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<br /> - �'�'�''"���_'� I hereby dealare my ix►tent and my wiah to live attd enjoy litA =
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<br />- {`�'" �� "" as long as possible. However, I do also hereby dealare my inten� _�
<br /> � � `-''�k-' thr�t ][ do not a�iah to reaeive extraordinery mediaai tre�tsaent at ��
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<br /> _ ,.,j:•. � . � any tiime which would only postpone the moment oP say de�ath from an
<br /> � �°- ' � inaurabie ar terminr�l aondi�ion (if so c�iac,�oeed by say afi�ten8lflg �'"'°��
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<br /> �'�`�'` f' �'� physiaian) or prolo�ng an irreversibie coma (if so �iagnosed by my . ___�
<br /> -�1.�, •,.. . attending physiaian). ..---
<br /> � �s:`�_.
<br /> � My Agent may qrant releases to hospital staff, physiaians, ..,-_____
<br /> " nurse� and other mediaal arid hospiteai a8ministrative paraonael, who ;,����r:_------
<br /> � ... �� aat in relianae upon inatructions given by my Agent, or who render ���'='''�'--�=
<br /> � � �• • written opinions to my Agent in aoianeation witb any ma�ter =��;:M�---�..�...
<br /> • ' ' �� • desaribec� in t2�is artiale, from ali liability for 8amagea sufPered ='_='-"'"R"�- -__
<br /> 1 � � or to be suPPered by me� to aign doauatents, titled or purporte8 tA '��`�==�Y
<br /> � � be a nRefusal oP Zhceatment" and "I�eaving Hospital Againet Mediae�l � ��°` -� '�"
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<br /> Adviae", aa well as any neaessary waivers of or releases from ; ,�,�;,;_�.._..
<br /> .. liability required lay a hospital or a physiaian to implement my ; ��� '�;�"�_,_
<br /> - - -��-�L�---�•-���--. . FriBhes rAgar.ding mediaal treatment or non-treatntent. ___.____ __ �_
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<br /> •- � ° g. T.,t�,-rrAtAt��r end Govert�{na �w T�is i.nstrument is to -:� __
<br /> � ' be aonstrued and interpreted as a Ganeral Durable Power oP Attorney `� �'����``='"�
<br /> � � ., and Durable Power of Attorney for Health Care. The enumeration •of ,. ;�;� -
<br /> speaifia powers herein is not intsnded ta, nor does it, limit or � ''�''�i'
<br /> � re�trict the general powers granted herein to my Agent. Thie �"�-y=.�-
<br /> � ins�rument is exsauted and delivered in the State of Nebraska and , � ��""'°�
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<br /> �• the laws of said State shall govern all questions as to the "�°�--
<br /> ' validity of this Power and the aonstruation of its proviaions. _ �•� ,..•�.
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<br /> . 4. D�sa�ility of t�rinaipa�,_ Thier GeiZei�al Bur'ahle Fawer of
<br /> , Attorney an� Durable Power oP Attorney for Health Care shall not be �
<br /> � � affected by my disability and shall remain in full forae and effeat
<br /> � . , throughout any period of disability. ° " +
<br /> �x .
<br /> DATED this � day of � 1992• �Y :
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<br /> ' - ,- _� ! �Ad/v 3,
<br /> �C/W� • '".,r
<br /> �''�^'V u.q,::w
<br /> HELEN GLIEM, Princ pal .�� <.
<br /> . ,.
<br /> • ��.��nd
<br /> STATE OF NEBRASKA) '.°+����-.
<br /> )ss. :�"
<br /> COUNTY OF HALL ) , ��' '�
<br /> HELEN GLIEM, being the named principal, who is to me knowr3 !�o � � . ��� ---.
<br /> bs the person described in and who exeauted the above Durable Power ` �
<br /> � of Attorney and Durable Power of Attorney for Health Care and I � -
<br /> acknowledqed the same to be her voluntary act and deed. '
<br /> IN WITNE88 WHEREOF, I have her to scribed my e d �_ .
<br /> affixed my official seal the day d ear st above wr en. �, ,
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<br /> eQF1ERAt MOtAAY,SUa ot Ncdr�sh .
<br /> ,.JL 8.J.CUNNINGHAM,,1R. tary Publ •
<br /> ' �.°�h Comm.ExA Au�.17,I993
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