn necessary to deter~i~e which,
0'"
... of< .;.. ...::.., t.h." .. L~"'''c . h,hi,.h +h .. ~Ai-i-lrlY1"'r I-~~ l':P-CJ'llested be :emoved. tr.e
o..l!~1JiJdly "'n~4Ior.'0\'.; 1;4f"~rl (lAf'tW/I (;flH uv lvn91!) :: tiuffie.i.l!JY'1tlv r.o!:' .:ld"~\l.i\t.1!t1 II
~Ker=ise, and he/she hereby ~resents to ths Court his/her eonc~uBlo~S(
evaluations anc reeo~endation8. ht least one me~er of the conmitte~ h~s
knowledge of the type of incapac~ty alleged in the petition.
NOTE; ~F ANr M~~m~R O~ Tf.E EXAMINING CO~:~TEE WISH~S TC EXP~IN p.rs CR aE~ ~vftL~ATION OR
R8CO~.MEKDJ\TIONS .'.5 TO ANY POR':.'ION OF Tf;E: FOREGuING REPORT, S;JCR MEtolfBER MAY AT'1'.~ca A SlGKE:O
ST~TEMENT lNCORPOP~JING SOCK MATTERS.
Jate mail~d/faxed to Clerk of Cou=t/Lead Doc~or, th~a leth- day Qf September,

20J.i.
... 9/16/14
fJate
~\';J:+9U.9 ~, !i! ..'~N., ~" . o .

Pri n ~ Name Above
08-25-~14 08:27 FROM- PROBATE SERVICES 305-348-7484 T-754 P0002/0005 F-527
IN THE CIRCUIT COURT Of nIE ELEVENTH JUDICIAL CIRCUIT .

IN AND fOR MIAMI-DADE COUNty, FLORIDA
REPORT OF EXAMINING COMMITTEE MEMBER r:: .... . . ."'\

~ :;- ,-
PROBATE CASE NO.lDIVISION _~13~2~O:..l<:.OA.l_._ __ _~ t::I~": - _. tI) M
i:; ~.:: :i::; 1""'\ (.::J
rn~:;;: -0 ~Y\
INRE: c-> c:: ": . N (;:)
<=> ~.::;r:.
(;;::".-::.
(J1 -J
,,-.,
_ Carlos Alberto .M unoz SCl.n8ch
=:.-< ,><>("") :;:.:;
C e& ;:::c..
1""1
'
(lng~l't NHme of Allege(llllcapnci.tftted Penon (AIP 'CF~ ~ c:e g

. . r.~ ~
The undersigned, being II member oithe duly appointed examining committee, heTC~tCpol12Nbn.F
...-. ;n
the AlP was examined as directed by the Order AppoilUing Examining Cominittcc, and a.~pOrt of the
comprehensive examination is liS follows (attach sheets ifncce88a.ry):
I. GENERAL INFORMATION
A. NAME OF AIr Callos Alberto Munoz Sems<;h
B, ADDRESS 11355 SW 841h S trccr Mia~m!.!.i.!:..

F!: L-=!.3~
3~17~3_ _ _ _ _ _ _ _ _ _ _ __ _
C, DATE OF BIRTH -,M

~ aY ",-,1....
l-2 . ~19<!.:4~8,---_ _ _ __ __ _ _ _ _ _ _ _ _ _ _~
D. LOCATION OF ASSESSMENT THE PALACE AT K ENDALL. ADDRES S AS ABOVE
E, DATE AND TIME OF ASSESSMENT Tliesday SC12tembeT 162014; 4pm
f. NAME ANYONE, OTHER THAN AlP, PRESENT PUlliNG ASSESSMENT (DlRECTL y)
Danaisy Dliarry - aidc._ __ _ _ _ _ _~_ _ _ __ __ __ __ _ _ _~
G, NAME ANYONE IN IMMEDIATE VIClNlTY DURING ASSESSMENT (NOT DIRECTLY)
Giulia Covella ~ director of customer service
II. SOURCES OF lNFORMATION
A. TREATING PHYSICIAN Name Milton Jimcnq-MD: Miguel Almunic MD
Datc contactcd ~_ _ 9!. (chcck one):
Call not rctumed _ _ _o,r Not contacted _ _x_Rcason AlP ' s medical record rev icw~ on
site ~_ _ __ _ _ _
DIAGNOSES (short summary)

(1) Pcr medical tecords
TOlJrCltC' s Disorder: Hypc.ncnsion: Domentia; Ollit Disorder: Hyp'crcholcstcroicmia
RECEIVED 09-25-' 14 01 :04 FROM- 13057180628 TO- PROBATE SERVICES P0001/0004

elise No. 13 - 200l
(2) Per treating physician
(3) Per M.D. Or Ph.P. examining committee member (only if different from 1 or 2)
B. lNTERVIEW WITH OTHER HEALTH CARE PROVIDER(S) _ _ _ __
Namc(s) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. _ _ _ _ _ _ _ _ __ _ _~
Contact (tel #) _ _ _ _ _R.clationship to AlP _______________ _
C. INTERVIEW WITH fAMILY/OTHERS Namc_T!...:e::!:l'e:::::s~a_!:K~c~tz~c'!..l.!::O:!!a:!..lly:..__ _ _ _ _ _ __
Contact (tel #) _ . _Relationship to AlP life..."p""a""'rt""llc""'r'--_ _ _ _ _ _ _ _ _ _ _ __
D. MEDICAL RECORDSIDOCUMENTS (IDENTIFY RECORDS AND WHO PROVIDED WITH

TELEPHONE NUMBER) _ _ __ _ _ _~_ _ _ _ _ _ _ _ _ _ __
III. COMPREHENSIVE EXAMINA'I'ION
Please give the ,esults of the comprehensive examination an(l the committee member's
assessmcnt. Attach ext,a sheets if nccessary .
At. PHYSICAL EXAMINATION
Thin, pale, uusteady gait, lInlabore~d_!:b~re:;:!:a~th~i~ngD.J,L...!n~o~~a~c:::u""te'__'d!!.!.i"_'st.....,re8",",,-s_____________
A.2 OBSERVATION Of PHYSICAL STATUS/PHYS1CALCAPABILlTJES
~hearing and eyesight g'rollsly fntact _ _ _ _ _ __
B. MENTAL STATUS EXAMrNA'tION
AlP WM alort, oT~cntCd to pcrsoll ilnd time. not plnce.Jsll.id he was in Conti 0<\410s). Social graces
wete prescrved foy introductions and grcetings but he was disinhibitcd dt1rin~ om meeting.
picking his nose often and disposing of his mucous by smearillg if On my desk or his :gants. He
also used cXPletives. Tc:ierring to his sons as "sons of bitches" and his ox-wife as a "bitch". He
understood the Rltrpose of OUT meeting and repeatedly stated "I am fine") "I don't trust my sons" ,
"the younger one ;s the mastcrmind". He could not maintain attention for mOre than soveral
minutes. He had poor immedinte and 5 minute recall. He would ignorcth questions asked of hil~
nnd inStead repeat complaints about his sous or to sn.? "I don't want to go to Loudon". The
meaning of this phrnse was explained by his aide, who believes AIP is jc..'tlo\ls of Ws partner's
gra.ndchild who takes attention away from AlP when they go to London. AlP !ltMed he is afra.id
"they will COltle and get me in the night". When asked to explain. he 8l\id: '~I dou't want my ex
wife and sons to know I am here". He told me he had Tourette's since age 10. He was able to sa.y
his medicntions. He blurted out I/'fhe presideut of Peru is Humala" out of context and Jatcl when
asked about current events mentioned. "they killed the Blnck man in FCrffi,lson". He could nor
eJ\:plain the meaning of proverbs instead repeated thcm several times . I uscd an ~xnmplc in
Spanish lIen boca. canada uO Cut ran moscas". He referred me to his pa.nner, Tcre8n.~ Kotzel Daly.
')
RECEIVED 09-25-' 14 01 :04 FROM- 13057180628 TO~ PROBATE SERVICES P0002/0P04

whom he sTaTed he trusts, when I Mkcd h.im abour his fututo plans. He was angry fOT periods
during the Iheet,ing when describing his letir()m~nt TIl 2008 which he said -resulted ltQm..~_~etraya!
by h.is bost friend and when call<it!g about his ex~wife ;l.nd sons. He could not peYiorm serial
sevens, and would instead start repeating, "I run 11. grad.!late of Wharton". He left the Toom
abruptly and sac in a nearby office. After n. 5-minute pause ~n he sa.w me again he greeted me
as if we were just meeting. His nose picking, c\ltsing and dis inhibited behavior along with poor
memory. concentration and attention point to significant co'gnitiye impairment.
C. FUNCTlONAL ASSESSMENT
bIt. requires assistance with ADLs and supervision. He is able to get around the facility, eat,
loilct. groom himself. lie is easily confusQ,.,d",a...
n,.,d-"n.",eo""d""s'-'y"'c""d.....
iy""'cc""'tio"",
"" o""._ _ __ __ _ _ _ __
If any of the three parts of the comprehensive examination were: not indicated or could not be
accomplished for any reason, the ,eMon for the omissiolllllllst be explained below.
Prognosis and likelihood of future restora.tion of rights:

