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Page 2 of 4 6. Other Information (Optional) Initial I provide the following information to help my agent(s) understand my wishes, beliefs and values when making decisions about my personal matters: 7. Who Determines My Capacity (Optional) Initial I designate __________________________________________________________, to determine (Name of Individual(s)) my capacity under Section 9 of the Personal Directives Act. 8. Notification (Optional) If a determination is made under the Personal Dire.

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