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201106848
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Last modified
10/9/2011 10:52:06 PM
Creation date
9/16/2011 9:06:16 AM
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DEEDS
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201106848
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� <br />2011U684� <br />DURABLE POWER OF ATTORNEY <br />OF <br />Allen Robert Blake <br />I. PRINCIPAL AND ATTORNEY-IN-FACT <br />I, Allen Robert Blake, who resides at 1212 Dodd Street, Wood River, <br />Nebraska 68883, appoint the following person to serve as my attorney-in-fact, to <br />act for me in any lawful way with respect to the subjects indicated below. <br />Name: Jennifer L. Blake <br />Address: 1212 Dodd Sireet <br />Wood River, Nebraska 68883 <br />If Jennifer L. Blake resigns or is unable or unwilling to serve as my <br />attorney-in-fact, I appoint the following person to serve as my successor <br />attorney-in-fact: <br />Name: Glenn M. Blake <br />Address: 1533 Meadow Lark Road <br />Lincoln, Nebraska 68521 <br />II. EFFECTIVE TIME <br />T'his Power of Attorney shall become ef£ective immediafely, and shall not <br />be affected by any subsequent disability or incapacity of the principal. This is a <br />Durable Power of Attorney. <br />Pursuant to the Health Insurance Portability and Accountability Act of <br />1996 (HIPAA) and any similar state laws, and exclusively for the purpose of <br />making a determination of my incapacitation or incapability of managing my <br />financial affairs and obtaining an affidavit of such incapacitation by a physician, I <br />authorize any health care provider to disclose to the person named herein as my <br />DOC#9659816 <br />
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