HomeMy WebLinkAbout973433NOTICE OF REVOCATION OF DURABLE POWER OF ATTORNEY
Know all men, by these presents that I, MARY KATHERINE MORRISON, also known as
KATHY MORRISON, of 605 Emerald Street, City of Kemmerer, County of Lincoln, State of
Wyoming, 83101, in and by my written durable power of attorney, dated January 21, 2009, did make
and appoint my daughter, Shinnin S. Miles, of the Town of Lyman, County of Uinta, State of
Wyoming, my true and lawful agent or attorney in fact for the purposes and with the powers therein
set forth, as more fully appears upon review of the durable power of attorney, a true copy of which
is attached to this instrument of revocation as Exhibit A. In my second written durable power of
attorney dated September 25, 2013, I did make and appoint my daughter, Leanna Lee Collins my
attorney in fact and agent for the purposes and with the powers therein set forth as more fully appears
upon review of the durable power of attorney for health care and my general durable power of
attorney, a true copy of both of which are attached to this instrument of revocation as Exhibit B.
This instrument of revocation is made pursuant to 3 -5 -103 W.S.
Notice is hereby given that I, MARY KATHERINE MORRISON, also known as KATHY
MORRIS ON, by these presents, have revoked, and do hereby revoke said durable power of attorney,
and all power and authority thereby given, or intended to be given, to my daughter, Shinnin S Miles
as set forth in the two (2) separated instruments referred to above as Exhibit B.
In witness whereof, I have signed this instrument this ;35 th day of September, 2013.
STATE OF WYOMING
ss.
COUNTY OF LINCOLN
This Notice of Revocation of Durable Power of Attorney was subscribed, sworn to and
acknowledged before me by Mary Katherine Morrison, a /k/a Kathy Morrison, this day
of September, 2013.
WITNESS my hand and official seal.
DEBRA A. HANSEN NOTARY
COUNTY OF
LINCOLN
MK COMMISSION EXPIRES
S1Alt OF
WYOMING
,./S
Notice of Revocation of Durable Power of Attorney Morrison, Kathy
MARY KAT ERINE MORRISON, a/k/a
KATHY MORRISON
/90 .A c- 0 Na.m15.
NOTARY PUBLIC
My Commission Expires 3 y/ 2C i.S
RECEIVED 9/25/2013 at 3:47 PM
RECEIVING 973433
BOOK: 821 PAGE: 240
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
0240
STATE OF WYOMING
COUNTY OF LINCOLN
0241
DURABLE POWER OF ATTORNEY
Know all men, by these presents that I, MARY KATHERINE MORRISON, also known as
KATHY MORRISON, of the City of Kemmerer, County of Lincoln, State of Wyoming, hereby
make, constitute and appoint my daughter, SHINNIN S. MILES, of the Town of Lyman, County of
Uinta, State of Wyoming, my true and lawful agent or attorney in fact for me and in my name, place,
and stead, and on my behalf, with the following powers to be exercised in my name and for my use
and benefit:
1. General Grant of Power. To exercise or perform any act, power, duty, right, or obligation
whatsoever that I now have, or may hereafter acquire the legal right, power, or capacity to exercise
or perform, in connection with, arising from, or relating to any person, item, transaction, thing,
business property, real or personal, tangible or intangible, or matter whatsoever, including, without
limitation, the following specifically enumerated powers. I grant my attorney in fact full power and
authority to do everything necessary in exercising any of the powers herein granted as fully as I
might or could if personally present, with full power of substitution or revocation, hereby ratifying
and confirming all that my attorney in fact shall lawfully do or cause to be done by virtue of this
power of attorney and the powers herein granted.
2. Collection Powers. To forgive, request, ask, demand, sue for, recover, collect, receive, and hold
and possess all such sums of money, debts, dues, commercial paper, checks, drafts, accounts.
deposits legacies, bequests, devises, notes, interests, stock certificates, bonds, dividends, certificates
of deposit, annuities, pension, profit sharing, retirement, social security benefits, insurance benefits
and proceeds, any and all documents of title, chooses in action, personal and real property, intangible
and tangible property and property rights, and demands whatsoever, liquidated or unliquidated, as
now are, or shall hereafter become, owned by, or due, owing, payable, or belonging to, me or in
which I have or may hereafter acquire interest, to have, use, and take all lawful means and equitable
and legal remedies, procedures, and writs in my name for the collection and recovery thereof, and
to adjust, sell, compromise, and agree for the same, and to make, execute, and deliver for me, on my
behalf, and in my name, all endorsements, acquittances, releases, receipts, or other sufficient
discharges for the same.
3. Real Property Powers. To bargain, contract, agree for, option, purchase, acquire, receive, improve,
maintain, repair, insure, plat, partition, safeguard, lease, demise, grant, bargain, sell, assign, transfer,
remise, release, exchange, convey, mortgage, and hypothecate real estate and any interest therein
(and including any interest which I hold with any other person as joint tenants with full rights of
survivorship, or as tenants by the entireties), lands, tenements and hereditament, for such price, upon
such terms and conditions, as my attorney in fact shall determine.
4. Personal Property Powers. To bargain, contract, agree for, purchase, option, acquire, receive,
improve, maintain, repair, insure, safeguard, lease, assign, sell, exchange, redeem, transfer,
mortgage, hypothecate and in any and every way and manner deal in and with goods, wares,
merchandise, furniture and furnishings, automobiles, bills, notes; debentures, bonds, stocks, limited
partnership interests, certificates of deposit, commercial paper, money market instnuents, and other
securities, chooses in action and other tangible or intangible personal property in possession or in
action, for such price, upon such ternls and conditions, as my attorney in fact shall determine.
5. Contract Power. To make, do, and transact every kind of business of whatever nature, and also for
me and in my name, and as my act and deed, to sign, seal, execute, deliver and acknowledge such
stock certificates, stock powers, assignments separate from certificates, deeds, conveyances, leases
and assignments of leases, convents, indentures, options, letters of intent, contracts, agreements,
closing agreements, certificates, mortgages, hypothecation, bills of lading, bills, bonds, debentures,
notes, receipts, evidences of debts, releases and satisfaction of mortgage, judgments and other debts,
waivers of statutes of limitation, and such other documents and instruments in writing of whatever
kind and nature as may be necessary or proper in the premises, as fully as I might do if done in my
own capacity.
