Health Care Power Of Attorney Form - South Carolina Page 7

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(This portion of the document is optional and is not required to create a valid health care power of
attorney.)
STATE OF SOUTH CAROLINA
COUNTY OF__________________________________________________________________
The foregoing instrument was acknowledged before me by Principal on ______________________,
20 _______________.
Notary Public for South Carolina___________________________________________________
My Commission Expires:_________________________________________________________
Page 7 of 7

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