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X015 iUE 01: i 3 3M Shamberg Law Firm SAX 11o. 308 334 1759 All Preceding Subjects GRANT OF SPECIFIC AUTHORITY (OPTIONALI My agent MAY NOT do any of the following specific acts for me UNLESS I have INITIALED the specific authority listed below: (CAUTION: Granting aay of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death, INITIAL ONLY the specific authority you WANT to give your agent.) Create, amend, revoke, or terminate an inter vivos trust Make a gift, su Act and any spe Create or change Create or change Delegate to anot attorney Waive the incipal' right to be a beneficiary of a joint and survivor annuity, includi • : a survivor b efit under a retirement plan Exer se fiduciary power that the principal has authority to delegate Re ounce or disclaim an interest in property, including a power of appointment ect to the limitat' .ns of the Nebraska Uniform Power of Attorney 201506916. P. 001101 ial instructi • in this power of attorney ights • urvivorship b eficiary designation person to exercise the authority granted under this power of MUTATION ON AGENTS AUTHORITY Except as otherwise authorized by the Power of Personal and Family Maintenance, an agent MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless 1 have included that authority in the Special Instructions or the Grant of Specific Authority. SPECIAL INSTRUCTIONS (OPTIONAL): `(Give special instructions here) EFFECTIVE D &TE This power of attorney is effective immediately unless I have stated otherwise in the Special Instructions. NOMINATION OF (CONSERVATOR QR GUARDIAN) (OPTIONAL) if it becomes necessary for a court to appoint a (conservator or guardian) of my estate or (guardian) of my person, nominate the following person(s) for appointment: Name of Nominee for (conservator or guardian) of my estate: Susan Lauver