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2. I UNDERSTAND: <br />a) that it allows another person to make life and death decisions for me if I am <br />incapable of making such decisions <br />b) that I can revoke this Power of Attorney for Health Care at any time by <br />notifying my attorney in fact, my physician, or the facility in which I am a <br />patient or resident, <br />c) that I can require in this document that the fact of my incapacity in the <br />future be confirmed by a second physician. <br />EXECUTED on July 23, 2002. <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />I declare that Dale R. Davis is personally known to me, that he signed this power of <br />attorney for health care in my presence, that he appears to be of sound mind and not under duress <br />or undue influence, and signs the foregoing Health Care Power of Attorney as his voluntary act <br />and deed, and that neither I nor his attending physician is the person appointed as attorney in fact <br />or successor attorney in fact by this document. <br />GENERAL NOTARY-Stale of Nebraska <br />BARBARA A. WROBLEWSKI <br />My Canna Esp. Judy 15.2043 <br />WROBLEWSKI LAW OFFICE <br />Barbara A. Wroblewski <br />Rodney M. Wetovick <br />Attorneys at Law <br />P.O. Box 23 <br />617 Howard Ave. <br />St. Paul, NE 68873 <br />Phone: (308) 754 -4442 <br />) ss. <br />dY;rVee 1 atN <br />Dale R. Davis <br />201801297 <br />