I AM INTERESTED IN: *
MY AGENT IS: *
MY FIRST ALTERNATE AGENT IS:
MY SECOND ALTERNATE AGENT IS:
For my MEDICAL POWER OF ATTORNEY, I want my Agent(s) to have the following Authority, or Order, to be able to act: *
For my DURABLE BUSINESS POWER OF ATTORNEY, I want my Agent(s) to have the following Authority, or Order, to be able to act: *
THE AUTHORITY OF MY AGENT(S) IN MY DURABLE BUSINESS POWER OF ATTORNEY SHALL BE: *
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