Ohio Durable Power Of Attorney For Health Care Will To Live Form Page 7
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7ALTERNATIVE TO WITNESSES
ACKNOWLEDGMENT
NOTARY PUBLIC
State of Ohio
County of ____________________________________________________________________
On this _____________ day of __________________, 20____,
before me, (name of notary public)_________________________________________________
personally appeared, known to me or satisfactorily proven to be the person whose name is
subscribed to the above Durable Power of Attorney for Health Care as the principal, and
acknowledged that (s)he executed the same for the purposes expressed therein. I attest that the
principal appears to be of sound mind and not under or subject to duress, fraud or undue
influence.
Notary Seal
My Commission Expires:_________________________________________________________
Signature of Notary Public________________________________________________________
Form prepared 1997
*clerical changes made 11/05
Page 7 of 7
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