Prognosis is g\larded: lie Wj\8 evaiun.ted lasr yew- and has deteriorated cognitivclyJ!.Qm that J;!oint_
'Unless a reversible efiology is established for his..cognitive decline and he is trented successfully'
his condition is likely to progress, WOrSen and restoration would be unlikely.
Treatmcnt recommend ations:
Supervision for safety; il dementia proofed hothe OT senio, Ii vingjl:~i lity; medical care <\S needed;
XV. REPORT OF EXAMINING COMMITTEE MEMBER
Lcgislative intent in adopting the current 'Version of the florida Guardianship Law is to n1akc
available the least restrictive fonn of guardianship to assist persons who are only partially incapable of
ca.rin.g fay their needs, with inca.pacita.ted persons to be able to participate as fully as possible in all
. decisions affecting them. POL 744.1012.
Is able to make infotnled dccisions rega.rding his/her "t'ight to: (please stl1.tC Ye!l or No)
No vote No sue, Or assist in the defense of suits

of any !latllN agnillst him/her.
No personaHy apply for government
bcncflts No manage property or to lhakC a.ny
gift or disposition of property
No have 11. driver's license or operate a
vehicle. No determine his/her residence.
No travel. No consent to medical treatmen.t.
~_ seck or retaill employmellt. ~____ ha VC an effcct on his/her social
No contract. environment, or socia.l aspects of
his/her life.
No _ _ Many
No ha vc a license to carry a weapOll
lmd firearm and or own or posscss
a weapon and fireann.

Case No. 13 - 29-,,-

0;1_ __ _
In the following blank. Please .~.WnIhaTi2e spccific evidence of the persoll's incapacity to exercise
informed decisions in the categories you have checked above OT in any other al'eas not listed.
AlP hns lIi. gnifi~lmt co rnitiye impai'rtncnr inclt)ding conftlsion nnd forgctl\lln\!~s. He also demonstrates
mood lability. He cannot process information effectively to makc rational iufonl1od decisions.
Recommendation (Please cirele one):
Limited guardiAnship
The \Jndersigucd member of the examining committee fnrrhcT states that he/she has
examined the nlleged incapacitated person in accordance with Florida Statute
744 .331(3)(b) and ( c), perfonned the examination necessary to determine which, if any.
of the rights, which the petitioner has rcqueste(\ be Icmoved, the llllege(lly incapacitated
person can no longer sufficiently nor adequa.tely exercise, and he/sho hereby presents to
the Court his/her concluSions, evaluations and 1;tc(lmmen(lations, At least one member of
the committee has knowledge of the type of ineapa.city alleged in tile petition.
NOTE: If ANY MEMBER OF THE EXAMINING COMMITTEE WISHES TO EXPLAIN HIS OR

HER EVALUATION OR RECOMMENDATIONS AS TO ANY PORTION OF THE FOREGOING
REPORT, SUCH MEMBER MAY ATTACH A SIGNED STATEMENT INCORPORATING SUCH
MATTERS.
Date mailecVfaxed to Clerk of CotlItJLcnd DoetoT, this _24'h day of September, 20_~
Date

EXHIBIT 4
.._ -- -- - - - -,
---------- Forwarded message ----------

From: "Teresa Koetzle-Daly" <teresa.koetzle@mykaptive.com>
Date: Oct 3, 2012 4:01 PM
Subject: Latest progress and Update on Carlos after the psychiatrist and psychologist
To: "Malena de Mulanovich" <malena@malena-opportunity.com>, "Malu" <malu.semsch@gmaiLcom>
Cc: .
Malena and Malu,
Tomorrow it will be a week already that Carlos was taken off the medication to fight Alzheimer's and his memory is "tops," as he
says. .
The wrong diagnosis came from the first consultation In January with the neurologists, where the high consumption of alcohol and
Xanax was left out of the report. With this misinformation that the doctors had and seeing the brain "shrinking" in the scans and more
so, based on the report that Carlos suffered persistent confusion and repetitions, it was determined that he was in the early stages of
Alzheimer's and was prescribed the corresponding medications.
When I later accompanied him to see the same neurologist, we found out about that misconception, and they proceeded to do new
tests with the new information. .
No specific evidence of Alzheimer's was found, but a reduced brain size was, which, at that time, with the information "on hand," we
knew was a consequence of the alcohol and Xanax.
Detox and the series of activities that you already know, from dance, to yoga and a healthy diet, were then started.
Now, you may wonder why-for example-sometimes he calls 2 or 3 times in a row or why sometimes he is distracted or lad<ing
attention. These are the answers:
1. Carlos has an OCD (Over Compulsivity Disorder); apparently he has always been oompulsive abOut topics of interest to him and
this behavior is typical of people with Tourette's syndrome (there isn't much we can do.)
2. He's suffering from a bit of a lack of self-confidence, following his departure from the bank, the subsequ ~iQJJ,
emphasized by the abuse, insult and criticism that he has reported. This leads him to want to look l' el~ rhR8it~a he
does so by asking or affirming once more something that he already said. (This is manageable, an we are all already ~'h
him assurance through support, understanding, care,affection, etc.) f!.c
C~rtlfJ
ed 7'''a ..
,slafJoll
..-- - ,----- - ,' -----------'-----.-~~~--'-~~~....L
3. He also has ADD (Attention Deficit Disorder), a disorder that he has always had, according to what people who have worked with
him tell me, even in his most successful period at the bank, He is so intelligent that his mind gallops and therefore jumps from one topic
to another and tends to get distracted quicldy. Additionally, this is another characteristic of Tourette's syndrome, (Solution: When he is
given an instruction or is told something important that we want him to pay absolute attention to, the psychiatrist recommends looking
him in the eye when talking to him. And, hey! It WORKS great!)
The psychiatrist believes that by March/May, he should have regained all the brain [sic] that he lost (which was corroborated by the
psychologist), but indicated that it is essential to continue with a healthy diet and exercise, especially dance and yoga. By the way, it is
important that he continue to sleep eight hours, which he is doing!
Well, we have already gone through the worst part of the journey, and now all we have to do is maintain the same discipline to
completely get back the Cartos of the past, that brilliant, setf-confid~nt and independent Cartos.
Kind regards,
Tire5~ Koetzle-b.iI'v:
Miguef Oasso i1'7'piio's
.:~!~a- 27, ~e~.g
T: -5 11422'7311 ' I
;
Ceil,Lima: 51 .99 ,415'1317
tel MfA: 305'753':7974
Skype! tkd19S9 ,:
WWW ~mykaptiv~com , :
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---------- Mensaje reenviado ----------

