Laserfiche WebLink
<br />~ '" f ~... <br /> <br />;JOO 70to97/ <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 />It) . ;z. 7-e:l .3 <br />Date <br /> <br />/In/I-Ii e . ;t{~ <br />Printed Name 0 itness <br /> <br />li')~3 <br />Da e I <br /> <br /> <br />STATE OF NEBRASKA <br /> <br />ss. <br /> <br />COUNTY OF HALL <br /> <br />MARJORIE ETHEL JENSEN, being the named principal, who is to me <br />known to be the person described in and who executed the above <br />Durable General and Health Care Power of Attorney, acknowledges the <br />same to 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 />&lW.NOTARY ~_ d Nebraska <br />REGINA R. OLSEN <br />Itt Camm. . OCt. 27. 200T <br /> <br />~I/2. ~ <br /> <br />Not y Publlc <br /> <br />-5- <br />