Laserfiche WebLink
DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL) <br />If my agent is unable or unwilling to act for me, I name as my successor agent: <br />Name of Successor Agent: <br />Successor Agent's Address: <br />Successor Agent's Telephone Number: <br />Cynthia M. Gillespie <br />1022 S. Vine, Grand Island, NE 68801 <br />(308) 380 -8251 <br />RELEASE OF INFORMATION <br />201708771 <br />I agree to, authorize and allow full release of information, by any governmental agency, business, <br />creditor, or third party who may have information pertaining to my assets or income, to my agent <br />named herein. <br />( ) Real Property <br />( ) Tangible Personal Property <br />( ) Stocks and Bonds <br />( ) Commodities and Options <br />( ) Banks and Other Financial Institutions <br />( ) Operation of Entity or Business <br />( ) Insurance and Annuities <br />GRANT OF GENERAL AUTHORITY <br />I grant my agent and any successor agent general authority to act for me with respect to the following <br />subjects as defined in the Uniform Power of Attorney Act, Nebraska Revised Statutes Sections 30- <br />4001, et seq. <br />(INITIAL each subject you want to include in the agent's general authority. If you wish to grant <br />general authority over all of the subjects you may initial "All Preceding Subjects" instead on <br />initialing each subject.) <br />( ) Estates, Trusts, and Other Beneficial Interests <br />( ) Claims and Litigation <br />( ) Personal and Family Maintenance <br />( ) Benefits from Governmental Programs or Civil or Military Service <br />( ) Retirement Plans <br />Taxes <br />( All Preceding Subjects <br />