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201707117 <br />LIMITATION ON AGENT'S AUTHORITY <br />Except as otherwise authorized by the Power of Personal and Family <br />Maintenance, an agent MAY NOT use my property to benefit the agent or a person to whom the <br />agent owes an obligation of support unless I have included that authority in the Special <br />Instructions or the Grant of Specific Authority. <br />SPECIAL INSTRUCTIONS (OPTIONAL) <br />You may give special instructions on the following lines: <br />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 and/or guardian] of my estate or <br />[guardian] of my person, I nominate the following person for appointment: <br />Name of Nominee for [conservator and /or guardian] of my estate: Tiffany Dahlgren <br />Nominee's Address: 1612 Lake Ave. Gothenburg, NE. 69138 <br />Nominee's Telephone Number: 308 -258 -4364 <br />Name of Nominee for [conservator and /or guardian] of my estate: Rona Dahlgren <br />Nominee's Address: 10457 Silverock Drive, Dallas TX 75218 <br />Nominee's Telephone Number: 214- 415 -6793 <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 <br />of it unless that person knows it has terminated or is invalid. <br />