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600 Ninth Ave Apts <br />RESIDENT PERSONAL INFORMATION SHEET <br />44 COAST <br />NAME <br />City of Everett <br />DATE <br />August 2, 2023 <br />ADDRESS <br />600 9th Ave. #1 - 401, Seattle, WA 98104 <br />PHONE <br />(425) 257-8105 <br />We are requesting the following VOLUNTARY information in case of an emergency. In case of a medical emergency or if I am incapacitated, <br />all these local contacts: <br />NAME <br />PHONE <br />NAME <br />PHONE <br />DOES ANYONE HAVE THE POWER OF ATTORNEY FOR YOU? <br />❑ YES O NO <br />FILE COPY <br />❑ YES O NO <br />LIMITED? <br />❑ YES O NO <br />UNLIMITED? <br />❑ YES O NO <br />NAME <br />FOR WHAT PURPOSE? <br />ADDRESS <br />PHONE <br />WHO IS THE EXECUTOR OR EXECUTRIX OF YOUR ESTATE? <br />ADDRESS <br />PHONE <br />MAY WE RELEASE ITEMS OF PERSONAL <br />IN THE EVENT OF A MEDICAL EMERGENCY NECESSITATING MY ABSENCE FROM MY APARTMENT, <br />PROPERTY TO AN AUTHORIZED PERSON(S)? <br />O YES O NO <br />AUTHORIZED PERSON <br />PHONE <br />ADDRESS <br />CITY/STATE <br />AUTHORIZED PERSON <br />PHONE <br />ADDRESS <br />CITY/STATE <br />PRIMARY PHYSICIAN <br />PHONE <br />CHURCH AFFILIATION <br />PHONE <br />ANY SPECIAL INSTRUCTIONS IN CASE OF AN EMERGENCY? <br />DOES OR WILL ANYONE HAVE A KEY TO YOUR UNIT BESIDES YOU? <br />O YES O NO <br />NAME <br />NAME <br />SIGNED <br />WITNESSED <br />g � 2-8 -3 <br />35 <br />