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. r <br />200505290 <br />DECLARATION OF WITNESSES <br />We declare that the principal is personally known to us, that <br />the principal signed or acknowledged her signature on this Durable <br />General and Health Care Power of Attorney for health care in our <br />presence, that the principal appears to be of sound mind and not <br />under duress or undue influence, and that neither of us nor the <br />principal's attending physician is the person appointed as Attorney <br />in Fact by this document. <br />Witnessed by: <br />Signa re of W tness Da e <br />/4z <br />Printed Name of W ness <br />Ur1/ / a u S /9�4ICJ L• ZL�1la�S <br />Signature of Witness Date Printed Name of Witness <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF HALL ) <br />MARY ANN BOWDEN, being the named principal, who is to me known <br />to be the person described in and who executed the above Durable <br />General and Health Care Power of Attorney, acknowledges the same to <br />be her voluntary act and deed. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and <br />affixed my official seal the day and year last above written. <br />GENERAL. WTARY - 60 of Nebraska <br />REGINA R. OLSEN <br />M'CM'� � 27' Nota Public <br />-5- <br />