6. Banking Powers. To make, receive, sign in my name, indorse, execute, acknowledge, deliver, and
possess such applications, contracts, agreements, options, covenants, conveyances, deeds, trust
Durable Power of Attorney
deeds, security agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills of
lading, warehouse receipts, documents of title, bills, bonds, debentures, checks, drafts, bills of
exchange, letters of credit, notes, stock certificates, proxies, warrants, commercial paper, receipts,
withdrawal receipts and deposit instruments relating to accounts or deposits in, or certificates of
deposit in any commercial banks, savings and loan or other financial institutions or associations, in
my name or in joint name with another person, proofs of loss, evidences of debts, releases, and
satisfaction of mortgages, liens, judgments, security agreements and other debts and obligations and
such other instruments in writing of whatever kind and nature as may be necessary or proper in the
exercise of the rights and powers herein granted in my sole name or in joint name with another
person, in any bank or financial institution; and to carry on all my ordinary banking business.
7. Tax Return. To prepare, execute, and file reports, returns, declarations, forms and statements for
any and all tax purposes including income tax, gift tax, real estate tax, personal property tax,
intangibles tax, single business tax, or any other kind of tax whatsoever, to pay such taxes and any
interest or penalty thereon or additions thereto; to make and file objections, protests, claims for
abatement, refund or credit in relation to any such tax proposed, levied or paid; to signify, as may
be required by Section 2513 of the United States Internal Revenue Code of 1986, as amended, or any
corresponding section of any future United States law, my consent to have one -half (1/2) of any gift(s)
made by my spouse considered as made by me; to represent me and to institute and prosecute
proceedings in court or before any administrative authority to contest any such tax in whole or in
part or for recovery of any amount paid in respect of any such tax, to defend or settle any amount
paid in respect of any such tax, to give full and final receipt for any refund or credit and to endorse
and collect any checks or other vouchers therefor; to pay any and all such taxes and any interest,
penalty or other additional amounts; to employ attorneys, accountants, or other representatives and
grant powers of attorney or'letters of appointment thereof for any of the purposes aforesaid.
8. Safe Deposit Box. To have access to any safe deposit box of which I am a tenant or cotenant with
full power to withdraw or change from time to time the contents thereof; and to exchange or
surrender the box and keys thereto, renew any rental contract therefor, and to do all things which any
depository, association, or bank or its agents may require, hereby releasing the lessor from all
liability in connection therewith.
9. Employ Agents. To employ and compensate agents, accountants, attorneys, appraisers, financial
consultants, real estate brokers and other professional assistants and to retain and compensate such
persons for services rendered; and to waive any attorney /client privilege.
10. Motor Vehicles. To apply for a Certificate of Title upon, and endorse and transfer title thereto, for
any automobile, or other motor vehicle, and to represent in such transfer assignment that the title to
said motor vehicle is free and clear of all liens and encumbrances except those specifically set forth
in such transfer assignment.
11. Settlement Powers. To adjust, settle, compromise, or submit to arbitration any accounts, debts,
claims, demands, disputes or matters which are now subsisting or may hereafter arise between me
and my agent and any other person or persons, or in which any property, right, title, interest or estate
belonging to or claimed by nie may be concerned.
12. Legal Actions. To commence, prosecute, enforce or abandon, or to defend, answer, oppose,
confess, compromise or settle all claims, suits, actions or other judicial or administrative proceedings
in which I am or may hereafter be interested, or in which any property, right, title, interest or estate
belonging to, coming to or claimed by me may be concerned.
13. Dividends. To receive all dividends which are or shall be payable on any and all shares of stock in
any corporation which may stand in my name on the books of such corporation or to which elect to
reinvest such dividends, all as my agent may deem appropriate.
14. Vote Stock. To vote at all stockholder meetings of corporations and otherwise to act as my proxy
or representative in respect of any shares now held or which may hereafter be acquired by me therein
and for that purpose to sign and execute any proxies or other instruments in my name and on my
behalf.
15. Transfer of Stock. To sell, assign, transfer, and deliver all and any shares of stock standing in my
name on the books of any corporation, or which I may be, in equity or otherwise, beneficially
entitled, and for that purpose to make and execute all necessary acts of assignment and transfer.
Durable Power of Attorney
2
0242
16. Insurance and Employee Benefit Plans. To redeem, surrender, borrow, extend, cancel, amend,
pledge, alter or change, including change of beneficiary, any insurance policies in which I may have 0 2 4 3
an interest, as my attorney in fact may deem proper and expedient, and for such purpose to sign and
execute any documents, affidavits or forms required in my name and on my behalf, except however,
my attorney in fact shall have no power and authority over life insurance policies I may own on my
attorney in fact's life; and to exercise all powers and options involving retirement programs,
compensation plans, pension, profit sharing and other employee benefit plans.
17. Social Security and Governmental Benefits. To make application to any governmental agency for
any benefit or government obligation to which I may be entitled; to endorse any checks or drafts
made payable to me from any government agency for my benefit, including any social security
checks.
18. Business Interests. To continue to conduct or participate in any business in which I may be
engaged or to carry out, modify, or amend any agreement to which I may be a party, and to sell.
exchange, modify, or terminate such interest to or with such person or persons as my agent may
deem proper and on such terms and with such security as my agent may deem appropriate; to execute
partnership agreements, and amendments thereto; to incorporate, reorganize, merge, consolidate,
recapitalize, sell, liquidate or dissolve any business; to elect or employ officers, directors and agents;
and to carry out the provisions of any agreement for the sale of any business interest or the stock
therein.
19. Debts and Expenses. To pay, compromise, and settle any and all bills, loans, notes, or other forms
of indebtedness owed by me at the present time, or which may be owed by me or incurred by my
agent hereunder for my benefit at any time in the future, and incur and pay from any of my assets
or property all reasonable expenses in connection with control, management, and supervision of my
property, and the maintenance, support, care, and comfort of myself and those dependent upon me,
including reasonable compensation for the services of my attorney in fact, and including the fees and
charges of such agents, attorneys, accountants, or others as my attorney in fact may, in the exercise
of his discretion, employ in the management of any of my affairs.
20. Investments. To invest and reinvest in loans, stocks, bonds, including United States Bonds
purchased at a discount but redeemable at face value, securities, real estate, life insurance, annuities,
or endowment policies or combination thereof, or in any other investment which my attorney in fact
may deem proper; to reduce the interest rate at any time and from time to time on any mortgage or
land contract; to deal with and give instructions to any brokerage firm with respect to the purchase.
sale or other disposition of securities and other assets; to add assets to or withdraw assets from any
account in my name and sign any representation, certification or agreement, including agreements
regarding margin, option trading, or commodities accounts, that my attorney in fact deems advisable.
