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' . ;. . . .. . . . • ,tl ;p. <br /> ' •��f f ` � 4 ` 4} � _� _.._._..__.-.•4 - b'• ' . _ , � - t �'-�t'�'��� , n _'_ <br /> . �. � i .. . .. . <br /> �•..�-.=-.._.._:......'..'-a..._� • '..:_. c , . ri. ., _ . . . . - -� . <br /> -.�.......... — .�• ' �4• J��. <br /> . . • •� . . �k��M�<`.4.`��i7�.'d���_^�'�. _.. - <br /> � gP' ��}8�1.45 . .- ^n�,v.�:-�-- <br /> _�;-�7-�.�ia. <br /> � _ `_*.�-fi.�.?it�wr..�.--_--. <br /> . � .:. �,> .,'.i...:,,.��°"_ <br />� g�op�r, ari� to �eceivo aazd gfve receipts gar any i�aome or dividend .' :�-�-_ :�:�r;;�; <br /> •.'��c+.{.:•:-aL.:tc+h`rx,. <br /> asi�i.ia� fscoffi su�� i�vss�aents, and to vary or dispose of all and ,�3 y4 ,,. _ <br />— a�y szac� �nve���s�r� or aY.YieP inves�n�� for my use an� benef it as :- <br /> B� t��y �i.snk �a.�:. _ ' � ...._.... :- <br /> - s,> <br /> �.i*�5°a'�'�»}-,tprt9J'y:_,_� <br /> l�. �,�`P �s at Sfiockholders� Meet�na� h'Mecut� Prox�es. and :�',;�, _°==°----4, <br /> n�o'n,,������ a���i�.�te f�r Owner. 'so vote at the mestinqs of .-1_1i����:'' <br /> .:"�°—..Yr_-�_es�rirx- <br /> s'�aa'�?�a3.�� as ot.Pisr aae�ings of an� corporation or company, or , �.�� _ <br /> ot.��+ui�e t.� a��. as my attorn�y or progy, cvit.� power of ,�_, s,���A.=-�=---_�"-�"�_� <br /> szab��itcr,�tian, i.ia���ss���'t of any stocks, shares, bon=ie, d�bentures, - ��.� - <br /> � ��. �w���,�e� Qg o�rship, or securi�fes, now or h�rea�te� _�.;.�;-.:_ <br /> Baal�l �y ��► � ���ed by or an account of said corporation o� ������_----`— <br /> c��yY � i��• �i�t pu�cpose to execute amy proxiQS, aimitad or 'TT���„� �.�� <br /> ga�v�za3., a� a�te�r instruments. ~'��='�`���� ".-�'�` <br /> ��:W "" f <br /> tes arsd Similar Instrum�ntse "'�"�%"'��=`�1°�� <br /> 11.. T,�'s ��cute Reecl� Bills Na � �p,�. <br /> «;. <br /> F��e a11 � ��. af the purposes herein stated to enter fnto and �� _ ''r�.�t^: <br /> sign, se�7L, �z�c�xte, acknawledqQ, � deliver ar►y contrac�ts, deec� �- i�. � ,�, <br /> v� uYhar ixt�.�r�nts ctha�so@vc��. �nd to draFr, acc�pt, maIte, - .. ,� , <br /> r -�- <br /> er�cla�s, di��ar�rni�, or otherwise d�al with any commercial os �;�. i+�i=�=�: <br />_ ;� r�or�:nti3c irr.�ra�inen�so �"'`�,'_- <br /> ��_�:��':� <br /> ; 1�. �o Cca��azt� to Medical T�eatm�n�. To exercise fuT3l right <br /> '�.��•��`.��� <br />, aa�i �.a•.x�i.nl ao����i.ty to make and ex�cu�e all me�cal c�c-�isions �1�� ��, . <br /> c�ao�i�j tng pexson, inaluding, buL not limited to the ���ction � ,,�: � <br /> of p��•yici�,^, and heal�h caae services, and the use, withDcsS�i!�g or ;, .. ,��,.. <br /> h <br /> cai.sao��i�eti�e of inechanical or other life-suppart syst�� and I y� ' '.;�'�: �� " <br /> ��s,rr�by �ia:��t� that all physicians and other health care g��el � ��� <br /> ' � z <br /> sh�1:.�. aa'� �mw�auan� to �hhe olirectidrn af my attornay�in-fact. :�.. '� <br /> '< .',-°`_ <br /> ;:,»�;��. <br /> �t is to be undorstood, .aowr��o �hat I hav� strong � - , = <br /> � ob��acticttr»a� 2o the a8ministration of inedical �reatinent to any pe�son �.,. <br /> ra <br /> s�l:+�ly fo9e� the p�arpose o f presesw i nq t h a t p e r s o n's l�f e, w h e n �h e A� � ��_ _ <br /> . ' gs�z.l�.