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Page 1 of 4 <br />Nebraska Power of Attorney <br />Designation of an Agent <br />1 S errac!r,ie (i.)h r 1e (your name) name the following person as my agent: <br />Name o f agent c ct.r L k <br />Agent's address S D Lary Rd <br />832 <br />Agent's telephone number 30 3 " 3 9 - 1 3 <br />Designation of successor agent (optional) �l <br />Name of successor agent . c b e -rt L,3/\ + l e <br />Successor Agent's address , 0 4 6" Pr ft e 3± <br />c cr ie-.oit N6 6 3 a:3 2 <br />Successor Agent's Telephone number 30 W'" 3 8 a " 0 95.2 <br />Release of Information <br />I agree to, authorize and allow full release of information, by any govemmental agency, <br />business, creditor, or third party who may have information pertaining to my assets or in come, <br />to my agent name herein. <br />Form Provided by Legal Aid of Nebraska <br />1904 Famam St., Omaha NE 68102 <br />1- 888 -991 -9921 <br />Page 1 of 4 <br />201502 <br />vivo. <br />Access <br />Ttl JUFi.r,t <br />