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<br />'Ij .'ft,- !' ~. ..' <br /> <br />200606559 <br /> <br />DECLARATION OF WITNESSES <br /> <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 /> <br />Witnessed by: <br /> <br /> <br />~ ~3-/( <br />Da e <br /> <br />--- <br />J;rJYffT 7//d-fL/EV <br />Printed Name of /7SS / <br /> <br />U/f- {U;~1Ic- <br /> <br />Name of Wi ness <br /> <br /> <br />;:.,?~IJ ~ <br />Date <br /> <br />STATE OF NEBRASKA <br /> <br />ss. <br /> <br />COUNTY OF HALL <br /> <br />MARY E. LESLIE, 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 /> <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and <br />affixed my official seal the day and year last above written. <br /> <br />j GENERAL NOTARY. State of Nebraska <br />J REGINA R. OLSEN <br />My Comm. Exp. Oct. 27, 2007 <br /> <br />+~J f? ~ <br /> <br />Nota Public <br /> <br />~5- <br />