De: "Teresa Koetzle-Dalylt <teresa.koetzle@mykaptive.com>
Fecha: oct 3, 2012 4:01 PM
Asunto: ultimo avance y Update de Carlos despues del psiquiatra y psicologa
Para: IIMalena de Mulanovich" <malena@mal ena-oPPo,rtunity.com>, "Malu" <malu.semsch@gmail.com>
Cc: .
Malena y Malu,
Manana ya es una seman a de q a Carlos se Ie retiro la medicaci6n contra el Alzheimer y .......esta con la memoria "caMn" tal como se
expresa el.
EI diagn6stlco equivocado proviene de la primera dta en enero con los neurologos, donde se obvio informar del alto consumo de
Alcohol y de Xanax. Can esa deslnformadon q tenian los medicos y al ver el cerebro "shrinking" en los scans y mas bien, basado el
Informe de q Carlos tenia continuas confusiones y repetidones, se determina q tiene prindpios de Alzheimer y se Ie prescriben las
medicadones correspondientes.
Cuando 10 acompane posteriormente al mismo neur61ogo nos enteramos de ese "mlssconception" y se procede a hacer tests nuevos
con la informadon nueva.
No se encuentra evidenda de Alzheimer precisamente, pero si un cerebro reducido q en ese momenta can la Informacion "on hand" se
sabe q es consecuenda del alcohol y xanax.
Ahl se inicia el detox y la serie de actividades q ustedes ya conocen, desde baile, yoga y una alimentadon sana.
Ahora ustedes se preguntaran que porque - por ejemplo - a veces el llama 2 6 3 veces seguidas 0 porque a veces esta distrafdo 0 falto
de atencion? Aca las respuest:ls:
1, Carlos tiene OCD (OVer Compulsivity Disorder) q aparentemente siempre ha sldo compulsivo en los temas de su interes y este
compartamiento es tiplco de las personas con sindrorne de Tourette. (there isn't much we can do)
2. Esta sufriendo de un poco de lack of self-confidence, a rarz de la salida del banco, la subsecuente depresion, enfatizado con el
maltrato, insulto y critlca q el ha reportado. Esto 10 lIeva a querer buscar nself-assurance'" y 10 hace par medio de volver a
preguntar 0 afirmar algo q ya dijo. (esto si es manejable y ya todos 10 estamos haciendo al darle seguridcid por medio del
apoyo, comprension, atencion, carino, etc)
I
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3. EI es aparte ADO (Attention Deficit Disorder), un desorden q siempre ha tenido por 10 q me comentan personas'q han trab9jadO con
el, y hasta en su mejor epoca exitosa del banco. Es tan inteligente q su mente galopa y por eso se salta de un tema al otro y tiende a
distraerse rapidamente. Adicionalmente, esta es otra caracteristia del Sind rome de Tourette. ( solucion: cuando se Ie da una InstrucciOn
o se Ie dice algo importante q queremos nos ponga absoluta atencion, el pslqulatra recomienda verle a los ojos para dirigirla la palabra:
hey, FUNOONA de maravlllal) .
EI psiquiatra considera q para marzo/mayo debe haber recuperado todo el cerebra q perdi6( y 10 corrobor6 la PSicologa, pero indlc6 q
es fundamental que continue con la dieta sana y los ejercicios en espedal el baile y yoga. By the way es importante que siga
durmiendo sus B horas, q silo esta logrando! .
Bueno, ya recorrimos la peor parte del camino y ahora solo toca mantener la misma disciplina para terminar de recuperar al Carlos de
antes, ese carlos brillante, seguro de si mlsmo e independiente.
Kind regards
Teresa K'oetzre~1)aly ,
Miguel Dasso 111'Plso8
Uma 21~ Peru .
T: S11422~7.gil :
eel Llmii! : 51 (99 ,4~~)3J7
eelMIA: 305.153-:7974 :
skype: tkdl!;;S9 ,
n ,r www..mykaptjya. com
ftew,UJoII,';Ptdd\lCU
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ProTranslating
CERTIFICATE OF ACCURACY
The undersigned, Dr. Luis A. de la Vega, Chainnan of ProTranslating, appearing

on behalf of ProTran slating, hereby states, to the best of his knowledge and belief,
that the foregoing is an accurate translation of the attached original document in
the 5 ~16b language, consisting of Z. pages, and that
this is the I t of the attached.
Luis A. d~ Vega, Ph. D.

Chairman
For ProTranslating
State of Florida
County of Miami-Dade
The foregoing certificate was acknowledged before me on this ~ l @- day of

\':>eJ?QfYybzc , 20 I4 , by Dr. Luis A. de la Vega, Chairman of
ProTranslating, a Florida corporation, on behalf of the corporation. He is
personally known to me.
~----
Notar;rPubiic\! ~----
My commission expires:
--
2850 Douglas Rd . Coral Gobles, FI33134 PI,. 305.371 .7887 Fax 305 .371.4816
'Nww .protranslo1ing .colll
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" ' " II! ' III . .. . " . --1'- ' _.. 'I I
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From: Teresa Koetzle-Daly <teresa.koetzle@mykaptive.com>

Date: Tue, 29 Jan 2013 06:49:40 -0500
To: Malena de Mulanovich<malena@malena-opportunity.com>~ Malu MuAoz<malu.semsch@gmail.com>
Subject: Carlos .
Malena and Malu.:

I am very sorry that you and Carlos have distanced yourselvesj before you were so exdted to talk, to be together and to have lunch
together on Saturdays. I have asked him repeatedly to turn the page regarding some events, but you know very well how stubborn he
can be, and he simply prefers to avoid seeing you girls. I won't be able to do it alone and I need yOur help so that you become closer
again, please.
He is fascinated with the relationship with his kids, which, as you know, took "a little work" to achieve, but it has been achieved. And
the welfare of his family does him much good.
You have always been very special to him, and lately, you have been so possibly more than ever.
The only reason why carlos now prefers to avoid you girls is that he doesn't want to address certain issues, that's all.
And they are:
He doesn't want you to ask him to go to any neurologist in Lima again. He wants to go to NY Presbyterian and they have
already confirmed the appOintment.
He wants you to understand the seriousness and stop questioning him about the HIPAA confidentiality law of health services
in the US
He doesn't want to show his medical records to anybody. I finally convinced him to show them to his kid 1.Jlp'ing
to go to his appOintment in May in NYC. ~'( . ~tI . . ,
In general, he wants his life to be quiet and private again as it was before. You know very well how IS life is in the mou~o
everyone in Lima and even worse, gossiping full of lies and exaggerations, and even possibly malic from the people who do
not like him, which happily there are only a few people who do not like and respect him. I've been neluded in this ugly
gossiping, but I'm strong; I don't deny that it bothers me, but I know my truth. I'm just waiting fo M9.,ttili%tJ ~ differe~ce
in his brain now in the scan as compared to the one from last year. I am very confident that the d velopment and~Qwtn
will be very noticeable. .
1
I have talked to him on several occasions, to make him see how happy he is now that he's regained his relationship with his children
and that he please not lose his relationship with you. I have reminded him what you did for him during those difficult months, but in his
mind, to avoid talking about issues he doesn't like, the (wrong) solution is to avoid them. And as the saying goes: ''the tail cannot wag
the head."
I hope I'm not bothering you by meddling in this, but I just want the three of you to become close like you were before. And if there
was any misunderstanding, I ask you to forget it, it's not worth it ......
To bring you a bit up to date: .

He continues, very enthusiastically, with all his classes, and all the teachers congratulate him continually for his progress and results. He
now dances and can converse at the same time without breaking stride and changes steps ONLY to the rhythm of the song (that is, his
coordination is coming back), French is still flowing (memory), and he does not interrupt at all during yoga (concentration). Oh, and
very important: ...... he now goes to the bathroom normally (this is new, he's only had this control for two weeks; he has lost the
"hurry.") He abandoned the guitar, it bored him.
All the same, he is still very punctual with his PT in the gym every day (he's almost recovered from his shoulder) and reflexology once a
week, which he loves, and occaSionally he asks me for the masseuse to come.
In mental exercises, he continues with Lumosity and, in addition, we do math exercises and word games (verbal and written) daily. And
he also plays Spider Solitaire dally on the iPad.
And in working matters: this past week, we have had a number of very, very difficult appointments, meetings of over three hours of
serious negotiating, and he has partiCipated without interruption and without getting up to go to the bathroom (something I think he
did when he was bored and lost track of what was going on in the meeting).
And his diet continues to be healthy and as natural as possible. Now we've added Kiwicha and Canigua to breakfast. He also periodically
does his blood controls, watching 612, cholesterol and sugar.
In summary, he's doing great... Only you are missing in his daily routine.
Thank you, a kiss, .
Kind regards,
Teresa ~o~~.~:paly
M1suel Oassoil~!~~1~9 8
uma~2i-#, Peru'
T:51142i7311
CaI.Urn.: 5.1 9.9 415 1317
Cal MIA: '305 7531974 ,
SkYPe: tkc:t1959 .
.~,mVIq!R~.com. ,
niD,f Aew U'odOl .iOd'~b I

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From: Teresa Koetzle-Daly <teresa.koetzle@mykaptlve.com>

