Durable Health Care Power Of Attorney And Health Care Treatment Instructions Page 9

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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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