Health Care Power Of Attorney Form Page 7
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7______________ COUNTY, ____________________ STATE
Sworn to (or affirmed) and subscribed before me this day by ___________________________________
(type/print name of signer)
____________________________________
(type/print name of witness)
____________________________________
(type/print name of witness)
Date _____________________
______________________________________
Signature of Notary Public
(Official Seal)
___________________________, Notary Public
Printed or typed name
My commission expires: __________________
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Parent category: Legal