Date: Tue, 29 Jan 2013 06:49:40 -0500
To: Malena de Mulanovlch<malena@malena-opportunity,coffi>i Malu MuAoz<malu.semscb@gmall.com>
Subject: Carlos
Malena y Malu:
Me apena mucho que se hayan dlstandado ustedes y Carlos cuando antes habra tanta iluslOn par hablar, par estar juntos y par los
lonchesitos del sabado. En repetldas veces Ie he pedidovoltee la pagina de algunos sucesos, pero bien saban ustedes 10 terco q puede
lIegar a ser y sendllamente prefiere evitar verlas. Yo sola no voy a poder y las necesito a uste<les para q se vuelvan a acercar por
favor.
Esta fascinado con la relacion con sus hijos q demas saben ustedes que tom6 su ''trabajito" lograrlo, perc ya se logro, Y eI bienestar
con su familia Ie hace mucho bien.
Ustedes han sido slempre muy espedales para el y en estos ultImos t1empos 10 fueron pOsiblemente mas q nunca.
La unica razon q ahora prefiere Carlos evitarlas es q no qulere tocar dertDs temas, nada mas.
Y estos son:
No quiere q Ie v\,lelvan a pedir q vaya a ningun neur61ogo en Lima. EI quiere ir al NY Presbyterian y ya Ie confirmaron Ia ata,
Qulere q comprendan la serledad 0 dejen de cuestlonarlo por Ia ley de confidencialidad HIPAA en la medicina de USA
No quiere ensenarle a nadie sus reportes medicos, Ya logre se los qulera ensefiar a sus hijos. Y Cabe va a Ir a la eita de mayo
en NYC. .
En general, quiere volver a tener su vida reservada y privada como era antes. Bien saben como su vida esta en bocas de todo
Lima y peor aun, un chisme bajo lIeno de mentiras y exageraciones, y hasta posiblemente maldad de la gente q no 10 quiere,
q felizmente son pocas las personas q no 10 quieren y respetan. Yo estoy comprendlda en esos ehismes reos, pero yo soy
se
fuerte, no nlego q me molestan, pero yo ml verdad. Y solo. espero q sea mayo para ver en los scans la diferenda de su
cerebro de ahora, comparado al del aNa pasado. Estoy muy connada q va a ser muy notono el desarrollo y la reeuperaci6n.
1
--~---- . ---- ------- - ~--------------__~____~
~I~I;~~__L
Le he hablado en repetidas ocasiones q mire 10 feliz q esta al haber recuperado la reladOn con sus hijos y q por favor no pierda la
relacion con ustedes, Ie he recordado 10 q ustedes hicieron por el en esos meses tan diffdles, pero en su mente para evitar hablar de
los temas q no Ie gustan, 1a soluciOn (equivocada) es evitarias. Y como dice el dicho: "Ia cola no puede mover 1a cabeza" , .
Espero no se molesten q me entrometa en este tema, pero solo busco q ustedes 3 se acerquen como era antes, Y si hubo algun
malentendido, les pido 10 olviden, no vale la pena ..... ..
Para ponertas un poco al corriente:

EI. continua, y con muchas ganas con todas sus dases y los profesores 10 felidtan continua mente por ef progreso y los resultados, Ya
baila y puede conversar a la misma ve~ sin perder el paso y cambia de paso SOLO segun el ritmo de fa canci6n ( 6sea su coordinadon
fa esta reruperando), el frances sigue fluyendo (memoria), ya no intenumpe para nada durante la yoga (concentracio[l),
uyyyyy,lmportantfsimo: ......... ya va al bano normal ( esto es nuevo, sofo tiene 2 semanas con este control, ha perdido el "urge"), la
guitarra si Ie ha dejado, Ie aburrfa.
Igual sigue cumplldisimo can su PT en el gym a diarlo (ya casi se recuper6 del hombr~) y la reflexologia una vez a la sernana q Ie
encanta y por ahi me pi de venga la masaji5ta de vez en ruando,
En ejercicios mentales, sigue can Lumoslty y aparte hacemos a diario ejercicios matematlcos y juegos de palabras (verbal y escrlto) Y
juega tambien a diario su Spider Solitaire en el I Pad,
Yen el plano laboral: hemos tenido esta semana pasada una sene de citas muy, muy pesadas; citas por mas de 3 horas de alta
negociadon y ha partidpado sin Interrumpir y sin pararse al bano (acto q cree 10 hacia ruando se aburna y perdia el hilo del meeting),
Y su dieta sigue sana y 10 mas natural posible, Ahora Ie hemos agregado Kiwicha y canigua al desayuno. Tamblen hace pert6dicamente
sus controles de sangre observando la B12, colesterol y azucar,
En condusion, el va campeon, .............5010 faltan ustedes en su dfa a dfa,

GraCias, un beso
Kind regards
Teresa Ko.etz te~Da tv .

Miguel Oasso'117 Piso '~~
Um~ ~', P.eru
T:. 511 4i.2 7~11.
tel Lima:5199 4i-s -1317'
eel MIA; 305 753 7974::
Skype: tkd1959
www.my~aptive.com
n, w!U"ofld.,,,,ducu

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ProTransiatlng
CERTIFICATE OF ACCURACY
The undersigned, Dr. Luis A. de la Vega, Chairman of ProTran slating, appearing

on behalf of ProTranslating, hereby states, to the best of his knowledge and belief,
that the foregoing is an accurate translation of the attached original document in
the t> eo,M h language, consisting of '1. pages, and that
this is the last of the attached.
Luis A. d~ a Vega, Ph. D.

Chairman
For ProTranslating
State of Florida
County of Miami-Dade
The foregoing certificate was acknowledged before me on this l ~.y day of

5
be.em ~, 1-0 t:'l , by Dr. Luis A. de la Vega, Chairman of
ProTranslating, a Florida corporation, on behalf of the corporation. He is
personally known to me.
~ . ~
NOtarYP\lb1iCV .c:----
-----
2850 Douglas Rd Coral Gables, FI 33134 Pli: 305,371.7887 Fox 305.371.4816

vvww.pmtrollslojing.com
... - .. .....,0 ....... ..... _

I .I '11 !~. ,, '
EXHIBIT 5
Filing tI 17423216 Electronicolly Filed 08/22/201403:02:21 PM
rrrwno l.
(~~/''t.A1
IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT

IN AND FOR MIAMI-DADE COUNTY, FLORIDA
IN RE: GUARDIANSHIP OF MENTAL HEALTH DIVISION

Case No.
CARLOS ALBERTO
MUNOZ SEMSCH,
1-0f3MH2001
An alleged Incapacitated person.
- - -----',
I, LEONARDO PEREZ, the affiant, do hereby swear and affirm that the following
statement Is based on my knowledge, and that same is true and correct:
1. My name is Leonardo Perez, and I am over 18 years of age.

2. I studied Biology in Nicaragua, and I got my licentiate degree in 1976. I work
as a handyman.
3. I have known Carlos Alberto Munoz Semsch for over 26 years. I started to
work for Mr. Mu~oz Semsch as a handyman at his home In Hammock Oaks,
In 1988. Later, I continued working for him at his apartment In Edgewater
DrIve, and then, at the Grovernor House Condominium In Coconut Grove. As
part of my Job, I have been visitrng the home of Mr. Munoz semsch on a
weekly basis for 26 years.
4. On July 15, 2014, Mr. Munoz Semsch was transferred from the Grovernor
House CondomInium to an assisted living center called The Palace.
5_ As of the time I met him and up until a short time ago, Mr. Munoz Semsch
was a hardworking person, and he always said that the fruit of his hard work
would be left to his children.
6. However, I have noted marked changes in the personality and overall
behavior of Mr. Mufloz Semsch. I have been a witness to the followIng cases
of unusual behavior:
a. Mr. Munoz Semsch has become a repetitive individual. For Instance,
when he writes a check for me, he tells me 5 or 6 times that he did this.
b. He acts strangely; I have seen him go around his house completely naked
or without any underwear at Icast on two occasions, seemingly aloof
from the presence of others.
c. The housekeeper has told me that Mr. Munoz Semsch turns on all the
----- ----- - -- - -- - - wateriaucets-in-the-hotlse-for-no-reason-whatsoever;-and-he-turn on-all- - - - - - -- I
the lights late at night.
--------------------.. --.-----------------.------:~- -~-----.
- ~-.--.---:
d. I have seen Mr. Munoz Semsch looking neglected and slovenly, without
combing his hair.
e, He changes his clothes lots of times each day for no reason.
f. Mr. Mufloz Semsch has grown apart from his children and his friends of
many years, like Mr. Fernando Montero, who has been his friend of many
years.
g. Mr. Mufloz Semsch has told me several times, without my suggesting it,
that he wants to come live with me at my house.
h. Teresa Marla Koetzle Barreda Daly has hired Julio Alamlno to care for Mr.
Munoz Semsch. Julio Alamino helps him bathe, and he takes him out on
walks. Teresa Marla Koetzle Barreda Daly has also hired other people
brought from Peru to help care for Mr. Murloz Semsch when she is out of
town, Mr. Luis Daly, the former husband of Teresa Marfa Koetzle Barreda
Daly, and Cristian Daly, his son, have also cared for Mr. Munoz Semsch
when Teresa Is out.
i. Teresa Mar(a Koetzle Barreda Daly has told me Mr. Munoz Semsch acts
Violently at times, and she Is scared of his behavior.
7. have noted that Mr. Murlez Semsch Is completely dominated and
manipulated by Teresa Marfa Koetzle Barreda Daly.
8. Teresa Marla Koetzle Barreda Daly has done away with all signs of the family
members of Mr. Munoz Semsch and all the belongings of his children at the
apartment in Grovernor House.
9. In my opinion, Mr. Mufloz Semsch's Isolation and his separation from his
family are the result of his mental deterioration and Teresa Marfa Koetzle
Barreda Daly's manipulation.
10. Based on my observations this past year and on my knowing Mr. MuMoz
Semsch from before, I have no doubt that he is Incapacitated, and he Is no
longer the person I met 26 years ago. I consider him a danger to himself and
others.
[TN: Handwritten date] 08/07/14 [TN: Signature]

