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SPECIAL INSTRUCTIONS; <br />ON THE FOLLOWING LINES YOU MAY GIVE SPECIAL INSTRUCTIONS LIMITING OR EXTENDING THE <br />POWERS GRANTED TO YOUR AGENT. <br />TH <br />s rix of As2oiursx Exezxas oN May 3 0 , 2 D 15 <br />to make health care decisions.. <br />UNLESS YOU DIRECT OTHERWISE ABOVE, THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY <br />AND WILL CONTINUE UNTIL IT IS REVOKED. <br />This power of attorney will continue to be effective even though I become incapacitated, <br />STRIKE THE PRECEDING SENTENCE IF YOU DO NOT WANT THIS POWER_ OF ATTORNEY TO CONTINUE <br />IF YOU BECOME INCAPACITATED. <br />EXERCISE OF POWER OF ATTORNEY WHERE MORE THAN ONE AGENT DESIGNATED <br />If I have designated more than one agent, the agents are to act <br />Separately. (Either one acting alone), <br />IF YOU APPO.INTE'D MORE THAN ONE AGENT AND YOU WANT EACH AGENT TO BE ABLE TO ACT ALONE <br />tNITHOUT THE OTHER AGENT JOINING, WRITE THE WORD "SEPARATELY" IN THE BLANK SPACE <br />ABOVE. IF YOU DO NOT INSERT ANY WORD IN THE BLANK SPACE, OR IF YOU INSERT THE WORD <br />"JOINTLY", THEN ALL OF YOUR AGENTS MUST ACT OR SIGN TOGETHER. <br />I agree that any third party who receives a copy of this document may act under it. A third party may <br />seek identification. Revocation of the power of attorney is not effective as to a third party until the third <br />party has actual knowiedge of the revocation. I agree to indemnify the third party for any claims that <br />arise against the third party because of reliance on this power of attorney. <br />Signed s 7th day of _MaY 20 14 <br />signature) <br />State of California County of Orange <br />BY ACCEPTING OR ACTING UNDER THE APPOINTMENT, THE AGENT ASSUMES THE FIDUCIARY AND <br />OTHER LEGAL RESPONSIBILITIES OF AN AGENT. <br />[Include certificate of acknowiedgment of notary public incompliance with Section 2169 of the <br />,Civil Code or other applicable law.] <br />