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Last updated: 11/9/2017
Revocation Health Care Directive (Generic) {POA 201}
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Description
REVOCATION OF ADVANCE HEALTH CARE DIRECTIVE I, , Declarant, having executed a Advance Health Care Directive on the day of [month] [date] This is my written revocation of the above referenced Directive and I am providing a copy of this revocation to all parties to whom I provided a copy of the original directive. DATED this the day of , 20 . Signature of Declarant: Printed Name of Declarant: Address of Declarant: American LegalNet, Inc. 251 www.FormsWorkFlow.com
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