HomeMy WebLinkAbout895964Rn'nF IVED
COUNTY CLERK
89596h
Power of Attorney:
~'~~(~ ' of the County of
the state of ~//~~ : The united: States of The America:, Is of the
· w~//- _ 6../
delegation of 5-/~-e.,n/; ~/-~-~, _ : for the appointment of Attorney in
fact in action fo//~,.~~ ~_50 ' for the following:
Delegation of authority for negotiation of transactions, denials, there- of. For
authorization .of provision, / for termination of life - support. For delegation of decisions
for medical - intervention'. For delegation for c_relnation of the.body. For t.~.he rendering of
the tangiblf-/- no,n 7 t~angible property for
~, ~ :js: with -,out.- responsibi~ty for debts in
Litigati(~nz~ending/'n,9:n - pgnding of ~ ~ ('~ ·
_~_~./~~,' .~ ~) :here-by Is: o,f, the d.elegation of benefits
of Social - Security, of rehrement,/pensions, for ,~,,-v-O_.,.~, ._~'~~., :
Signature - under - seal -
day of ~ '20 O~ -
state of
County of SS.
/,R- o~ :, 20 d:>_~ -
Grantor:,
' ./f~_r~.r.~z¢__ :. ~.~JEr~.~._, Attorney in fact:,
Is: of app' earance in person, Is: l~nown by the Notary - Public, Is: of the acknowledgment
of the signature of the execution of Power of Attorney by freedom of act / deed, in the
presence of:
Notary - ~'"
Expiration of Commission: