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I ADVANCE HEALTH-CARE DIRECTIVE FOR JACQUELINE M. WHITE  Explanation  You have the right to give instructions about your o...
After completing this form, sign and date the form at the end and have the form witnessed by one of the two alternative me...
--   2  AGENT S AUTHORITY  My agent is authorized to make all health-care decisions for me, including decisions to provide...
-- -  l    b   -  Choice To Prolong Life  I want my life to be prolonged as long as possible within the limits of generall...
 11   EFFECT OF COPY    12   SIGNATURES  Sign and date the form here   gf   .  1JPY of this form has the same effect as th...
WITNESS  I declare under penalty of perjury pursuant to Section 97-9-61, Mississippi Code of 1972, that the principal is p...
L  State Farm Mutual Automobile ln1urance Company  POLICY NUMBER  P.O. B x 3080 N wark, OH. 43058-3080  LONG TERM CARE FEB...
GENERAL POWER OF ATTORNEY  KNOW ALL BY THESE PRESENT  That I, the undersigned JACQUELINE M. WHITE, as principal, do hereby...
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Ii    .   6 232  SECOND REQUEST  Representative Payee Report Social Security Administration, P.O. Box 6232, Wilkes-Barre, ...
FOR SSA USE O NLY  62328  xrrD  MAH       B  Answer t hi.   question only if you an  wered  OTHER  TYPE OF in 4.,  on the ...
v  , SE    ,        NJsTV--  1111111     Complete Your Representative Payee Accounting Report Online  www.socialsecurity.g...
Social Security Administration Representative Payee Report Why You Received This Form  We mu st r egularly review how repr...
Some Definitions To Help You  Benefits -The Social Security and or SSI money that you receive. Payee - You. The person  or...
D. Unused Benefits  Show the total amount of benefits you have saved for the beneficiary at the end of the report period, ...
The law sometimes requires us to give out the facts on this form without your consent. The information must be released to...
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