Date -~TWr>rA"R1JO PEREl;'~ffIailt
State of Florida
County oflVliaml-Dade
-- - -.---~--' --.-,,----.-,---.-,--,-.--------
The foregoing Instrument was acknowledged before me this (TN: Handwritten) 7th day of [TN:
Handwritten] At!fL2014 by LEONARDO Pt:REZ, who Is personally known to me ( ), or who
has produced [TN: Handwritten) Fla. Drivers lie. , as Identification, and who did ( ) did not
( ) take an oath.
[TN: Handwritten] P620-536-5H061
[TN: Stamp]
Notary Public State of Florida [TN: Signature)
Yvette Van Bylevell NOTARY PUBLIC, State of [TN: Handwritten) Florfda
My Commission FF 015080 at large

Expires 06/23/2017
- ---.--='- _.. ... ~ -- - - ---

The Cakov Group
La nguage Solut ions, Inc,
2600 Douglas Road, Suite 1103, Coral Gables, Florida 33134

Tel: 305,854,818 I Fax: 305,854 ,S1 22
Inro@cakovlangllagesolullons"om
'II IV IV , C a k 0 v I 8 n 9 u a !l e sol uti 0 n s , com
STATE OF FLORlDA
COUNTY OF MTAMf~))AI)E
CRRTI FICATION
This is to cerlify that thc following is, to the best of Olll' knowledge and belief, a tl'lle and
accurotc (mllslation into ,~ng! i1l.!l, or(hc referenced s.p~,n.\~J11angunge document:
.... Affidnvit of Lcolllmlo PCI'C1.
Before me, the undersigned Authority, pcrsonally appears M~! Stepj!!lJlie Cnkov who is
personally known to me / is identified with the following:
~L
Slcphnftie Cokoy
VP Operations
C21 0-780-75-908-0
SWOI'll und slibsel'ibcd berme me this U'~d.y or !\I'Il.IISt)Jll1~
_- ~ ~0 /}! .v'1Ar~
,~
.,~~~~i'; ;;;';"'" ... ",tOLit/A enUl
N~~~--TrIOrida l,!SZUl'gc
f" . ~) NotilY Public 81ale 01 FlOrid.
\' . ' Illy Oomm. ~plr" feb 2, 2()11
"~:!;, I l& Commit,' Ion , E 8&2&28
My commission exph'es: fe,.P, O~ I ~DI7
"
I .
..' i'
)'
IN THE ClRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT

IN AND FOR MIAMI-DADE COUNTY, FLORIDA
IN RE: GUARDIANSHIP OF MENTAL HEALTH DIVISION

CnseNo.
CARLOS ALBERTO
MUNOZ SEMSCH,
An 1111eged incapacitated persoll.

J
DECLAM~IQN JU RADA DE LEONARDO PER~
Yo, LEONARDO PEREZ, el declal'ante, pOl' mediC) de la presente juro y afirmo que la
siglliente decluraei6n cs basada en mi eonocimiento, y que In misma es vel'dadera y conecta:
t. Mi nombl'e es Leonardo Perez y tengo nUls de 18 arias de edad.

2. Estudie biologfa en Nicaragua y obtuvc Illi Iicenciatura en 1976. Trabajo como
"handyman. "
3. Conozco a Carlos Alberto Mllfio~ Sernsch desde hace mas de 26 atlos. Empecc a
trabajul' para er SI'. Muffoz Sell1sch como hnndyman en Sll casa en Hammock Oaks
en 1988. Despucs continue tl'abajalldo para el en su apa11amento en Edgewater
Drive, y luego en el Grovernor I-louse Condominium en Coconut Grove. Como
parte de mi trabajo, visito In casa del Sr. Munoz Semsch semanalmcnte desue
haec 26 atlos.
4. EllS dcj\llio del 2014 el Sr. Mufl.oz Semsch fue trasladado del Grovernor House
Condol1lini~lm II un centro de asistcncia Hamado The Palace.
S. Desdc qlle 10 conoel y hasta haee poco tiempo, cl Sr. Mui10z Semsch fue una
persona muy tmbajadol'a y siempl'e me dijo Clue los frutos do su duro trab~o emn
su Icgado para sus hijos.
6. Sin embargo, he obscrvado mal'cados cam bios en 1a personalidad y eJ
comportamiento general del Sr. Munoz Semsch. He sido testigo de los siguientes
casos de comportamiento inusual:
a. EI Sr. Munoz Semsch se ha cOlwertido en una persona l'epetitivfl, pOl' ejempl0
cuando me prcpal'a lIll cheque me dice 5 0 6 veces que 10 ha hccho.
b. So compOlta exlrai'1amente, 10 he visto andal' pOl' Sll cas a completamente
desnudo 0 sin ealzol1ciJlos pOl' 10 menos 011 2 ocasioncs, apal'cntemcnte ajeno
a In presencia de los demns.
c. El ama de lIaves me ha dicho que el 81'. Muffoz Semsch eneiel1de todos los
grifos de ngua en el hogar sin raz6n algullu y enciende todas las luces, tarde
pOl' In noche.
"-- ------------ -- - -- -- -
d. He vista a1 Sr. MUlloz Semsch luciendo descuidado y dcsllli~ado, sin peinarse.
e. Se cambia de ropa muchas veces al d(a sin ninguna razon.
f. E1 Sr. Mtlf'loZ Semsch se ha distanciado de sus hijos y de sus Rmigos de
muchos afios, como el Sr. Fernando Montero can ql1icn ha ten Ida una amistad
pOl' muchos af\os.
g. EI Sr. Mu~oz Semsch me ha dicho en vadas ocasiones, sin stlgerencia de mi
pal1e, que quiel'e venit' a vivir conrnigo en tni casa.
h. Teresa Maria Koetzle Barreda Daly hu contratado a Julio Alamino para cuidar
al S... Muf'loz Semsch. Julio Alamino ayuda a bafiarlo y 10 lIeva a caminar.
Teresa Marfa Koetzle Barreda Daly tambien ha contratado a otlas personas
tra/das de Peru para ayudEll' a cuidal' al Sr. Munoz Semsch ctlando ella se
encllcntl'a de vinje. El cxesposo de Teresa Marla Koetzle Ba1'1'eda Daly, el Sr.
Luis Daly, y su hijo Cristian Daly tambien han cuidado al Sr. Mufioz Semsch
cn III ausencia de Teresa.
1. Teresa Marfa Koetzle Barl'eda Daly me ha dicho que el Sr. Mu(\oz Scrnsch a
veces actlill de manera violenta y que su compOltamiento Ie ha causado temor.
7. He obsel'vado que el Sr. Mufioz Semsch es completamente dominado y
manipllllldo pOl' Teresa Marfa Koetzle Barreda DEIly.
8. Teresa Marla Koetzle Ban'eda Daly ha eliminado todos los rastrQS de la familia
del Sr. Munoz Semsch y todas las pel'tenencias de sus hijos del apmtamento en
Grovemor House.
9. En mi opini6n, el aislamiento del Sr. Mufioz Semsch y su separaci6n familiar son
producto de su deterioro mental y de la manipulnci6n de Teresa Marla Koetzle
BalTcda Daly.
10. Basado en mis observaciones del ultimo aHo yen mi conocimiento prevjo del Sr.
Munoz Semsch, no tengo duda alguna de que el estft incapncitado Y ya no es Ja
persona que yo conocl haee 26 afios. Yo 10 cOllsidero un peJigl'O pal'a sf mismo y
los demas,
. ,";7 s;il) '2,/1\;:' --~.,k-.- -- - ----- -