21. Personal and Medical Care. To make each and every judgment necessary for the proper and
adequate care and custody of me and my family; to hire, fire, employ, pay for and discharge such
domestic help, social services, nursing services, and practical and/or registered nurses or any other
support personnel responsible for my health and personal care, as my attorney in fact may determine
to be in the best interest of my health; to execute or complete an advance directives for treatment
form, including revising, changing or overriding a form I may have completed; and to give an
informed consent or an informed refusal on my behalf with respect to my physical and mental health
care and comfort, including specifically, by way of illustration only and not by way of limitation:
a. Any medical care, diagnosis, surgical procedure, therapeutic procedure and/or other
treatment of any type or nature including but not limited to the cessation or withdrawal of
any and all types of medical care, treatment, surgical procedures, diagnostic procedures,
medication, and health care;
b. Any physical rehabilitation program;
c. Any dental procedure;
d. Any psychiatric or psychological care or treatment;
e. The admission to or discharge from any hospital, medical center, rehabilitation center,
nursing home, residential care, assisted living or similar facility or services, or mental
institution;
f. The use of any drugs, medication, therapeutic devices, or other medicines or items related
to my health;
g. The execution of waivers, medical authorizations and such other approval as may be
Durable Power of Attorney
3
required to permit or authorize care which I may need and to disclose the contents of my
medical records to others;
h. The waiver of any doctor /patient privilege;
and in general to take and authorize all acts with respect to my health and well being, and to expend
all amounts in connection therewith, to the extent that I could, if mentally competent to do so. The
prices, costs, expenses and compensation incurred in furtherance of the foregoing are all to be within
the sole and absolute discretion of my attorney in fact.
Regarding the Health Insurance Portability and Accountability Act of 1996 (also known as
HIPAA), 42 USC 1320d and 45 CFR 160 -164:
a. I intend for my attorney -in -fact to be treated as I would be with respect to my rights
regarding the use and disclosure of my individually identifiable health information or other
medical records. This release authority applies to any information governed by the Health
Insurance Portability and Accountability Act of 1996 (also known as HIPAA), 42 USC
1320d and 45 CFR 160 -164.
b. I authorize any physician, health care professional dentist, health plan, hospital, clinic,
laboratory, pharmacy or other covered health care provider, any insurance company and the
Medical Information Bureau, Inc. Or other health care clearinghouse that has provided
treatment or services to me or that has paid for is seeking payment from me for such services
to give, disclose and release to my attorney -in -fact, without restriction or reservation, all of
my individually identifiable health information and medical records regarding any past,
present or future medical or mental health condition.
c. The authority given my attorney -in -fact shall supersede any prior agreement that I may have
made with my health care providers to restrict access to or disclose of my individually
identifiable health information.
d. The authority given my attorney -in -fact has no expiration date and shall expire only in the
event that I revoke the authority in writing and deliver it to my health care provider.
I grant to said attorney in fact full power and authority to do, take, and perform all and every
act and thing whatsoever requisite, proper, or necessary to be done, in the exercise of any of the
rights and powers herein granted, as fully to all intents and purposes as I might or could do if
personally present, with full power of substitution or revocation, hereby ratifying and confirming
all that said attorney in fact, or his substitute or substitutes, shall lawfully do or cause to be done by
virtue of this power of attorney and the rights and powers herein granted.
My attorney -in -fact shall incur no personal financial liability for any health or personal care
arranged by him for me.
22. Terminate Life Support Systems. To determine whether and when life support shall be withdrawn
from me. In this connection I intend this document to be and include hereby all aspects of a Durable
Power of Attorney for Health Care as provided under Sections 3 -5 -201 through 3 -5 -213 of the
Wyoming Statutes (as they exist at this date or are subsequently amended), and it is my intent by this
Power of Attorney, Durable Power of Attorney, or Declaration to grant to my agent all authority
permitted by Wyoming law to give directions regarding the use of life sustaining procedures, and
to contest the fees and charges of any health care providers for services rendered by them contrary
to my desire that life- sustaining procedures be withheld if they only serve to prolong the dying
process.
Being of sound mind, I willfully and voluntarily make known my desire that my dying shall
not be artificially prolonged and do hereby declare:
a. If at any time I should have an incurable injury, disease or other illness certified to be a
terminal condition by two (2) physicians who have personally examined nie, one (1) of
whom shall be my attending physician, and the physicians have determined that my death
will occur whether or not life sustaining procedures are utilized and where the application
of life sustaining procedures would serve only to artificially prolong the dying process, I
direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally
with only the administration of medication or the performance of any medical procedure
deemed necessary to provide me with comfort care.
b. In addition to those conditions defined as a "terminal condition" at Wyo. Stat. 35-22
101(a)(ix), as currently enacted and as amended from time to time, a terminal condition shall
include any coma or permanent vegetative state from which there is no known hope of
Durable Power of Attorney
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regaining awareness and higher mental functions regardless of treatment.
c. I specifically direct that all artificially introduced nourishment (food) and hydration (water)
be withheld or withdrawn.
d. In the absence of my ability to give directions regarding the use of such life sustaining
procedures, it is my intention that this declaration shall be honored by my family and
physician(s) and agent as the final expression of my legal right to refuse medical or surgical
treatment and accept the consequences from such refusal.
23. Restrictions on Attorney in Fact or Agent's Powers.
a. My agent cannot execute a Will or Codicil on my behalf.
b. My agent cannot execute any trust on my behalf; however, my agent can enter into a
custodial agreement with a financial institution having trust powers.
c. My agent cannot divert the beneficial use of my assets to herself, her creditors, or her estate
(although my agent may have legal title to the same by virtue of joint ownership or
otherwise).
d. My agent shall not exercise, and shall not be vested with any incidents of ownership as to
insurance policies insuring my agent's life, owned by me.
e. My agent is a fiduciary, possessing no general or limited power of appointment.
f. My agent shall not exercise any powers which I received from my agent in a fiduciary
capacity, and my agent shall have no authority to exercise any powers, the exercise of which
would cause assets of mine to be considered as taxable in my agent's estate for the purpose
of the federal estate tax.
24. Benefit Planning. My agent shall be authorized on my behalf to take such steps as shall be
necessary to ensure or enhance my eligibility for governmental, medical and other benefits. The
power of my agent shall arise only with respect to transactions which might involve transfers to my
agent or the entry into contractual relationships with my agent in my agent's individual rather than
fiduciary capacity. My agent's power shall include but not be limited to: the power to enter into an
agreement with my agent with respect to the division of assets which might be jointly owned by
myself and my agent; to make transfers of property to my agent; to discharge any legal obligation
of support I might have with respect to my agent; to acquire assets jointly with my agent; to convert
assets which might be considered in reducing available governmental benefits into assets which
would be exempt from such consideration; to expend more assets for the joint benefit of myself and
my agent; and to take any and all other actions which might retain, secure, or enhance my eligibility
for governmental benefit regardless of whether my agent might incidentally benefit as well.
