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200709322 <br />IN WITNESS WHEREOF, I have executed this document this <br />day of September, 2006, at Grand Island, Hall County, Nebraska. <br />I HAVE READ THIS POWER OF ATTORNEY FOR HEALTH CARE. I <br />UNDERSTAND THAT IT ALLOWS ANOTHER PERSON TO MAKE LIFE AND DEATH <br />DECISIONS FOR ME IF I AM INCAPABLE OF MAKING SUCH DECISIONS. I <br />ALSO UNDERSTAND THAT I CAN REVOKE THIS POWER OF ATTORNEY FOR <br />HEALTH CARE AT ANY TIME BY NOTIFYING MY ATTORNEY IN FACT, MY <br />PHYSICIAN, OR THE FACILITY IN WHICH I AM A PATIENT OR RESIDENT. I <br />ALSO UNDERSTAND THAT I CAN REQUIRE IN THIS POWER OF ATTORNEY FOR <br />HEALTH CARE THAT THE FACT OF MY INCAPACITY IN THE FUTURE BE <br />CONFIRMED BY A SECOND PHYSICIAN. <br />=AffOk G. MIDDAGH, Prin pal <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 in our presence, that <br />the principal appears to be of sound mind and not under duress or <br />undue influence, and that neither of us nor the principal's <br />attending physician is the person appointed as Attorney in Fact by <br />this document. <br />Witnessed by: <br />S' na re of Witness u.. <br />Sig ture of Witness <br />STATE OF NEBRASKA ) <br />) ss : <br />COUNTY OF HALL ) <br />Date <br />lkdm <br />Date <br />ELEANOR G. MIDDAGH, being the named <br />known to be the person described in and <br />Durable General and Health Care Power of <br />the same to be her voluntary act and deed. <br />-5- <br />Sheryl Schilowsk <br />Printed Name of Witness <br />Stephanie L. Ounsombath <br />Printed Name of Witness <br />principal, who is to me <br />who executed the above <br />Attorney, acknowledges <br />