Durable Health Care Power Of Attorney And Health Care Treatment Template Page 8

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NOTARIZATION (OPTIONAL)
(Notarization of document is not required by Pennsylvania law, but if the document is both
witnessed and notarized, it is more likely to be honored by the laws of some other states.)
On this _____ day of ____________________, 20__, before me personally appeared the
aforesaid declarant and principal, to me known to be the person described in and who executed
the foregoing instrument and acknowledged that he/she executed the same as his/her free act
and deed.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal in the
County of ____________________, State of ____________________, the day and year first
above written.
Notary Public
My commission expires ______________________

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