Fecha LEONARDO PEREZ, Declarante
STATEOF}:::(O YrrJ...~_ )
COUNTY OF M.I'Q(}~~' cP.dq./
-------
---
.. -:::.::.-..-__"""-'' ""_-- _ .___,_. . __
'_--~-~ ____
_.=- ~ - _ .. _--:-....----:-----:----....-----1
,. A
'J "ltt
The foregoing instrument was acknowledged before me this _.._ .. day 01(:r.U:(\ 2014 by
LEONARDO PEREZ, who is personally known to me ( ), 01' wlm ~ produced
f':.'( (~d r t't.,:e.t:s-U.C_, _, as identification, and who did ( ) did not ( ) take an oath.
Pu2-D- 5 36~SJ -Y-DG-(
'~_~111~
;J'r~~Y P~BLlC, State of .El~ Large
My commission expires;
...----,---------~-----~
------------.------------~~--~~~---,.--.----~~~~~-------
EXHIBIT 6
DECLARATION OF ,JUAN DtJANY
I. My name is Juan Duany ,mel I am over the age of J 8. I make this declaration on
personal knowledge.
2. I am a businessman and a lawyer in Lima, PCI'll. I am a citizen of Peru.
]. I have kno\vn Carlos Albelto Munoz Scmsch (Carlos Sr.) for around 40 years. He
has hecn my banker and I trusted him. I consider Carlos Sr. a personal friend and someone \vhom
I care abo ut.
4. In 2012, Curios Sr. and his then-wife, Ana Ines Munoz (Ana), asked me if I \vould
mediate their divorce in Perll , which I agreed to do.
S. Carlos r\/lunoz Sr. and Ana Munoz met with me ovcr the course of several weeks
II) Peru in order to mediate the divorce. It was at this time that I met Teresa Koctzlc Daly
C'Koctzlc"), \vho at this point had already moved in with Carlos SI'. at his homes in Miami and
PCI'll. C81'105 Sr. also told me Ihat Koetzle had moved her husband Jose Luis Daly into Carlos
Sr. ' s homcs as \vell.
6. During the negotiating sessions, it \vas clear to me that Carlos Sr. was behaving
oddl y and erratically. For example, one clay he called me and asked to rneel me at my hmne in
Lima, Peru to discuss the divorce. He arrived at my home, sat down, and approximately flfteell
seconds later. stoociliP and abruptly deparled \vith no explanation. Another time, he asked mc to
meet him at a com~e shop in Lima 10 discuss Lhc divorce. Again, he sat clown, ancl within
approximately fifteen seconds, he stood up 8ncl said that hc was leaving because he hael finished
reading the newspaper. These events troubled me greatly .

7. Carlos Sr. also made several bizarrc statements to me during the negotiations,
\-vhich greatly concerned me and were out ofcharacler. Once, he told me that his then-wife. Ana.
had stolen an umbrella n'om his car. and thcreCore she would not get any money in the divorce
scttlement. Another time. he told me that he was grcatly upset with Ana because she had stolcn a
duvet cover, and therefore, she would receive no money in the settlement. Koetzle was present
when CHrlos Sr. made these statements.
8. Koetzle was physically present at some negotiating sessions, and fully controlled
and dominated Carlos Sr. throughout the ncgotiations. Koetzlc oftcn attemptcd to speak and
negotiate on behalf or Carlos Sr. 011 several occasions [ had to ask her to leave the negotiating
roOlTl. Her statements to me clearly indicated that she was very interested in Carlos Sr. retaining
as many assets as possible in the divorce.
9. Whell Carlos Sr. and I disclissed the divorce over the telephone, Carlos Sr. would
almost al\vays pass the phone to Koetlze. who would attempt to discLiss the cletails of the divorce
negotiation::; with me.
10. During this time period, I observed Koctzle often treating Carlos Sr. in a
demeaning f<1shion.
II . I have known Carlos Sr.'s only sons, Carlos Munoz Milberg and Ignacio Munoz
Milberg, since they were young children. They always appeared to have a close, loving
,.
relationship with their father, Carlos Sr. Since around 2011, Carlos 11'. and Ignacio have orten
expressed to me their extreme concern for their father's mental health.
12. I am also concerned about Carlos Sr.'s health and vvel fare. Based on my
ohservations during the negotiations of Carlos Sr.'s divorce, 1 do not believc that Koetzle has
Carlos Sr.s best interests in mind.

13, I am aware that I have been assigned as alternate attorney-in-fact under the
Durable Power of Attorney that was executed on January 7, 2013. I am willing and able to
asslime the responsibilities ofattorney-in-fact for Carlos Sr" if this court deems it appropriate.
14, I hereby declare under the penalties of perjury that the foregoing is true and
correct to the best of my recollection,
Executed this 9th day of January, 2015,

DECLARAC16N DE JlJAN DUANY
I. Mi nornbre es Juan Duany y yo soy mayor de 18 afios. Hugo esta declaraci6n en cl
cOl1ocimicnto personal.
2. Yo soy Ull hombre de negocios y un abogado en Lima, Perll. Soy Ull ciudadano
pcrU<Lllo.
3. lie conocido a Carlos Alberto Mufloz Scmsch (Carlos Sr.) pOI' mas de 40 anos. I la sido
rni banquero de cOlllianza. Considero a Carlos Sr. Ull amigo personal y alguien a qllicn Ie tengo
mucho carino.
4. En 2012, Carlos Sr. y su entonces esposa, Alla Illes Mufloz (Ana), me pidieron medial'
Sli divorcio en Perll, 10 ellal acepte.
5. Carlos Munoz Sr., y Ana Munoz se rClinieron cOllmigo en el Iransclil'so de varias
SCI1WIl8S ell Perll con cl fin de medial' en el divorcio. ruc en este momenta que conoer a Teresa
Koetzle Daly ("Koctzle"), que en este mOl11ento ya se habra jdo a vivir con Carlos Sr. en su s
hogarcs en r'vliami y Perlt. Carlos Sr. tambien me dijo que Koetzle habra trasladado iguall11enle a
Sli mlll'ido Jose Luis Daly a los hogares de Carlos Sr.
6. Durante las scsioncs de negociaci6n, me quccl6 claro que Carlos Sr. sc cOl11portaba de
forma extrai'ia y emHica. POI' ejemplo, un ella me IIam6 y me pidi6 encontrarnos en mi casa ell
,.
Lima. Peru. para discutir cl divorcio. Llcg6 a mi casa, sc scnt6, y aproximadamcntc quince
scgllJlllos clespucs, sc leV1111[() y se fue abruptarnenle sill explicaci6n. En otra ocasion, me pidi()
reunirmc con cl en un cafe en Lima para discLitir el divorcio. Una vez mas, se sento, y dentro de
L11l0S quince segundos y se puso de pie y dijo que se mnrcilaba porque habia terl11inado de IceI' el
peri6dico. Estos eveillos, entre olros, me preocuparon.

7. Carlos Sr. tam bien me hizo vadas dcelaraciones extrafias durante las ncgociaciones,
que me preocupaban mucho y estaban fuera de lugar y cankter. Una vcz, me dijo que su
ento11ees esposa, Ana, se habia robado un paraguas de Sll coehe, Y pO\' 10 tanto ella no recibini
ning(m dinero en el aCLIerdo de divorcio. En otra ocasi6n, me dijo que estaba muy molesto can
Ana porquc ella Ie habia robado un cdredon, y par 10 tanto, ella 110 recibirfa dinero en cl el
divorcio. 1(0ct7ole estaba presente cuando Curios Sf. him estas declaraciones.
8. Koetzle cstahn fisieRmcnte prcsente en algunas de las sesiones de negociacioll, y
totalmente controlando y dominado Carlos Sr. A 10 largo cle las negociaciones. Koetzle en varias
oporlunidades lrat6 de hablar y negociar en nombre de Carlos Sr. I::n varias ocasiones tuve que
peclirle que se fucra la sala de negociaciones. Sus declaracioncs y comportamicnto me indiearon
claramcnlc que cstaba muy interesada en Carlos Sf. retencr tantos aetivos como sea posible en el
divorcio.
9. Cuando Carlos, padre, y yo disclItimos el divol'cio por telelollo, Carlos Sr. C<lsi siemprc
pasarfa el telelono a Koetl7oc, que inlenLaba discLiLir los detalles de las negociaciones de divorcio
COlll11igo.
10. Durante esle periodo de tiempo, en varias ocasioncs observe a Koetzle LraWI' a Carlos
Sr. de tina manCI'R dcgradante.
11. lie conocido a los hijos de Carlos Sr. Carlos Munoz Milberg e [gnacio Munoz.
Milberg, desde que cran llifios. Sicmprc vi que tcnlan una relacion de amo[' con su padre. Desde
alrcdedor de 20 I I, Carlos Jr. e Ignacio en varios momentos me han expresado Sll alta
preoclipaci6n pOl' In sailld mental de Sll padre.

