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200306602 <br />DECLARATION OF WITNESSES <br />We declare that Bobby L. Royle, the principal, is personally known to us; that the principal <br />signed or acknowledged his signature on this power of attorney for health care in our presence; that <br />the principal appears to be of sound mind and not under duress or undue influence; and that the <br />person appointed herein as the principal's attorney in fact, by this document, is not one of the <br />following described persons, to -wit: one ofthe witnesses herein; the principal's attending physician; <br />an employee of the attending physician who is unrelated to the principal by blood, marriage or <br />adoption; a person unrelated to the principal by blood, marriage or adoption, who is an owner, <br />operator or employee of a health care provider in or which the principal is a patient or resident; or <br />a person who is unrelated to the principal by blood, marriage or adoption and who is presently serving <br />as an attorney in fact for ten or more principals. <br />We further declare that neither of us witnesses are the principal's spouse, parent, child, <br />grandchild, sibling, presumptive heir, known devisee at the time of this witnessing, attending <br />physician, attorney in fact, or an employee of a life or health insurance provider for the principal. No <br />more than one witness is an administrator or employee of a health care provider who is caring for or <br />treating the principal. <br />Witnessed by: <br />Signature of Witness/Date <br />Printed Name of Witness <br />t <br />­ <br />—Signature of Witnes /Date Printed Name of Witness <br />t <br />G <br />