Power Of Attorney Over A Minor Child - Health Care Page 4

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4.
This Power of Attorney will begin on ______________ and expire on
_________________ unless I revoke it earlier.
Date
No more then 6 months
5.
I have given this consent of my own free will.
6.
A photocopy or other reproduction of this power of attorney may be relied upon
to the same extent as a signed original.
Witness signature
Signature of parent granting power of
attorney
SUBSCRIBED and SWORN to before to on this date:
Notary Public
My Commission Expires:

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