12. Tambien estoy preocupaclo pOl' In salud y el biencstar de Carlos Sr. Basado en mis
obscrvaciones dlll'Untc las negociacioncs del ciivorcio de Carlos Sr., no creo que Koetzle tiene los
Illejores inlercses de Carlos Sr. en mente.
13. Soy conscienlc de que se me ha clesignado como abogado-dc-hecho de alternativa, en
cl poder notarial duradcro que fue cjecLltado cl 7 de cnero de 2013. Estoy dispucsto y capaz de
aSLImir las rcsponsabi lidadcs de abogado-c1e-hecho por Carlos Sr., si eslc tribunal 10 eslil11a
cOl1vcnicnte.
14. Por la prcscnle declaro bajo pena de perjurio que 10 anterior es verdadero y correclo a
10 rncjor de rni rcclIerdo.
Lima. 9 de febrero de 2015
,.
EXHIBIT 7
DECLARATION OF CINTYA H. GARCIA
1. My name is Cintya H. Garcia and I am over the age of 18. I make this declaration
on personal knowledge.
2. I am the administrative assistant to attorney Alcides Avila, a founding partner of
the law firm, Avila, Rodriguez, Hernandez, Mena & Ferri, LLP., in Coral Gables, FL ("Avila
Rodriguez") .
3. I have known Carlos Alberto Munoz Semsch since 2009, when I began working
at Avila Rodriguez. At that time, Mr. Munoz was a client of Mr. Avila. Between 2009 and 2013,
I had many interactions with Mr. Munoz, and during those years, I observed significant changes
in his personality and social interactions. In fact, beginning in around 2011, it seemed to me that
Mr. Munoz's mental health may be failing. I acknowledge that I am not a medical professional,
but it was clear to me that he was not the same person that I met in 2009. I discussed my
observations and concerns with Mr. Avila and others in my office.
4. In or around 2011, Mr. Munoz began arriving at our office with Teresa Koetzle
Daly. I had never met Ms. Koetzle or spoken to her prior to this time. From the time when Ms.
Koetzle first came to our office until the last time I saw and spoke with her and Mr. Munoz, she
appeared to totally control and dominate Mr. Munoz. In fact, I have observed Ms. Koetzle
verbally abuse and insult Mr. Munoz on several occasions in our office. Mr. Munoz never
reacted to Ms. Koetzle's verbal abuse and insults, and generally appeared to be inattentive and
despondent once Ms. Koetzle began bringing him to our offices.
5. Ms. Koetzle also frequently called our offices to speak to Mr. Avila on behalf of
Mr. Munoz. She was rude to me and others on the telephone, and often spoke in an abrasive and
aggressive manner. She was frequently persistent and even incessant in her demands to speak to
Mr. Avila regarding Mr. Munoz's legal affairs.
6. Additionally, in or around this time, it is my belief that Ms. Koetzle began
sending e-mails from Mr. Munoz's email address to Mr. Avila, in effect impersonating Mr.
Munoz. I have no way of proving that Ms. Koetzle was actually writing the emails from Mr.
Munoz's accounts, but I certainly noticed an extreme change in the writing style of emails from
Mr. Munoz to me or Mr. Avila once Ms. Koetzle became involved in Mr. Munoz's affairs with
Mr. Avila.
7. In or around the first quarter of 2013 , Mr. Munoz ceased to have any dealings
with Mr. Avila, and I have not seen or heard from Mr. Munoz or Ms. Koetzle since that time
period.
8. From the time Ms. Koetzle first accompanied Mr. Munoz to our offices until the
end of Mr. Munoz's business relationship with Mr. Avila, I never received a call from Mr.
Munoz asking to speak to Mr. Avila - I only received calls from Ms. Koetzle.
9. I hereby declare under the penalties of perjury that the foregoing is true and
correct to the best of my recollection.
Executed this 11 til day of February, 2015.
QWJ'~E>=
.
ya '
cr .. .
Cla
EXHIBIT 8
,
11111 """ 11111 ".11 1I1I.lfin 111111111111
FH 2012R07"i-7202
R Bk 28320 PI. 2622 - 2623. (2PI')
RECOROED 10/19/2012 tll09J52
DEED DOC TAX 0.60
HARVEY AUVIth CLEftK OF COURT
nl~"l-OADE COUNTY, FLORIDA
Prepared by and rp\ym worded copy 10:
Alcldea I, Avila, Bsqulre
Avilo Rodriguez Hilmandez Mellil & Ferri U:P
2525 Ponce de Leon Blvd.1#122S
eo,.l ClablD, PL 33146
FoUo# 03-4129-066-1160
_ _ - _ _ _ _- _ __ _ fSlJlctAbon ThiIUna for RecOl'llIIl8 D.III_-~ _ _ _ _ _ _ _ __
Quit Claim Deed

nus QUIT CLAIM DEED nwle lhls ltl da)' of Octcbcr, 2012 by Carloll A "ft02, Q siDgie mall, wbose post
offico addtess is 60 Edgewalm Drive, PH2A, COl'al Gables, Florida 33133 (" antol''). in favor of Cal'lOi A.
MuIkr.!:, a stnllc IlIaD and Teraa Koe.zl~ a slJl&le "oman. as tenants ,.. (OBiOn, whose post office addJ,'eBs
Is (;() Edgewater Drive, PH2A, Conal Gables, Florida 33133 ("Qmntee"),
(WhoneVClr used hOl'e;n the lOnna "Otantor" and "Onnteo" include all the parti to this inst{'lJntent and the heirs.
legal rep(esenlatlvess, and assiens of individuals. and the succcssors and ass gus of corporations. trusts and
tnlstees) .
wrrN.SSEm. that Grantor, for and in consideration of the BUm TEN ANl> 0/100 DOLLARS ($10.00) and
other good and valuable oOJlalcieration to Grantor in hand paid by Grantee the receipt whcreof is hereby
acknowledged. doc. bereby remise. release, and qUitclaim to Grantee. and Grant 's hCU3 and assip! forever. all
tbe riaht, title, interEst, claim and demand which OnuJror bll6 in and to the folIo 'ng deacribed land, situate. lying
a.nd belng in MiIWiDade County .P1crida., to-wit:
Condomtruum unit PH2A, in Phase Two, of TIlE GABLES, Condominium.

lICCordlng to the Declaration of Condominium thereof. reeo ed in Official
Records Book 17318. at Page 1665, of the Public RecordiS of Miami-Dade
County, florida, as amended and supplemented from time to (j e, togbtbC-\' with
an undivided iore:rest in the common elements.
TO HAVB AND TO SOLD, the same together with aU and singular the appuhenal\ces thereto belonging or In
anywise appartainins, and all the estate, right. tltlo, Int~lIt, lien. equity and cl,~ wlllltsoevor of Grantor. either
in law or equity, for 'he O$e. benefit and profit of Granlee forever.
i
NotAl to lluorder: J'OI'8~t to ftorlda 8tablllllll Secltou :IOl.0~ ..d FI~rldll A4mlnlacP&&va de Rill. llB-4.Ol4, No do~
ltullp laX II doe Qd lIa,.blo on this in-lrlllMDt IMIc ..II84I thlR II no colll1d.~t!ol) a-1d d no oU1SCaodl.,. IIIOl'CIIg, OJ: otblll'
~r....
0007418U)OC v.1
Book28320/Page2622 CFN#20120747202 Page 1 of2

DR bK
LASr- PAGE
28320 PG 2623
IN WITNESS WREkEOF. GRIltor hll8 hereunto set Gtantor's hand and Be",1 the! day and year first abow
written.
COUNTY OF MJAMI-DADB
'fbis instl'llment was acknowledged before roo t s L day of Octobtr, ~012 by Carloe A. Muftoz, who
is penonaDy known to me or who has produced - eI' i {i 8$ identification . .
( Seal }
QIdI C/AI"" Drcd Pile 1
Book28320/Page2623 CFN#20120747202 PaQe 2 of2

EXHIBIT 9
111111111111111111111 11111111111111111111111
CFN 2013R06~S82?
OR Bk 28781 P99 4331 - 4333, t3Pls)
RECORDED 08/20(2013 lS.0VI~
QEED DOC TAX 0.60
Preparld by and ~etum to: HARVEY RUVIH, CLERK OF COURT
:al'ld H. Mi)bausBI'. Esq. nIAnlyOADE CDUNTY, FLDRlDA
MlLHAUSBR LAW FIRM, PL.
4800 N. Ped.eral H1&hway. Suite 302-8
Boca Raon, Flotlda 33431
'61-4]73005
Tax: Folio No: 03-4129"()661160
QUITCLAIM DEED
~ THISQUIT-CLAIM DEED, executed tltis ~ day of

