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201503296
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Last modified
11/5/2015 9:11:34 PM
Creation date
5/20/2015 3:49:24 PM
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DEEDS
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201503296
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$055734_DOC2.doc <br />DURABLE POWER OF ATTORNEY <br />OF <br />Barbara J. Rayback <br />I. PRINCIPAL AND ATTORNEY -IN -FACT <br />201503296 <br />I, Barbara J. Rayback, who resides at 2508 Cochin Street, Grand Island, <br />Nebraska 68801, appoint the following person to serve as my attorney -in -fact, to <br />act for me in any lawful way with respect to the subjects indicated below. <br />Name: Pamela Susan Leeper <br />Address: 2620 West Forrest <br />Grand Island, Nebraska 68803 <br />If Pamela Susan Leeper resigns or is unable or unwilling to serve as my <br />attorney -in -fact, I appoint the following person to serve as my successor <br />a ttorney -in -fact: <br />II. EFFECTIVE TIME <br />Name: Terrence L. Rayback <br />Address: 13055 Decant Drive <br />Poway, California 92064 <br />This Power of Attorney shall become effective immediately, and shall not <br />be affected by any subsequent disability or incapacity of the principal. This is a <br />Durable Power of Attorney. <br />Pursuant to the Health Insurance Portability and Accountability Act of <br />1996 (HIPAA) and any similar state laws, and exclusively for the purpose of <br />making a determination of my incapacitation or incapability of managing my <br />financial affairs and obtaining an affidavit of such incapacitation by a physician, I <br />authorize any health care provider to disclose to the person named herein as my <br />"attorney -in- fact," any pertinent individually identifiable health information <br />sufficient to determine whether I am by reason of illness or mental or physical <br />
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