25. Full Power and Authority. I grant to said attorney in fact full power and authority to do, take, and
perform all and every act and thing whatsoever requisite, proper, or necessary to be done, in the
exercise of any of the rights and powers herein granted, as fully to all intents and purposes as I might
or could do if personally present, with full power of substitution or revocation, hereby ratifying and
confirming all that said attorney in fact, or his substitute or substitutes, shall lawfully do or cause
to be done by virtue of this power of attorney and the rights and powers herein granted.
26. Ratification. I hereby undertake to ratify everything which my attorney or any substitute or
substitutes, or agent or agents appointed by me hereunder shall lawfully do or cause to be done in
the premises.
27. Revoke Previous Powers of Attorney. I hereby cancel and revoke all previous powers of attorney
executed by me except any power of attorney for health care purposes, whether or not the same shall
have been filed with the registrar of deeds in any jurisdiction.
28. Interpretation and Governing Law. This instrument is to be construed and interpreted as a general
durable power of attorney. The enumeration of specific powers is not intended to, nor does it. limit
or restrict the general powers herein granted to niy agent. Paragraph headings are for convenience
only and are not to be deemed to be part of this instrument. This instrument is executed and
delivered in the State of Wyoming, and the laws of the State of Wyoming shall govern all questions
as to the validity of this power and construction of its provisions.
29. Third Party Reliance. Third parties may rely upon the representation of my agent as to all matters
relating to any power granted to my agent, and no person who may act in reliance upon the
representations of my agent or the authority granted to my agent shall incur any liability to me or my
estate as a result of permitting my agent to exercise any power, and for the purpose of inducing third
parties to rely on this power of attorney, I warrant that, if this power is revoked by me or otherwise
Durable Power of Attorney
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terminated, I will indemnify and save such third party harmless from any loss suffered or liability
incurred by such third party in good faith reliance on the authority of my agent prior to such third
party's actual knowledge of revocation or termination of this power of attorney whether such
termination is by operation of law or otherwise. This warranty shall bind my heirs, devises and
personal representatives.
30. Photographic Copies. Photographic or other facsimile reproduction of this executed power may
be made and delivered by my agent and may be relied upon by any person to the same extent as
though the copy were an original. Anyone who acts in reliance upon the representation or certificate
of my agent, or upon a reproduction of this power, shall not be liable for permitting my agent to
perform any act pursuant to this power.
31. Effective Date. This power of attorney shall become effective immediately upon my signing below
and shall be and remain effective indefinitely thereafter notwithstanding my subsequent disability
or incapacity. The authority of my attorney in fact shall be exercisable notwithstanding any
uncertainty as to whether I am alive. Any act done by my attorney in fact during any period of my
disability or incompetency or during any period of uncertainty as to whether I am alive shall have
the same effect as though I was alive, competent, and not disabled, and shall inure to the benefit of
and by me, my heirs, devises, and personal representatives. For the purposes of determining whether
I am disabled or incapacitated I specifically intend for my attorney -in- factto be treated as I would
be with respect to my rights regarding the use and disclosure of my individually identifiable health
information or other medical records and thereby waive the privacy protections of the Health
Insurance Portability and Accountability Act of 1996 (also known as HIPAA), 42 USC 1320d and
45 CFR 160 -164 so any health care provider of mine may communicate with my designated attorney
in -fact, even if I am not disabled or incompetent.
NOTICE
This document has significant medical, legal and possible ethical implications and
effects. Before you sign this document, you should become completely familiar with these
implications and effects. The operation, effects and implications of this document may be
discussed with a physician, a lawyer and a clergyman of your choice.
2009.
Dated this 21' day of January, 2009.
7)1)1 -0 rio
MARY KATHERINE MORRISON, a/k/a
KATHY MORRISON
In witness whereof, I have signed this Durable Power of Attorney this 21' day of January,
Durable Power of Attorney
71)91 ft 1
ARY KA ERINE M�� a/k/a
KATHY MORRISON
6
I declare under penalty of perjury under the laws of Wyoming that the person who signed or
acknowledged this document is personally known to me to be dependable, that the principal signed
or acknowledged this Durable Power of Attorney in my presence and that the principal appears to
be of sound mind and under no duress, fraud, or undue influence, that I am not the person appointed
as attorney in fact by this document, and that I am not a treating health care provider, an employee
of a treating health care provider, the operator of a community care facility, an employee of an
operator of a community care facility, the operator of a residential care facility, nor an employee of
an operator of a residential care facility.
I further declare under penalty of perjury under the laws of Wyoming, that I am not related
to the principal by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled
to any part of the estate of the principal upon the death of the principal under a will existing or by
operation of law.
DEL;RA A.
7 C.01!:TY OF
LC.;
.4?eis
Durable Power of Attorney
Witf!iess
7
L
Mary Katherine Morrison, a/k/a
Kathy Morrison
SUBSCRIBED AND SWORN to before me by Joseph B. Bluemel, Yoshiye Tanaka, and
Mary Katherine Morrison, also known as Kathy Morrison, this 21s day of January, 2009.
Witness my hand and official seal.
BolAn, d iiaprz..601,L)
NOTARY PUBLIC
My Commission Expires: 3/24/2011
g.
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
AND LIVING WILL DECLARATION
Durable Powcr of Attorney Morrison, Kathy
NOTICE
This document has significant medical, legal and possible ethical implications and effects.
Before you sign this document, you should become completely familiar with these implications
and effects. The operation, effects and implications of this document may be discussed with
a physician, a lawyer and a clergyman of your choice.
1. I, MARY KATHERINE MORRISON, also known as KATHY MORRISON, hereby appoint
my daughter, LEANNA LEE COLLINS, as my attorney -in -fact to make health and personal
care decisions for me as authorized by this document.
2. This document shall not be affected by any subsequent disability or incapacity from which
I may suffer.
