REVOCATION OF MEDICAL CARE DIRECTIVE

I, Javi Espinoza of 8 Hayes St, San Rafael, California 94902, SSN: 314-14-4053, hereby revoke my Medical Care Directive dated February 15, 2012. The power and authority granted to my physician or any health care provider and health care agent is revoked and withdrawn and this document provides notice of such revocation. Dated this _____ day of _______________, _____, at San Rafael, California.

________________________________________ Javi Espinoza

Witness Signature: Witness Name: Witness Address:

________________________________________ Johnny White 34 A St San Rafael, CA 94902

Witness Signature: Witness Name: Witness Address:

________________________________________ Alex Smith 45 D st San Rafael, CA 94902

Names of institutions/individuals who have been provided a copy of this revocation: -Dr. John Lin -Mike Thompson

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