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the William Crane Gray Inn for Older People shall have full authority to take such ateps as in t?is ~udgment
may be necessarY to give me care and treatment. including consent for the performance of any operation
which in the opinion of physicians treating me may be required. I further agree Xhat in my care and trea~
ment, the selection of a doctor shall be in the discretion of the Resident Manager of the William Crane Gray
Inn for Older People.
IN WITI~Tr.SS WHEREOF, I have hereunto set my hand and seal this 15~ d~? of N~r
A.D. 2972 - - i ~ ,
ES: 3igned: • L)
Philiips
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STATE OF FLORIDA
COUNTY OF_polk _
Beiore me personaliy appeared ~rY_ A. Phf llfpe ~~own as the petson wZio
executed the foregroing instruraent and aclrnowledged the due execution of the same to be he~_ free act and
deed. ~
! Witness my hand and oif'icial seal this 15th ~y ~ No~vember 18 72
j tloT1RY PUIi11C, STATE OF fIORIQA AT LAR6E
~ ~~~~.,~1~ • cY,Pio`> JUI_Y 11. 1973
~0I`IDED THRU fRED W. DlESTElHaRST
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Not~ ~'.ubkic, 9tate:ot Flo at Large
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~ Annexed hereto is a schedule of the Assets of Mary A. Phillips ahrn?ing
an estimated totai value on November 15th, 1972 of: ~11,455.40
~ pius monthlp income in the totai amount of: 396.84
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Signed:
~ WITNESSES: " M A. P'h 11 ps
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