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201602501
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Last modified
5/17/2016 12:56:32 PM
Creation date
4/25/2016 4:12:16 PM
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DEEDS
Inst Number
201602501
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J) <br />201602501 <br />physical or mental health including medical and hospital records and to execute any <br />releases or other documents that may be required in order to obtain such information; <br />to make health care decisions on my behalf including choice of care and therapy, the <br />selection of physicians, hospitals, and health care facilities; to sign the necessary <br />consents, releases, claims, insurance forms, and waivers; and to make any and all <br />decisions regarding the commencement or withdrawal of life support measures; <br />i) To make application for benefits or assistance through the Nebraska Department of <br />Health and Human Services or any other service; <br />Giving and granting unto the said attorney -in -fact full power and authority to do and <br />perform every act and thing whatsoever requisite and necessary to be done in and <br />about the premises, as fully to all extent and purposes as I might or could do if <br />personally present, ratify and confirming all that said attorney -in -fact shall lawfully do or <br />cause to be done by virtue of these presents. <br />This power of attorney shall not be affected by disability of the undersigned principal, <br />and all acts done by the said attorney in fact hereunder shall have the same effect and inure to <br />the benefit of and bind myself, my heirs, devisees and personal representatives. • <br />IN WITNESS WHEREOF, I have hereunto set my hand and seal this 27th day of <br />Nover-rrbpr, 2007. <br />Richard E. Davis <br />STATE OF NEBRASKA ) <br />) :ss <br />COUNTY OF HALL ) <br />BE IT REMEMBERED that on the 27th day of November, 2007, before me the <br />undersigned, a Notary Public in and for said State, personally appeared Richard E. Davis, to <br />me known to be the identical person described in and who executed the foregoing Power of <br />Attorney and acknowledged said instrument to be his v.luntary act and deed. <br />WITNESS my Hand and Seal the day and year I st above written. <br />j�GENERAf. NOTARY - State of Nebraska <br />JEROM E. JANULEWICZ <br />Ny Comm. Exp. Jan.10, 2011 <br />Notary Pub is <br />Richard E. Davis, Power of Attorney <br />Page 2 of 2 <br />
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