Health Care Power Of Attorney Page 8
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III:
S
W
ART
IGNATURE AND
ITNESSES
By signing below as the Declarant, I indicate that I am emotionally and mentally
competent to make this advance directive and that I understand its purpose and effect. I
also understand that this document replaces any similar advance directive I may have
completed before this date.
(Signature of Declarant)
(Date)
The Declarant signed or acknowledged signing this document in my presence and,
based upon personal observation, appears to be emotionally and mentally competent to
make this advance directive.
(Signature of Witness)
(Date)
Telephone Number(s):
(Signature of Witness)
(Date)
Telephone Number(s):
(Note: Anyone selected as a health care agent in Part I may not be a witness. Also, at
least one of the witnesses must be someone who will not knowingly inherit anything
from the Declarant or otherwise knowingly gain a financial benefit from the Declarant’s
death. Maryland law does not require this document to be notarized.)
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