�cr��:�=�ated is naither phyefcally abae, a�or m�nically competent, - - ,-==—i <br /> td ercj.a�� fcurther life. I therefore request tt:at my attorney-in-- �� _•� <br /> �: N J ��C.__. <br /> _ ''� �'"L—`_�'__ <br /> � �aut, h+�s �ided by this expreasio�a of my wishes. If I am physically �r�,����.�..f,,�Y_, <br /> �x�n�bi�a �+:s eare f�or mysel� without cosastant help, and mentally ,,;,,-,r,�F, <br /> • 3,n��p�tc-�4�tt to unc3erat�nd my conxlitfon anc� recognize those abou� -�_•� �-���y��:: <br /> ' ��,. �tci. �y physicat and mental cai�dit�f.oa cannot be significantly ---- -��_. <br />;;��� � ��tr�ved by further treatmer�t, tt�.� I request that no trea�en'k �� -- _ <br />'� inU�x�dac��solely to prolong my life b� applfed, and that my life be �.,.; <br /> �rr�f��� to end without medical interference. nw.��. _ :v_.,-=-M.- <br /> .I ,'_" r,,,e4,�„�,� -; <br /> �, -� It shouidl be understoasl that tbis statement is not ����•. � � <br /> �.ttL�z�l�ed as a co�zg2�ate re jection af ineafcal treatm�nt intended to � ��i;•' ° ,�. �.,.�, <br /> rol�mv� paia, or r��daticsn useful in proviAinq for my care �e��fng a • -�`' � � <br /> � .�:... .--:.:._�:_ <br /> � term3.s�al i2l�ess, but it is intendPd to re�rent the a ai�,Lion of � ��� �� <br /> P Pl� r:: -�� ��- � . . .;�;�,..�_ <br /> . ..�;�il.,,1,. <br /> � oxygen+ i�.i:�.-�veae�us feeding and c�imilar tr��ianents intende� solely �,`;�,�.,��;��,.-_ <br /> �a� mafn�c�r��s�ce, aaLr�n no siqnifi�:t poss�lr+flity c� imp�ovem�nt in � ' • - -:.°--m;,,�;:,__ <br /> .m� �ndi�fo� 13 �u�dseen. It i�a � cvisA that no ��aatment be, ��:�"-RT'°�:`�`4i; <br /> �`��f_� <br /> _,:�;;;�,�, <br /> . �:�.,��..�..�,=: <br /> ir�-°— _. <br /> I!!"'- - .- <br /> . , �W�- .r.�_.. <br /> 3 �� ��`,�;'r+.,��- <br /> j.} �..,�� ..�.w...., <br /> ' 1F�p.-n��•"m,. �_.. <br /> P.F.+�' _ <br /> -- �=-`- <br /> ��.�..,��� �sr� <br /> .,.� w�+:�'4iv:.1-, <br /> _ __�. ...: �,. <br />- , . - � ..�,._... <br /> . �i1�i . ' � �. . ' ' ` _ ' � . •• . . . . -' _ . - - ' .. '_ _ . .. . . .. •_ . ' .. ,. � t. .. ..j...._ <br /> .. , . . <br />. ��? "" .. . ' • . _ , .. ' .. , ... - .: . � . � - ' , � . • . f <br />, <br /> . �r�; . . , _ _ <br /> "_"" " ' �i�;{�•��. , • • ' � �' • • � - . • , • ,_'�- • . • • . --' -•e. _ .. '" <br /> p°uw'. <br /> ' - f . . .. . . . , ' ' _. � - <br />. 1 . . . ,1 , '. .' ' : (: � . . � ' . - • ,' .i ' . ., � � � . . • . ' . ' .. . . �. <br /> ..` � • � . . .. ' � - _ • . . � � • �� _ : _ . � �. � ' . � _7•�. .� <br /> , � • • . <br /> ' - ' . . . • • . . -.��'v._�5�..��'..�� <br /> 1.�1� � ' ' . • � . . . . _ �:I. • ' � • � - , .. . ' . . • ' _ <br /> �,\. .� , : .. . • • - � .. • _ - � . -'�i� o ` � . .. . . . , ' . - . • ' � ' • '{4 <br />- .�.. _..... -' . .. .__....._......�...�.• ... , . <br /> ' f � , ._ ....�.. ..� .............. .�- • . . <br /> r� 1'" . _ . . �. • <br /> ��. ..{r�b '� . � � . .. � . . , y:� . ". � •'� i . �� • � , ' � <br /> - !1- . . . : - . . ' � ._ ' ._ ... . .. .. _ .. . .. _ . � .. _ . - .. . . � . � . . . . � . • ,. .. ... ., � . . . � . . , . ... <br /> �•r. <br />