3. As authorized by the laws of Wyoming, as currently enacted and as amended in the future,
subject only to the restrictions of Paragraph 6 below, I authorize my attorney -in -fact to make
any and all lawful health and personal care decisions for me including but not limited to
hiring, firing, employing, paying for and discharging domestic help, social services, nursing
services, and practical and /or registered nurses or any other support personnel responsible
for my health and personal care as my attorney -in -fact may determine to be in the best
interest of my health care; to execute or complete an advance directive for treatment form,
a Cardiopulmonary resuscitation directive, and a Psychiatric advance directive, including
revising, changing or overriding a fora I may have completed as I understand circumstances
may change from when I executed or completed such an advance directive; and to give an
informed consent, informed refusal, or withdrawal on my behalf with respect to my physical
and mental health care and comfort, including specifically, by way of illustration only and
not by way of limitation:
a. Any medical care, diagnosis, surgical procedure, therapeutic procedure and /or other
treatment of any type of nature including but not limited to the cessation or
withdrawal of any and all types of medical care, treatment, surgical procedures,
diagnostic procedures, medication, and health care;
b. Any physical rehabilitation program;
c. Any dental procedure;
d. Any psychiatric or psychological care or treatment;
e. The admission to or discharge from any hospital, medical center, rehabilitation
center, nursing home, residential care, assisted living or similar facility or services,
or mental institution;
f. The use of any drugs, medication, therapeutic devices, or other medicines or items
related to my health;
The execution of waivers, medical authorizations and such other approval as may be
required to permit or authorize care which I may need and to disclose the contents of
my medical records to others;
h. The waiver of any doctor /patient privilege;
EXHIBIT
b
a B
0248
and in general to take and authorize all acts with respect to my health and well being, and to
expend all amounts in connections therewith, to the extent that I could, if mentally competent
to do so. The prices, costs, expenses and compensation incurred in furtherance of the
foregoing are all to be within the sole and absolute discretion of my attorney -in -fact. 0 2 4 9
4. Regarding the Health Insurance Portability and Accountability Act of 1996 (also known as
HIPAA), 42 USC 1320d and 45 CFR 160 -164:
a. I intend for my attorney -in -fact to be treated as I would be with respect to my rights
regarding the use and disclosure of my individually identifiable health information
or other medical records. This release authority applies to any information governed
by the Health Insurance Portability and Accountability Act of 1996 (also known as
HIPAA), 42 USC 1320d and 45 CFR 160 -164.
b. I authorize any physician, health care professional, dentist, health plan, hospital,
clinic, laboratory, pharmacy or other covered health care provider, any insurance
company and the Medical Information Bureau, Inc. or other health care clearinghouse
that has provided treatment or services to me or that has paid for or is seeking
payment from me for such services to give, disclose and release to my attorney -in-
fact, without restriction or reservation, all of my individually identifiable health
information and medical records regarding any past, present or future medical or
mental health condition.
c. The authority given my attorney -in -fact shall supersede any prior agreement that I
may have made with my health care providers to restrict access to or disclosure of my
individually identifiable health information.
d. The authority given my attorney -in -fact has no expiration date and shall expire only
in the event that I revoke the authority in writing and deliver it to my health care
provider.
5. I grant to said attorney -in -fact full power and authority to do, take, and perform all and every
act and thing whatsoever requisite, proper, or necessary to be done, in the exercise of any of
the rights and powers herein granted, as fully to all intents and purposes as I might or could
do if personally present, with full power of substitution or revocation, hereby ratifying and
confirming all that said attorney -in -fact, or his substitute or substitutes, shall lawfully do or
cause to be done by virtue of this power of attorney and the rights and powers herein granted.
6. My attorney -in -fact shall incur no personal financial liability for any health or personal care
arranged by her for me.
7. My attorney -in -fact shall have authority to determine whether and when life support shall be
withdrawn from me. In this connection I intended this document to be and include hereby
all aspects of a Durable Power of Attorney as provided under Sections 3 -5 -101 through 3 -5-
103; Cardiopulmonary Resuscitation Directives as provided under Sections 35 -22 -201
through 35 -22 -208; Psychiatric Advance Directives as provided under Sections 35 -22 -301
through 35 -22 -308; and the Wyoming Health Care Decisions Act as provided under S ections
35 -22 -401 through 35 -22 -416 of the Wyoming Statutes (as they exist at this date or are
subsequently amended). It is my intent by this Power of Attorney, Durable Power of
Attorney, or Declaration to grant to my agent all authority permitted by Wyoming law to give
directions regarding the use of life- sustaining procedures, and to contest the fees and charges
of any health care providers for services rendered by them contrary to my desire that life
sustaining procedures be withheld if they only serve to prolong the dying process.
8. Being of sound mind, I willfully and voluntarily make known my desire that my dying shall
not be artificially prolonged and do hereby declare:
Durable Power of Attorney Morrison, Kathy
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a. If at any time I should have an incurable injury, disease or other illness certified to
be a terminal condition by two (2) physicians who have personally examined me, one
(1) of whom shall be my attending physician, and the physicians have determined
that my death will occur whether or not life sustaining procedures are utilized and
where the application of life sustaining procedures would serve only to artificially
prolong the dying process, I direct that such procedures be withheld or withdrawn,
and that I be permitted to die naturally with only the administration of medication or
the performance of any medical procedure deemed necessary to provide me with
comfort care.
b. If I am in and have been in a coma or permanent vegetative state for such a period of
time where my treating physicians have determined there is no reasonably known
hope of regaining awareness and higher mental functions regardless of treatment I
specifically direct that all artificial nutrition and hydration be withheld or withdrawn.
c. Artificial nutrition and hydration is defined for this instrument to mean supplying
food and water through a conduit, such as a tube or an intravenous line where the
recipient is not required to chew or swallow voluntarily, including, but not limited
to, nasogastric tubes, gastrostomies, jejunostomies and intravenous infusions.
Artificial nutrition and hydration does not include assisted feeding, such as spoon or
bottle feeding.
d. In the absence of my ability to give directions regarding the use of such life
sustaining procedures, it is my intention that this declaration shall be honored by my
family and physician(s) and agent as the final expression of my legal right to refuse
medical or surgical treatment and accept the consequences from such refusal.
9. If my attorney -in -fact shall be unavailable or unable to serve for any reason, I hereby appoint
my daughter, Shinnin S. Miles as successor attorney in fact.
10. The enumeration of specific powers is not intended to, nor does it, limit or restrict the general
powers herein granted to my attorney -in -fact. This instrument is executed and delivered in
the State of Wyoming, and the laws of the State of Wyoming shall govern all questions as
to the validity of this power and construction of its provisions no matter where I am located
or subsequently living.
11. I hereby cancel and revoke all previous powers of attorney executed by me including but not
limited to the Durable Power of Attorney that I executed on January 21, 2009, whether or not
the same shall have been filed with the registrar of deed in any jurisdiction. This revocation
is not intended to apply to the Durable Power of Attorney I am executing this same day in
conjunction with this instrument.
