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201907061 VIII. TERMS Ft CONDITIONS - Upon authorization by all parties, the Attorney -in - Fact accepts their designation to act in the Principal's best interests for all financial decisions legal under taw. IX. THIRD PARTIES - i, the Principal, agree that any third party receiving a copy via: physical copy, email, or fax that I, the Principal, will indemnify and hold harmless any and all claims that may be put forth in reference to this Limited Power of Attorney Form. X. COMPENSATION - The Attorney -in -Fact agrees not to be compensated for acting in the presence of the Principal. The Attorney -in -Fact may be, but not entitled to, reimbursement for all: food, travel, and lodging expenses for acting in the presence of the Principal. XI. DISCLOSURE - I intend for my attorney-in-fact under this Power of Attorney to be treated, as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health insurance Portability and Accountability Act of 1996 (aka HIPAA), 42 USC 1320d and 45 CFR 160-164 XII. PRINCIPAL'S SIGNATURE - I, 41,A 'C , the Printed Name of Principal Principal, sign my name to this power of attorney this day of Day ohlh fir— o'--0// and, being first duly sworn, do declare to the Month undersigned authority that i sign and execute this instrument as my power of attorney and that I sign it wittingly, or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes expressed in the power of attorney - d that I am eighteen years of age or older, of sound mind and unser no cot, rant or undue influence. Signat2 Tri cipoi