HomeMy WebLinkAbout895141 RECEIVED
~ ,., . ~LINCOLN COUNTY CLERK
~iOOK~-T PRP^GE ~, 2 8 DURABLE POWER OF ATTORNEY
8 9 5 1 I 03 NOV - 7 PH 3: I
KNOW ALL MEN BY THESE pRESENTS that I, NORA KELLERSJ~'I~R, ~O~$N E R
F EN!MEF~,EFL WYOMiN~
Town of Alton, County of Lincoln, State of Wyoming, make, constitute and appoint JACOB
KELLERSBERGER of Afton, Wyoming, to be my lawful agent for me and to do aH acts which I
could do if personally present. This includes the power to make health care decisions for me if and
when I am unable to make health care decisions and the power to consent to giving, withholding or
stopping any health care, treatment, service or diagnostic procedure. My agent has the authority to
talk with health care, treatment, service or diagnostic personnel, obtain information, sign forms
necessary to carry out these decisions. My agent also has authority to admit me to, or discharge me
fi.om, (even against medical advice) any health care institution, assisted living facility or other facility
or program.
If the person named as my agent is unwilling, or unable to act as my agent or cannot be
reached after reasonable efforts have been made, then I appoint the following person(s) to serve as
my agent in the order listed below:
CRAIG KELLERSBERGER
KENT KELLERSBERGER
KAREN K. TIMOTHY
This power of attorney shall' not become ineffective by disability. I intend to give my agent
the fullest powers possible and do not intend, by the enumeration of his powers to limit or reduce
them in any fashion.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this 14th day of January,
2000.
NORA KELLERSBERGER (/
STATE OF WYOMING )
) ss
COUNTY OF LINCOLN )
The foregoing instrument was acknowledged before me by Nora Kellersberger this 14th day
of January, 2000.
Witness my hand and official seal.
My Commission Expires:
IKoral Sanderson ;~ Notary Public1
County of ~'{~t~ State of I
My Commission Expires 6-3-2003 J
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