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20110093� <br />physical or mental health including medical and hospital records and to execute any <br />releases or other documents that may be required in order to obtain such information; <br />to make health care decisions on my behalf including choice of care and therapy, the <br />selection of physicians, hospitals, and health care facilities; to sign the necessary <br />consents, releases, claims, insurance forms, and waivers; and to make any and all <br />decisions regarding the commencement or withdrawal of life support measures; <br />i) To make application for benefits or assistance through the Nebraska Department of <br />Health and Human Services or any other service; <br />j) Giving and granting unto the said attorney-in-fact full power and authority to do and <br />perForm every act and thing whatsoever requisite and necessary to be done in and <br />about the premises, as fully to all extent and purposes as I might or could do if <br />personally pr�sent, ratify and confirming all that said attorney-in-fact shalf lawfully do or <br />cause to be done by virtue of these presents. <br />This power of attorney shall not be affected by disability of the undersigned principal, <br />and all acts done by the said attorney in fact hereunder shalf have the same effect and inure to <br />the benefit of and bind myself, my heirs, devisees and personal representatives. <br />IN WITNESS WHEREOF, I have hereunto set my hand and seaf this 27th day of <br />Nover�l�ier, 2007. p `----�- <br />� <br />�, / <br />� f f f ,� �% -�' ( � � ; <br />/'� �'C�. <br />�d..- ,-C,,, i ` __ --''"` C_._./ `'"_ - C_ i -CL_ <br />1 7 <br />Richard E. Davis ' <br />STATE OF NEBRASKA ) <br />) :ss <br />COUNTY OF HALL ) <br />BE IT REMEMBERED that on the 27th day of November, 2007, before me the <br />undersigned, a Notary Public in and for said State, personally appeared Richard E. Davis, to <br />me known to be the identical person described in and who executed the foregoing Power of <br />Attorney and acknowledged said instrument to be his �oluntary act and deed. <br />WITNESS my Hand and Seal the day and <br />�EppLNOTNiY - S1ate a� Ne� Z <br />J �m � � � 10,2�tit <br />Richard E. Davis, Power of Attorney <br />Page 2 of 2 <br />