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THIS POWER OF ATTORNEY FOR HEALTH CARE THAT THE FACT OF MY <br />INCAPACITY IN THE FUTURE BE CONFIRMED BY A SECOND PHYSICIAN. <br />We declare that the principal is personally known to rne; that the principal signed <br />or acknowledged her signature on this Durable Power of Attorney and Power of Attorney <br />for Health Care in our presence; that the principal appears to be of sound mind and not <br />under duress or undue influence; and that neither of, nor the principal's attending <br />physician, is the person appointed as attorney -in -fact by this document: <br />WITNESSED BY: <br />Signature of Witness/D <br />"AV ‘4'0 <br />Signature of Witne ate) <br />LOIS ANN I I MEISTER <br />DATED: r 2008 <br />DECLARATION OF WITNESSES <br />pas tAilk-QOAIF& <br />(Printed Name of Witness) <br />(Printed Name of Witness) <br />201507141 <br />