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Directory Results for I, name, of (address), on this day of , 20, hereby jointly appoint name of (address), and name of (address), or either one acting alone, or appoint name of (address) as my attorney-in-fact (herein called agent) to exercise the powers set to I, name, of county, Michigan, make this patient advocate designation, subject to the following terms and conditions, and revoke all designations and powers of attorney that I may have given previously to the extent that they grant authority

I, name, of (address), on this day of , 20, hereby jointly appoint name of (address), and name of (address), or either one acting alone, or appoint name of (address) as my attorney-in-fact (herein called agent) to exercise the powers set
I, name, of county, Michigan, make this patient advocate designation, subject to the following terms and conditions, and revoke all designations and powers of attorney that I may have given previously to the extent that they grant authority