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California Power of Attorney for Health Care Bet Tzedek Bettzedek Form
REPRESENTATIVE Required if person appointing the agent currently resides in a nursing facility. READ THE FORM CAREFULLY. CROSS OUT ANY PROVISION YOU DO NOT WANT. THIS FORM REVOKES ANY PRIOR DIRECTIVES YOU HAVE MADE. AFTER YOU COMPLETE THIS FORM SIGN AND DATE IT. Department of Aging and that I am serving as a witness as required by Section 4675 of the California Probate Code. AGENT Name Address City Home Phone Work Phone State Zip 1ST ALTERNATE AGENT If Agent is unavailable or unwilling to...
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