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<br />DECLARATION OF WITNESSES <br /> <br />;2. 0070 !s:Jcjt / <br /> <br />We declare that the principal is personally known to us, that <br />the principal signed or acknowledged his 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 <br /> <br /> <br />Iclllfr~ <br />Date <br /> <br />/It'd" tit C. AltC'Y <br />Printed Name of witness <br /> <br />p~~ Na~ 7w~tness <br /> <br />/0 -,.;2 7- e7:3 <br />Date <br /> <br />STATE OF NEBRASKA <br /> <br />ss. <br /> <br />COUNTY OF HALL <br /> <br />HORACE EDWARD 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 his 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 />, <br /> <br />GENERAl NOTARY. State of Nebliska ' <br />REGINA R. OLSEN <br />My Comm. Exp. Oct. 27, 2007 <br /> <br />~r;t!, ~ <br />Not Y Public <br /> <br />-5- <br />