Durable Power Of Attorney For Healthcare Decisions Page 5
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88. PRIOR DESIGNATIONS REVOKED
I revoke any prior Durable Power of Attorney for HealthCare:
(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY.)
I sign my name to this Durable Power of Attorney for HealthCare on: __________________
(Date)
at ______________________________________, _________________________________
(City)
(State)
_____________________________________
(Signature)
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