12. A photostatic copy or other facsimile reproduction of this Durable Power of Attorney for
Health Care and Living Will Declaration delivered by my agent or attorney -in -fact shall serve
in the same stead as an original. Anyone who acts in reliance upon the representation or
certificate of my agent or attorney -in -fact or upon a reproduction of this power, shall not be
liable for permitting my attorney -in -fact to perform any act pursuant to this power.
13. This power of attorney shall become effective only upon my disability as evidenced in
writing by a physician licensed in the United States who is my treating physician and shall
be exercised indefinitely thereafter notwithstanding my subsequent disability or incapacity.
The authority of my attorney -in -fact shall be exercisable notwithstanding any uncertainty as
to whether I am alive. Any act done by my attorney -in -fact during any period of uncertainty
as to whether I am alive shall have the same effect as though I was alive, competent, and not
disabled, and shall inure to the benefit of and by me, my heirs devises, and personal
representatives. For the purposes of determining whether I am disabled or incapacitated 1
specifically intend for my attorney -in -fact to be treated as I would be with respect to my
rights regarding the use and disclosure of my individually identifiable health information or
other medical records and thereby waive the privacy protections of the Health Insurance
Durable Power of Attorney Morrison, Kathy
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0250
Portability and Accountability Act of 1996 (also known as HIPAA), 42 USC 1320d and 45
CFR 160 -164 so any health care provider of mine may communicate with my designated
attorney -in -fact concerning that issue and matters related thereto, even if I am not disabled
or incompetent in their opinion.
DATED this Fh day of September, 2013.
In witness whereof, I have signed this Durable Power of Attorney for Health Care and Living
Will Declaration this day of September, 2013.
STATE OF WYOMING
)ss.
COUNTY OF LINCOLN
This Durable Power of Attorney for Health Care and Living Will Declaration was signed and
sworn to before me by Mary Katherine Morrison, also known as Kathy Morrison this 25t' day
of September, 2013.
Witness my hand and official seal.
DEBRA A. HANSEN NOTARY
COUNTY Cf
LINCOLN
NM' COMMISSION EXPIRES
S'I VE OF
WYOMING
Durable Power of Attorney Morrison, Kathy
MARY KATHERINE MORRISON, a /k/a
KATHY MORRISON
A
MARY KATHERINE MORRISON, a /k/a
KATHY MORRISON
A 4', 0 /1arnA.o.
NOTARY PUBLIC
My Commission Expires: .3A7 Y400/.5
-4-
0 251
STATE OF WYOMING
COUNTY OF LINCOLN
Flow all men, by these presents that I, MARY KATHERINE MORRISON, also known as KATHY
MORRISON, of the City of Kemmerer, County of Lincoln, State of Wyoming, hereby make, constitute and
appoint my daughter, LEANNA LEE COLLINS, of the Town of Lyman, County of Uinta, State of Wyoming,
my true and lawful agent or attorney in fact for me and in my name, place, and stead, and on my behalf, with
the following powers to be exercised in my name and for my use and benefit:
General Grant of Power. To exercise or perfonn any act, power, duty, right, or obligation
whatsoever that I now have, or may hereafter acquire the legal right, power, or capacity to exercise
or perform, in connection with, arising from, or relating to any person, item, transaction, thing,
business property, real or personal, tangible or intangible, or matter whatsoever, including, without
limitation, the following specifically enumerated powers. I grant my attorney in fact full power and
authority to do everything necessary in exercising any of the powers herein granted as fully as I
might or could if personally present, with full power of substitution or revocation, hereby ratifying
and confirming all that my attorney in fact shall lawfully do or cause to be done by virtue of this
power of attorney and the powers herein granted.
2. Collection Powers. To forgive, request, ask, demand, sue for, recover, collect, receive, and hold
and possess all such sums of money, debts, dues, commercial paper, checks, drafts, accounts,
deposits legacies, bequests, devises, notes, interests, stock certificates, bonds, dividends, certificates
of deposit, annuities, pension, profit sharing, retirement, social security benefits, insurance benefits
and proceeds, any and all documents of title, chooses in action, personal and real property, intangible
and tangible property and property rights, and demands whatsoever, liquidated or unliquidated, as
now are, or shall hereafter become, owned by, or due, owing, payable, or belonging to, me or in
which I have or may hereafter acquire interest, to have, use, and take all lawful means and equitable
and legal remedies, procedures, and writs in my name for the collection and recovery thereof, and
to adjust, sell, compromise, and agree for the same, and to make, execute, and deliver for me, on my
behalf, and in my name, all endorsements, acquittances, releases, receipts, or other sufficient
discharges for the same.
3. Real Property Powers. To bargain, contract, agree for, option, purchase, acquire, receive, improve,
maintain, repair, insure, plat, partition, safeguard, lease, demise, grant, bargain, sell, assign, transfer,
remise, release, exchange, convey, mortgage, and hypothecate real estate and any interest therein
(and including any interest which I hold with any other person as joint tenants with full rights of
survivorship, or as tenants by the entireties), lands, tenements and hereditament, for such price, upon
such terms and conditions, as my attorney in fact shall determine.
4. Personal Property Powers. To bargain, contract, agree for, purchase, option, acquire, receive,
improve, maintain, repair, insure, safeguard, lease, assign, sell, exchange, redeem, transfer,
mortgage, hypothecate and in any and every way and manner deal in and with goods, wares,
merchandise, furniture and furnishings, automobiles, bills, notes, debentures, bonds, stocks, limited
partnership interests, certificates of deposit, commercial paper, money market instruments, and other
securities, chooses in action and other tangible or intangible personal property in possession or in
action, for such price, upon such terns and conditions, as my attorney in fact shall determine.
5. Contract Power. To make, do, and transact every kind of business of whatever nature, and also for
me and in my name, and as my act and deed, to sign, seal, execute, deliver and acknowledge such
stock certificates, stock powers, assignments separate from certificates, deeds, conveyances, leases
and assignments of leases, convents, indentures, options, letters of intent, contracts, agreements,
closing agreements, certificates, mortgages, hypothecation, bills of lading, bills, bonds, debentures,
notes, receipts, evidences of debts, releases and satisfaction of mortgage, judgments and other debts,
waivers of statutes of limitation, and such other documents and instruments in writing of whatever
kind and nature as may be necessary or proper in the premises, as fully as I might do if done in my
own capacity.
