Power of Attorney Forms - US Midwest - Page 3

497318343-revised-uniform-anatomical-gift-act-donation-nebraska

Revised Uniform Anatomical Gift Act Donation - Nebraska

Donation pursuant to thenebraska revised uniform anatomical gift actin the event of my death, i donate the following part(s) of my body for the purposes identified in the nebraska revised statutes:tissue: eyes bone and connective tissue skin...

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Revised Uniform Anatomical Gift Act Donation - Nebraska
497326430-revised-uniform-anatomical-gift-act-donation-south-dakota

Revised Uniform Anatomical Gift Act Donation - South Dakota

Revised uniform anatomical gift act donation(south dakota codified laws 342648 et. seq.)i am of sound mind and 18 years or more of age. i hereby make this anatomical gift to take effect upon my death. the marks in the appropriate squares and words...

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Revised Uniform Anatomical Gift Act Donation - South Dakota
497317780-revised-uniform-anatomical-gift-act-donation-by-an-individual-over-18-years-of-age-north-dakota

Revised Uniform Anatomical Gift Act Donation By An Individual Over 18 Years of Age - North Dakota

Revised uniform anatomical gift act donation(north dakota century code 2306.604)i am of sound mind and 18 years or more of age. i hereby make this anatomical gift to take effect upon my death. the marks in the appropriate squares and words filled...

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Revised Uniform Anatomical Gift Act Donation By An Individual Over 18 Years of Age - North Dakota
497307150-revocation-of-anatomical-gift-donation-indiana

Revocation of Anatomical Gift Donation - Indiana

Revocation of donation pursuant to therevised uniform anatomical gift acti,, declarant, having made an anatomical gift by virtue of that document of gift dated the day of, 20 , do hereby revoke such gift pursuant to ic 29216.15, which...

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Revocation of Anatomical Gift Donation - Indiana
497305209-revocation-of-anatomical-gift-donation-iowa

Revocation of Anatomical Gift Donation - Iowa

Revocation of donation pursuant to therevised uniform anatomical gift acti,, declarant, having made an anatomical gift by virtue of that document of gift dated the day of, 20 , do hereby revoke such gift pursuant to idaho iowa code chapter 142c,...

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Revocation of Anatomical Gift Donation - Iowa
497307670-revocation-of-anatomical-gift-donation-kansas

Revocation of Anatomical Gift Donation - Kansas

Revocation of donation pursuant to therevised uniform anatomical gift acti, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20 do hereby revoke such gift pursuant to ksa 653225 which provides that...

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Revocation of Anatomical Gift Donation - Kansas
497311669-revocation-of-anatomical-gift-donation-michigan

Revocation of Anatomical Gift Donation - Michigan

Revocation of anatomical gift (michigan consolidated laws, .10104 to .10109)i, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20 , do hereby revoke such gift pursuant to the general laws of...

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Revocation of Anatomical Gift Donation - Michigan
497312822-revocation-of-anatomical-gift-donation-minnesota

Revocation of Anatomical Gift Donation - Minnesota

Revocation of anatomical gift (minnesota statutes 525a.01 et seq.)i, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20, do hereby revoke such gift pursuant to mcl 525a.06, which provides:sec. 5....

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Revocation of Anatomical Gift Donation - Minnesota
497313422-revocation-of-anatomical-gift-donation-missouri

Revocation of Anatomical Gift Donation - Missouri

Revocation of anatomical gifti, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20 , do hereby revoke such gift pursuant to missouri revised statutes 194.210 to 194.290, which provides that an...

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Revocation of Anatomical Gift Donation - Missouri
497318345-revocation-of-anatomical-gift-donation-nebraska

Revocation of Anatomical Gift Donation - Nebraska

Revocation of anatomical gifti, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20 , do hereby revoke such gift revised statutes of nebraska, which provides that an anatomical gift may be revoked...

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Revocation of Anatomical Gift Donation - Nebraska
497317782-revocation-of-anatomical-gift-donation-north-dakota

Revocation of Anatomical Gift Donation - North Dakota

Revocation of anatomical gifti,, declarant, having made an anatomical gift by virtue of that document of gift dated the day of, 20 , do hereby revoke such gift pursuant north dakota century code 2306.605, which provides that an anatomical gift may...

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Revocation of Anatomical Gift Donation - North Dakota
497326432-revocation-of-anatomical-gift-donation-south-dakota

Revocation of Anatomical Gift Donation - South Dakota

Revocation of anatomical gifti, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20 , do hereby revoke such gift pursuant to south dakota codified laws 342653, which provides that an anatomical gift...

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Revocation of Anatomical Gift Donation - South Dakota
497431246-revocation-of-anatomical-gift-donation-wisconsin

Revocation of Anatomical Gift Donation - Wisconsin

Revocation of anatomical gifti, , declarant, having made an anatomical gift by virtue of that document of gift dated the day of , 20 , do hereby revoke such gift wisconsin statutes 157.06(2), which provides that an anatomical gift may be revoked...

