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201900235
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Last modified
1/11/2019 3:31:03 PM
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1/11/2019 3:31:03 PM
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201900235
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201900235 <br />By this P °Wet' of Attorney, Princ.mal n takes .theloll (PiVirlg additional proviion or <br />10n\: Agent has Pdli power to make inter- v' os gifts o any kind or nature on behalf of <br />prinpal:, my Agent as -my Pergonal Representative i thorized to execute any and all releases <br />requiied by health care, providers and health plans under HIP PA. <br />4, This Power of Attorney revokes and supersedes all prior executedinstruments of like <br />impo t and remains operative until revoked. <br />STA <br />coL <br />FxEcuTED AT Grand Island, Hall County, Nebraska, on the" clay of September 2012. <br />'E OF NEBRASKA <br />NT Y OF HALL <br />— . <br />DELORES J. 1.31&)0K.S <br />The foregoing instrument was acknowledged before me on 1 day of t,5eptercha 2012, by <br />thel),incipal, DELORES J. BR.00KS. <br />Notary Public <br />GENERAL NOTARY State al NeVasie <br />51' KEVIN A. BROSTROM <br />,e,Tibr• - My Gnat. Exp, Sept 25, 2014 I <br />Paps. 2 of 2 <br />
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