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Name and address of Beneficiary:' <br />AI A. Avery and Teresa K. Avery <br />819 Diets Ave., Ste. 5 <br />Grand Island, NE 68803 <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />SS: <br />The foregoing instrument was acknowledged before me on <br />Manuel Gaspar, a single person. <br />My commission expires. <br />• <br />Notary Public <br />2016, by <br />GENERAL NOTARY - State of N� <br />M Comm. Exp. June 2, 2018 <br />201.00358. <br />