6. Banking Powers. To make, receive, sign in my name, indorse, execute, acknowledge, deliver, and
possess such applications, contracts, agreements, options, covenants, conveyances, deeds, trust
deeds, security agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills of
Durable Power of Attorney Morrison, Kathy
0252
DURABLE POWER OF ATTORNEY
lading, warehouse receipts, documents of title, bills, bonds, debentures, checks, drafts, bills of 5
exchange, letters of credit, notes, stock certificates, proxies, warrants, commercial paper, receipt s,'
withdrawal receipts and deposit instruments relating to accounts or deposits in, or certificates of
deposit in any commercial banks, savings and loan or other financial institutions or associations, in
my name or in joint name with another person, proofs of loss, evidences of debts, releases, and
satisfaction of mortgages, liens, judgments, security agreements and other debts and obligations and
such other instruments in writing of whatever kind and nature as may be necessary or proper in the
exercise of the rights and powers herein granted in my sole name or in joint name with another
person, in any bank or financial institution; and to carry on all my ordinary banking business.
7. Tax Return. To prepare, execute, and file reports, returns, declarations, forms and statements for
any and all tax purposes including income tax, gift tax, real estate tax, personal property tax,
intangibles tax, single business tax, or any other kind of tax whatsoever, to pay such taxes and any
interest or penalty thereon or additions thereto; to make and file objections, protests, claims for
abatement, refund or credit in relation to any such tax proposed, levied or paid; to signify, as may
be required by Section 2513 of the United States Internal Revenue Code of 1986, as amended, or any
corresponding section of any future United States law, my consent to have one -half of any gift(s)
made by my spouse considered as made by me; to represent me and to institute and prosecute
proceedings in court or before any administrative authority to contest any such tax in whole or in
part or for recovery of any amount paid in respect of any such tax, to defend or settle any amount
paid in respect of any such tax, to give full and final receipt for any refund or credit and to endorse
and collect any checks or other vouchers therefor; to pay any and all such taxes and any interest,
penalty or other additional amounts; to employ attorneys, accountants, or other representatives and
grant powers of attorney or letters of appointment thereof for any of the purposes aforesaid.
8. Safe Deposit Box. To have access to any safe deposit box of which I am a tenant or cotenant with
full power to withdraw or change from time to time the contents thereof; and to exchange or
surrender the box and keys thereto, renew any rental contract therefor, and to do all things which any
depository, association, or bank or its agents may require, hereby releasing the lessor from all
liability in connection therewith.
9. Employ Agents. To employ and compensate agents, accountants, attorneys, appraisers, financial
consultants, real estate brokers and other professional assistants and to retain and compensate such
persons for services rendered; and to waive any attorney /client privilege.
10. Motor Vehicles. To apply for a Certificate of Title upon, and endorse and transfer title thereto, for
any automobile, or other motor vehicle, and to represent in such transfer assignment that the title to
said motor vehicle is free and clear of all liens and encumbrances except those specifically set forth
in such transfer assignment.
11. Settlement Powers. To adjust, settle, compromise, or submit to arbitration any accounts, debts,
claims, demands, disputes or matters which are now subsisting or may hereafter arise between me
and my agent and any other person or persons, or in which any property, right, title, interest or estate
belonging to or claimed by me may be concerned.
12. Legal Actions. To commence, prosecute, enforce or abandon, or to defend, answer, oppose,
confess, compromise or settle all claims, suits, actions or other judicial or administrative proceedings
in which I am or may hereafter be interested, or in which any property, right, title, interest or estate
belonging to, coming to or claimed by me may be concerned.
13. Dividends. To receive all dividends which are or shall be payable on any and all shares of stock in
any corporation which may stand in my name on the books of such corporation or to which elect to
reinvest such dividends, all as my agent may deem appropriate.
14. Vote Stock. To vote at all stockholder meetings of corporations and otherwise to act as my proxy
or representative in respect of any shares now held or which may hereafter be acquired by me therein
and for that purpose to sign and execute any proxies or other instruments in my name and on my
behalf.
15. Transfer of Stock. To sell, assign, transfer, and deliver all and any shares of stock standing in my
name on the books of any corporation, or which I may be, in equity or otherwise, beneficially
entitled, and for that purpose to make and execute all necessary acts of assignment and transfer.
Durable Power of Attorney Morrison, Kathy
2
16. Insurance and Employee Benefit Plans. To redeem, surrender, borrow, extend, cancel, amend,
pledge, alter or change, including change of beneficiary, any insurance policies in which I may have
an interest, as my attorney in fact may deem proper and expedient, and for such purpose to sign and
execute any documents, affidavits or forms required in my name and on my behalf, except however,
my attorney in fact shall have no power and authority over life insurance policies I may own on my
attorney in fact's life; and to exercise all powers and options involving retirement programs,
compensation plans, pension, profit sharing and other employee benefit plans.
17. Social Security and Governmental Benefits. To make application to any governmental agency for
any benefit or government obligation to which I may be entitled; to endorse any checks or drafts
made payable to me from any government agency for my benefit, including any social security
checks.
18. Business Interests. To continue to conduct or participate in any business in which I may be
engaged or to carry out, modify, or amend any agreement to which I may be a party, and to sell,
exchange, modify, or terminate such interest to or with such person or persons as my agent may
deem proper and on such terns and with such security as my agent may deem appropriate; to execute
partnership agreements, and amendments thereto; to incorporate, reorganize, merge, consolidate,
recapitalize, sell, liquidate or dissolve any business; to elect or employ officers, directors and agents;
and to carry out the provisions of any agreement for the sale of any business interest or the stock
therein.
19. Debts and Expenses. To pay, compromise, and settle any and all bills, loans, notes, or other forms
of indebtedness owed by me at the present time, or which may be owed by me or incurred by my
agent hereunder for my benefit at any time in the future, and incur and pay from any of my assets
or property all reasonable expenses in connection with control, management, and supervision of my
property, and the maintenance, support, care, and comfort of myself and those dependent upon me,
including reasonable compensation for the services of my attorney in fact, and including the fees and
charges of such agents, attorneys, accountants, or others as my attorney in fact may, in the exercise
of his discretion, employ in the management of any of my affairs.
20. Investments. To invest and reinvest in loans, stocks, bonds, including United States Bonds
purchased at a discount but redeemable at face value, securities, real estate, life insurance, annuities,
or endowment policies or combination thereof, or in any other investment which my attorney in fact
may deem proper; to reduce the interest rate at any time and from time to time on any mortgage or
land contract; to deal with and give instructions to any brokerage firm with respect to the purchase,
sale or other disposition of securities and other assets; to add assets to or withdraw assets from any
account in my name and sign any representation, certification or agreement, including agreements
regarding margin, option trading, or commodities accounts, that my attorney in fact deems advisable.
