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DURABLE POWER OF ATTORNEY FOR HEALTH CARE
PRIOR DESIGNATIONSI revoke any prior Durable Power of Attorney for Health Care.
August 22, 2014
RECORD OF COPIES
Record of people and institutions to whom I have given a signed copy of this document:1. ____________________________________ Date: ____________________2. ____________________________________ Date: ____________________3. ____________________________________ Date: ____________________4. ____________________________________ Date: ____________________5. ____________________________________ Date: ____________________
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