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• <br />NOMINATION OF (CONSERVATOR OR GUARDIAN) (OPTIONAL) <br />If it becomes necessary' for a court to appoint a (conservator or guardian) of my estate or <br />(guardian) of my person, I nominate the following person(s) for appointment: <br />Name of Nominee for (conservator or guardian) of my estate: <br />Nominee's Address: <br />Nominee's Telephone Number: <br />Name of Nominee for (guardian) of my person: <br />Nominee's Address: <br />Nominee's Telephone Number <br />RELIANCE ON THIS POWER OF ATTORNEY <br />Any person, including my agent, may rely upon the validity of this power of attorney or a <br />copy of it unless that person knows it has terminated or is invalid. <br />SIGNATURE AND ACKNOWLEDGMENT <br />Printed Name Donnie D. Muir <br />Address Wedgewood Care Center, 800 Stoeger Dr., Grand Island, Nebraska <br />Telephone Number 308/382 -5440 <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />Notary Public <br />My commission expires: <br />SS: <br />This document was acknowledged before me on <br />Donnie D. Muir. <br />3- 22 -1`f <br />This document prepared by: <br />John B. McDermott, #16305 <br />SHAMBERG, WOLF, McDERMOTT & DEPUE <br />308 North Locust, Ste 501 <br />PO Box 460 <br />Grand Island, NE 68802 <br />Telephone: 308/384-1635 <br />Fax: 308/384 -1759 <br />Date <br />2 01306600 <br />1 ,` - to , 20 <br />/ / Ipt-cA (p 2-013 by <br />(Seal, <br />M. NOTARY - State et Nebr <br />JOHN B.M R T <br />My Comm. Exp. Match 22, 2014 <br />