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y the day and year last above written.\n\nSeal\n\n_______________________________ Signature of Notary Public\n\n-2-\n\nhat I am not the attorney in fact or successor attorney in fact designated by this power of attorney for health care. Witness my hand and notarial seal at _______________________________ in such countncipal, and I declare that he or she appears in sound mind and not under duress or undue influence, that he or she acknowledges the execution of the same to be his or her voluntary act and deed, and t__________________ County, personally came ______________________________, personally to me known to be the identical person whose name is affixed to the above power of attorney for health care as priCounty of ___________________ ) On this _______________________________ day of ________ , 20 ___, before me, ________________________________________________________, a notary public in and for ______nt Name: ______________________________________ ______________________________________ Date: _________________________________ Date: _________________________________\n\nOR State of Nebraska, ) ) ss. rson appointed as attorney in fact by this document. Witnessed By: ______________________________________ ______________________________________ (Witness Signature) (Witness Signature) Print Name: Priorney for health care in our presence, that the principal appears to be of sound mind and not under duress or undue influence, and that neither of us nor the principal\'s attending physician is the pemaking designation/date)\n\n-1-\n\nDECLARATION OF WITNESSES We declare that the principal is personally known to us, that the principal signed or acknowledged his or her signature on this power of attTHAT I CAN REQUIRE IN THIS POWER OF ATTORNEY FOR HEALTH CARE THAT THE FACT OF MY INCAPACITY IN THE FUTURE BE CONFIRMED BY A SECOND PHYSICIAN. _____________________________________ Signature of person UNDERSTAND THAT I CAN REVOKE THIS POWER OF ATTORNEY FOR HEALTH CARE AT ANY TIME BY NOTIFYING MY ATTORNEY IN FACT, MY PHYSICIAN, OR THE FACILITY IN WHICH I AM A PATIENT k Nebraska Power Of Attorney For Health Care - FindLegalForms.com Datingskincare Arkada Molurmusun Dating Skin Careo d o o Women Dating l Nebraska Power Of Attorney For Health Care - FindLegalForms.com Datingskincare Arkada Molurmusun Dating Skin Carey Singles