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��15�15�� <br /> My a��o�-ney-�n-fa��is granted fui�and un��mk�ted power�o ac�on my beha�f i�l�.he same maz�ner as if I��ere perso��- <br /> ally prese���. My a��arneyw�n-fact accep�s this appoin��nen�and agrees�o act ir�m}�bes�int�res�as he �r she cansiders <br /> advisa���. To induce �ny�h�rd party�o r��y upon�h�s pawer of a��o�-ney, I agree�hat any th�rd par�y r�ce�W�ng a signed <br /> cop�flr facsirnile af th�s power of a�torney may r��y upon such copy, and�ha�re�oca��on or termina�ion of this power <br /> af attorney shali be �neffect��e as�� su�h th�rd par�y un�i� ac�ual r�ot��e or kno��edge of such revoca�ion or��r�nina- <br /> ��on shall ha�e b�en recei�ed by such�hird party. �, for myse�f and far my he�rs, exe�u�ors, �egal representa��ves and <br /> ass�gns, agree�o �nde�n�fy and hold harm�ess any such�h�rd part�r fr�m.any and all c�aims tha�ma�arise agains� <br /> such third par�y b�reason�f such third par�y having re�ied on the prov�sions of th�s po�rer of at�orney. This pa�ver af <br /> a�tarney may b�re�oked by�r�e a�any���r�.e a�.d is au�oma��cally re�rol�ed upon my d�ath. M�a��arney�in-fac�shall nat <br /> be co��p�nsa�ed for his or her serv�ees n�r sha�i�ny at�orn�y�-�n-�fac�be l�abl���rr�e, my es�a�e, h�irs, successors, or <br /> assigns for ac��ng ar refra�t�zng fro�n acting under this document, excep�for w���fui m�sconduc�or gross neg��gence. <br /> Re�rocat�on of�his dacum�.ent�s nQ�effec��ve un�ess a third pa�ty has ac�ua� knov��edge of such re�oca�ion. <br /> I in�end far xny atto�-ne�-in-fac�under this Pow�r of At�orne��a be�rea�ed as �wou�d be uri�h respec��o m�r r�gh�s <br /> regarding the us�and d�sc�osure of my indi��dual�y identifia��e hea��h�nfarma�ion or o�her medical r�cords. Th�s <br /> �ieleas�authari�y app�zes �o any infarma�i���governed by�he H�a�th Insurance Por�abz���y and A�coun�abil��y Ac�af <br /> 1996(aka�IPA��,42 US� �3�Dd and 45 CFR ��0--16�-. <br /> S�gnature and 13ec�arat�on af Princ�pal <br /> � �. . �� � ����.�.� the rinci a� s� n�n name tfl�his ower of a��o�-ne <br /> , � �� � p p � � y p Y <br /> �his � day of �`�.��� �� and, being f�rs�du�y s�vorn, do declare�o th� <br /> undersigne�au�hority�hat� s�gn and execu�e�his ins�rumen�as my power of attarn��r and�ha�i sign ��wi�lingly, �r <br /> w���ingl�d��ect a�o�her�o ��gn for me, �ha�� exe�ute it as my free �nd vo�un�ar�ac�for the�urp�s�s expressed ir�th� <br /> power af at�orne�r and�hat�am eigh�een years of age or o�der, af sound m�nd and under no�onstrain�or undue inf�u- <br /> ence, and tha�I ha�re read and unders�and�he can�ents �f�he r���.ice a��he b��inning�f th�s document. <br /> � � <br /> .� . <br /> �gn �ure of r�ncipa� <br /> '�'itness Attestativn <br /> 7' ,� 1 � � ` <br /> ` � �� � ,' � �� �� �' <br /> Y .�..� - + :��..�:. ,�he f rst v���ness, ar�d I, t� � } <br /> � <br /> �he secand wi�ness, s�gn my nam�e��the foregaing p��er of a��orney be�ng first du�y sworn and do dec�are ta the <br /> undersigned authori���ha��he pri��.cipa� s�gns and e�ecu�es�h�s ins�ru�nen�as h�slh�r power of a��orn�y and�ha�helshe <br /> , <br /> signs i�wil��ngl�, ar v�ii�ingiy directs ana�he�•�o sign far h�mlh�r}and�ha��, in�he presence and hearing af�he pr�nc�- <br /> pai, sign�his po�ver of a��or�ey as�r�t�ess�o�he princ�pa�'s sig��ing and tha��o �h�best of my knowledge�he pr�nc�pal <br /> is eigh�een�ears of age or��der, of saund mind and under na �o ra�nt ur�du�influe ce. <br /> � � ' � ` . � . <br /> � � � �� � . <br /> �i na�ure�f First�Vit��ess S� na�ure of Se �nd Wi��less <br /> � � <br /> � � <br />