,"",,, ct.. t 2013, by CARLOS A. MUNOZ, a single man, whose post office
address is 60 Edgewater Drive, PH2A I Coral Gables, Florida 33133 and TERESA
KOETZLE, a single womllU (who was incOlTec;tly referenced as a s:iDgle woman in the
Qu.lt-Ciaim Deed datad October 1,2012, Recorded on October 19,2012 in the Miami-
Dade PubHc Records, Book 28320, Pa8B 2622-2623, ~ho is now single), as teoants in
common, Orllntor. in favor of CARLOS A. MUNOZ, as Tru~e of the Carlos A.
. Mblltn Revocable Trust dated June 18, 2013, whose post office address Is 60
Edgewater Dri~e. FH2A. Coral Gables. Florida 33133, and TERESA KOETZLE
DALY, a single woman, whose post office address is 60 Edgewater Drive, PH2A, Coral
Gables, florida 33133, each 819 to an equal undivided 50% interest as tenants-inconunon,
Gl'Mtee.
(Wln'l'eu used \wIt11l1JN, ImnIi "Oruttor" 8Dd "QIIIIIU4!' ,"1111 iMlud~ slnlllllir and pllDl, hein,lclla! repNKI\(lllvu, II1d 81111111 of
Inlll rlduall. aDd IIl.e SUDOOlfO" .111111111l1li' 01 oo~oratfOlll. wlle"'v~ lb. cOllt.~1 ,.., "dmil$ GI" ~CJIII"'I.)
WITNESSETH. that the said Grantor, for 'and in consideration of the sum of ten
dollars ($10.00) In hand paid by tbe said Gn\Dtee, the receipt whereof is hereby
acknowledged, does bereby remise, release and quit claim unto the said Grantee forever,
all the right, title, interest, claim and demand wmch the said GrantoX' bas in and to the
following described lot, piece:: or parcel of land, Ilitullte. Jying and being in the MiaMi.
Dade County, State of Florida. to wit:
CondominIum Unit PH2A, in Phase Two, of THE

GABLES, a Condominium, according to the l>oolaration of
Condominium thereof, recorded In Official Records Book
17318, at Page 1665, of the Public Reoords of Miami~Dado
Cowtty, F10dda, as amended and supplemented from time
to time. together with an undivided interest in the common
elClments.
TO HAVB AND TO HOLD the same together with all and Singular the appurtenances
therounto belongIng or in anyway apportaining, and all estate, right, dtle, interest, lien,
equity and claJm whatsoever of the said Grantor, either In law or equity, to the only
proper use, benefit and behoof of the said Grantee fOl'eve~.
Book28781/Page4331 CFN#20130658827 Page 1 of 3

IN wrrNESS WHEREOF. Grantor has signed and sealed these presents the day
and year first above written.
Signed. Sealed, and delivered

in tbo presence of:
Signature of WltncS$
PrInted N e: e.o. . . . (. ..n~ c..~te'r1
ignature of Witness
Prin~d Name: \.\.; ~.\~ @.Arb~ fI\
STATE OF r: (t) 2 , t>1r )

) SS .
COUNTY OF M 11Ir;:' - PA 1>[ )
SllBSCRIBED, SWORN TO, AND ACKNOWLEDGBDBBFORE ME thia.J1

day of :;s...,n-<- , 2013 by CARLOS A. MUNOZ, Ot'antor, who [...J-is
pereonaIly known to me, OR who [ ] bas produced as
l_eatl0I18ru1 .... nottalom an oath. ~M .
Notary Public; State of _~_ _ __

Print Name: _ _ _ _ _ _ _ __
My Comm;ssion Expires:
(I)
NOrMY PlllLIC.sTP.TE OF l'LORID~
.r'.,'"""", Brad H. Milhauser
CommisSion 1# JE0250S3
~!U "." EXll
IUIID
. 1m: SEP.14,2014
'19111 '\Tt.AtmClIo.'fl)),lIOCXl.,IIfC,
N.B. This Deed has been prepared at tbe Grantor's request without examination or legal
opinion of title.
BOok28781/Page4332 CFN#20 130658827 Pa~e 2 of 3

OR BK 28781 PG 4333
LAST PAGE
Signed. Sealed. aDd delivered

In tho presence of:
Gt-if#'y
Sftlature of Wi.noss
7'G,"rc",,~ """"
Signatll~ of WitnC88
Ptiotod Name: H~t.&-t'I~ G___ ci ~
STATE OF f(oA.1 M )
) 88 .
COUNTY OF ..... ',....,( .. Ptl " )
SWSCRIBBD, SWORN TO, ANt> ACKNOWLEDGED BEFORE ME this 1

day of ~1:!'" 2013 by TERESA KOETZLE, Grantor, who [~
personally known to me, OR who [ ] has produced 88
identification and hall not taken an oath.
;ZL1f~
Notary Public; State of _ _ _ _~-
Print Name: _ _ _~~_ _ __
My COmmission Expires:
(i+ Brad H. Milhauser

NOT:lftY PL'DUC-8TATEOl'FLOnIDA
~COmmiaslon # JJ:E02SQS3
:'.JJut Ex,pINls: SEp.14.2a~4
1I0lll.lJII 'nIP,V A'!WI"(IC i()IIDJN<I co..1lI1!.
Book28781/Paae4333 CFN#20130658827 Paae 30f3

Resolución Incapacidad

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Filing # 23752243 E-Filed 02/13/2015 02:11:28 PM

IN THE CIRCUIT COURT OF THE

MENTAL HEALTH DIVISION

CASE NO. 13-2001 MH 05

CARLOS ALBERTO MUNOZ SEMSCH,

CARLOS MUNOZ MILBERG, and ADVERSARY PROCEEDING

TERESA KOETZLE DALY, as Purported

their undersigned counsel, allege as follows:

Milbergs Petition to Terminate Durable Power of Attorney and Designation of Healthcare

Surrogate, attached hereto as Exhibit A.

3. Hereafter all proceedings relating hereto, as nearly as practicable, shall be

Dated: February 13, 2015.

WEINER & CUMMINGS, P.A. COFFEY BURLINGTON, P.L.

By: /s/ Paul M. Cummings By: /s/ Fernando L. Tamayo

Counsel for Petitioners

as indicated below, on this 13th day of February, 2015:

Candis Trusty VIA U.S. MAIL

VIA U.S. MAIL VIA U.S. MAIL

VIA U.S. MAIL

By: /s/ Fernando L. Tamayo

MENTAL HEALTH DIVISION

CASE NO. 13-2001 MH 05

CARLOS ALBERTO MUNOZ SEMSCH,

CARLOS MUNOZ MILBERG, and ADVERSARY PROCEEDING

TERESA KOETZLE DALY, as Purported

CARLOS MUNOZ MILBERG AND IGNACIO MUNOZ MILBERGS PETITION TO

the addendum, granting surrogate powers to Koetzle, and allege:

Care Surrogate statute, 765.105.

attached hereto as Exhibit 3.)

4. Florida Statute 709.2116 allows a court to construe or enforce a power of

proxy has abused his or her powers.

The University of Massachusetts Medical Center in Worcester. Ignacio Munoz is a

businessperson in Lima, Peru. He received his undergraduate degree in Business Administrations

of the Petitioners are United States citizens.

Ward with early-onset Alzheimers Disease.

husband and others.

stopped his medical treatment for Alzheimers Disease or dementia.

Ortiz de Zevallos, and Hortensia Munoz Semsch de Sobrevilla;

c. The Wards brother-in-law and confidant Raul Ortiz de Zevallos

e. The Wards longtime cardiologist, Dr. Cesar Conde;

f. The Wards longtime urologist, Dr. Luis Maggiolo;

g. The Wards longtime friend and colleague Ted Miller;

h. The Wards longtime friend and business associate Fernando Montero;

i. The Wards longtime friends Walter and Teri Shikany;

but are not limited to, the following:

a. Leonardo Perez, the Wards longtime handyman, reported to the Petitioners on

support of the Petitioners.

Ward behaved erratically during the settlement negotiations Id.

the Power of Attorney, reported to the Petitioners that Koetzle seemed to be

believes were written by Koetzle, not the Ward.

the Wards funds and assets for her own benefit.

Masserati that she now drives.

COUNT I: TERMINATION OF SIMPLE DURABLE POWER OF ATTORNEY

set forth herein, and further state as follows:

the Wards sons and are interested in his well-being.

state, in order to serve her personal interests.

in-fact and terminate the Durable Power of Attorney.

terminate the Simple Durable Power of Attorney.

COUNT II: TERMINATION OF DESIGNATION OF HEALTH CARE SURROGATE

set forth herein, and further state as follows:

generally providing ineffective assistance as healthcare surrogate.

24. Additionally, Mulanovich is not a U.S. resident, and is unavailable to exercise

Mulanovich. Mulanovichs assignment of surrogate power to Koetzle is highly irregular and

the United States.

Nam~s) ____________________________------ ~ ~ _