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