21. Restrictions on Attorney in Fact or Agent's Powers.
a. My agent cannot execute a Will or Codicil on my behalf.
b. My agent cannot execute any trust on my behalf; however, my agent can enter into a
custodial agreement with a financial institution having trust powers.
c. My agent cannot divert the beneficial use of my assets to herself, her creditors, or her estate
(although my agent may have legal title to the same by virtue of joint ownership or
otherwise).
d. My agent shall not exercise, and shall not be vested with any incidents of ownership as to
insurance policies insuring my agent's life, owned by me.
e. My agent is a fiduciary, possessing no general or limited power of appointment.
f. My agent shall not exercise any powers which I received from my agent in a fiduciary
capacity, and my agent shall have no authority to exercise any powers, the exercise of which
would cause assets of mine to be considered as taxable in my agent's estate for the purpose
of the federal estate tax.
22. Benefit Planning My agent shall be authorized on my behalf to take such steps as shall be
necessary to ensure or enhance my eligibility for governmental, medical and other benefits. The
power of my agent shall arise only with respect to transactions which might involve transfers to my
agent or the entry into contractual relationships with my agent in my agent's individual rather than
fiduciary capacity. My agent's power shall include but not be limited to: the power to enter into an
agreement with my agent with respect to the division of assets which might be jointly owned by
myself and my agent; to make transfers of property to my agent; to discharge any legal obligation
Durable Power of Attorney Morrison, Kathy
3
0254
of support I might have with respect to my agent; to acquire assets jointly with my agent; to convert
assets which might be considered in reducing available governmental benefits into assets which
would be exempt from such consideration; to expend more assets for the joint benefit of myself and
my agent; and to take any and all other actions which might retain, secure, or enhance my eligibility
for governmental benefit regardless of whether my agent might incidentally benefit as well.
23. Full Power and Authority. I grant to said attorney in fact full power and authority to do, take, and
perform all and every act and thing whatsoever requisite, proper, or necessary to be done, in the
exercise of any of the rights and powers herein granted, as fully to all intents and purposes as I might
or could do if personally present, with full power of substitution or revocation, hereby ratifying and
confirming all that said attorney in fact, or his substitute or substitutes, shall lawfully do or cause
to be done by virtue of this power of attorney and the rights and powers herein granted.
24. Ratification. I hereby undertake to ratify everything which my attorney or any substitute or
substitutes, or agent or agents appointed by me hereunder shall lawfully do or cause to be done in
the premises.
25. Revoke Previous Powers of Attorney. I hereby cancel and revoke all previous powers of attorney
executed by me, including but not limited to the Durable Power of Attorney that I executed on
January 21, 2009, whether or not the same have been filed with the registrar of deeds in any
jurisdiction. This revocation is not intended to apply to the Durable Power of Attorney for Ilea.lth
Care and Living Will Declaration I am executing this same day in conjunction with this instrument.
26. Interpretation and Governing Law. This instrument is to be construed and interpreted as a general
durable power of attorney. The enumeration of specific powers is not intended to, nor does it, limit
or restrict the general powers herein granted to my agent. Paragraph headings are for convenience
only and are not to be deemed to be part of this instrument. This instrument is executed and
delivered in the State of Wyoming, and the laws of the State of Wyoming shall govern all questions
as to the validity of this power and construction of its provisions.
27. Third -Party Reliance. Third parties may rely upon the representation of my agent as to all matters
relating to any power granted to my agent, and no person who may act in reliance upon the
representations of my agent or the authority granted to my agent shall incur any liability to me or my
estate as a result of permitting my agent to exercise any power, and for the purpose of inducing third
parties to rely on this power of attorney, I warrant that, if this power is revoked by me or otherwise
terminated, I will indemnify and save such third party harmless from any loss suffered or liability
incurred by such third party in good faith reliance on the authority of my agent prior to such third
party's actual knowledge of revocation or tennination of this power of attorney whether such
termination is by operation of law or otherwise. This warranty shall bind my heirs, devises and
personal representatives.
28. Photographic Copies. Photographic or other facsimile reproduction of this executed power may
be made and delivered by my agent and may be relied upon by any person to the same extent as
though the copy were an original. Anyone who acts in reliance upon the representation or certificate
of my agent, or upon a reproduction of this power, shall not be liable for pernitting my agent to
perforrn any act pursuant to this power.
29. Effective Date. This power of attorney shall become effective immediately upon my signing below
and shall be and remain effective indefinitely thereafter notwithstanding my subsequent disability
or incapacity. The authority of my attorney in fact shall be exercisable notwithstanding any
uncertainty as to whether I am alive. Any act done by my attorney in fact during any period of ny
disability or incompetency or during any period of uncertainty as to whether I am alive shall have
the same effect as though I was alive, competent, and not disabled, and shall inure to the benefit of
and by me, my heirs, devises, and personal representatives. For the purposes of determining whether
I am disabled or incapacitated I specifically intend for my attorney -in -fact to be treated as I would
be with respect to my rights regarding the use and disclosure of my individually identifiable health
information or other medical records and thereby waive the privacy protections of the Health
Insurance Portability and Accountability Act of 1996 (also known as HIPAA), 42 USC 1320d and
45 CFR 160 -164 so any health care provider of mine may communicate with my designated attorney
in -fact, even if I am not disabled or incompetent.
30. Alternate Power of Attorney. In the event that my daughter, Leanna Lee Collins is unable to serve
as my attorney, should she predecease me or by reason of her disability as evidenced in writing by
a physician licensed in the United States, then I direct that my daughter, Shinnin S. Miles, of the
Durable Power or'Attorney Morrison, Kathy
4
0255
Town of Lyman, County of Uinta, State of Wyoming, shall act as attorney for me and in my name
pursuant to the terns of this power of attorney and I hereby undertake to ratify everything which my
attorney might do or cause to be done in the premises hereunder.
This document has significant medical, legal and possible ethical implications and effects.
Before you sign this document, you should become completely familiar with these implications and
effects. The operation, effects and implications of this document may be discussed with a physician,
a lawyer and a clergyman of your choice.
2013.
Dated this u 7,5 1 1 day of September, 2013.
In witness whereof, I have signed this Durable Power of Attorney this .�.;i F day of September,
This Durable Power of Attorney was subscribed and sworn to before me by Mary Katherine
Morrison, a /k/a Kathy Morrison this 4,5 Fh day of September, 2013.
Witness my hand and official seal.
DEBRA A. HANSEN NOTARY
COUNTY OF
LNVCOLN
itW C■MMIS EXPIRES 3
Ads ►a
Durable Power of Attoniey Morrison, Kathy
STATE OF
WYOMING
.2
NOTICE
MARY KA'IQHERINE MORRISON, a /k/a
KATHY MORRISON
MARY KATHERINE MORRISON, a /lc/a
KATHY MORRISON
NOTARY PUBLIC
My Commission Expires:
5
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