Durable Power of Attorney for Health Care Decisions - Nevada

162A.860. Power of attorney: Form, NV ST 162A.860
CERTIFICATE OF ACKNOWLEDG MENT OF N OTAR Y PUB L IC
(You may use acknowledgment before a notary public instead of the statement of witnesses.)
State of Nevada )
)ss
County of )
On this day of , in the year , before me,
(here insert name of notary public) personally appeared (here
insert name of principal) pers onally know n to me (or pr oved to me on t he basis of satisfactory evidence) to be the person whose
name is subscribed to this instrument, and acknowledged th at he or she executed it. I declare under penalty of perjury that the
person whose name is ascribed to this instrument appears to be of sound mind and under no duress, fraud or undue influence.

(Notary Public)
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Durable Power of Attorney for Health Care Decisions - Nevada PDF

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