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Revocation of Anatomical Gift Donation - Wisconsin
497306457-revocation-of-appointment-of-short-term-guardian-illinois

Revocation of Appointment of Short Term Guardian - Illinois

Revocation ofappointment of shortterm guardiani, , declarant, having executed a appointment of shortterm guardian on the day of , 20 , naming as temporary guardian for .this is my written revocation of the above referenced appointment of shortterm...

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Revocation of Appointment of Short Term Guardian - Illinois
497318342-revocation-of-declaration-nebraska

Revocation of Declaration - Nebraska

Revocation of declaration (revised statutes of nebraska 20406)i, , declarant, executed a declaration relating to use of lifesustaining treatment on the day of , 20 .revised statutes of nebraska 20406 provides that a declarant may revoke a...

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Revocation of Declaration - Nebraska
497307137-revocation-of-declaration-of-mental-health-care-treatment-indiana

Revocation of Declaration of Mental Health Care Treatment - Indiana

Revocation of declaration for mental health treatmenti, , declarant, executed a declaration for mental health treatment on the day of , 20 .ic 16361.510 provides that i have the right to withdraw my consent to treatment at any time.this is my...

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Revocation of Declaration of Mental Health Care Treatment - Indiana
497306458-revocation-of-designation-of-standby-guardian-illinois

Revocation of Designation of Standby Guardian - Illinois

Revocation ofdesignation of standby guardiani, , declarant, having executed a designation of standby guardian on the day of , 20 , naming as standby guardian for .this is my written revocation of the above referenced designation of standby...

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Revocation of Designation of Standby Guardian - Illinois
497307130-revocation-of-durable-power-of-attorney-for-health-care-indiana

Revocation of Durable Power of Attorney for Health Care - Indiana

Revocation ofdurable power of attorney for health carei,, declarant, having executed a durable power of attorney for healthcare on the day of, 20 , namingmy attorneyinfact/agent, do hereby revoke that durable power of attorney for healthcare...

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Revocation of Durable Power of Attorney for Health Care - Indiana
497326419-revocation-of-durable-power-of-attorney-for-health-care-south-dakota

Revocation of Durable Power of Attorney for Health Care - South Dakota

Revocation ofdurable power of attorneyfor health care(south dakota codified laws chapter 597)i,, declarant, executed a durable power of attorney for health care on the day of, 20 , stating my desires and wishes regarding various aspects of my...

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Revocation of Durable Power of Attorney for Health Care - South Dakota
497307115-revocation-of-general-durable-power-of-attorney-indiana

Revocation of General Durable Power of Attorney - Indiana

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - Indiana
497305180-revocation-of-general-durable-power-of-attorney-iowa

Revocation of General Durable Power of Attorney - Iowa

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - Iowa
497307643-revocation-of-general-durable-power-of-attorney-kansas

Revocation of General Durable Power of Attorney - Kansas

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - Kansas
497311640-revocation-of-general-durable-power-of-attorney-michigan

Revocation of General Durable Power of Attorney - Michigan

Revocation ofgeneral power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may...

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Revocation of General Durable Power of Attorney - Michigan
497318315-revocation-of-general-durable-power-of-attorney-nebraska

Revocation of General Durable Power of Attorney - Nebraska

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - Nebraska
497317756-revocation-of-general-durable-power-of-attorney-north-dakota

Revocation of General Durable Power of Attorney - North Dakota

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - North Dakota
497322553-revocation-of-general-durable-power-of-attorney-ohio

Revocation of General Durable Power of Attorney - Ohio

Revocation ofgeneral power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may...

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Revocation of General Durable Power of Attorney - Ohio
497326404-revocation-of-general-durable-power-of-attorney-south-dakota

Revocation of General Durable Power of Attorney - South Dakota

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - South Dakota
497431214-revocation-of-general-durable-power-of-attorney-wisconsin

Revocation of General Durable Power of Attorney - Wisconsin

Revocation of power of attorneyi, , declarant, having executed a general durable power of attorney on the day of , 20 , naming my attorneyinfact/agent, do hereby revoke that power of attorney pursuant to its explicit provision that it may be...

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Revocation of General Durable Power of Attorney - Wisconsin
497311661-revocation-of-health-care-proxy-michigan

Revocation of Health Care Proxy - Michigan

Revocation of designation of patient advocate(michigan consolidated laws, 700.5510)i,, declarant, executed a designation of patient advocate on the day of, 20 , regarding my decisions and choices concerning my health care. pursuant to the michigan...

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Revocation of Health Care Proxy - Michigan
497307147-revocation-of-life-prolonging-procedures-declaration-indiana

Revocation of Life Prolonging Procedures Declaration - Indiana

Revocation oflife prolonging procedures declarationi, , declarant, executed a life prolonging procedures declaration on the day of , 20 .ic 1636412 provides that a living will declaration or a life prolonging procedures will declaration may be...

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Revocation of Life Prolonging Procedures Declaration - Indiana

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