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EFFECTIVE DATE <br />This power of attorney is effective immediately unless I have stated otherwise in the Special <br />Instructions. <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 [guardian] <br />of my person, I nominate the following person(s) for appointment: <br />Name of Nominee for [conservator or guardian] of my estate: ,10. 4-ez 4• el <br />Nominee's Address:..._ :_+ ..._, - 4 s fr 4- <br />Nominee's Telephone Number: '3 1_03L(O <br />Name of Nominee for [guardiatij.ct> y persoui <br />y <br />Nominee's Address: 5 6454 2r) < I . c^vre.4 7.» 4'i . AiE GAa <br />Nominee's Telephone Number: ' ;fl w 361 i - ) b <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 copy of It <br />unless that person knows it has terminated or Is invalid. <br />SIGNATURE AND ACKNOWLEDGMENT <br />Your Signature Date:$e ,Q ta4F lit() ' � jet.r►rh - 3�sys <br />Your Name Printed: l e_s vs it... • en 5 i a 1 b 7.01 q <br />Your Address: 5 h& ear$) 2D 6 +. (► rd IS ow) ivE bSsa <br />Your Telephone Number: 3b <br />My commission expires <br />to gp—Ief <br />This document prepared by =S a5't6 R - {ac{ ft b Lcc - tv <br />201404287 <br />CC13 ito <br />State of Iv E. ttrat.6 <br />•[County] of L4nrd <br />This docume,ir Lwas acknowledged- before-rne-cn__ <br />byy IPpt <br />(Name o Principal) <br />(Seal, if any) <br />Signature, n€ Notary: <br />