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201 70877,E <br />GRANT OF SPECIFIC AUTHORITY (OPTIONAL) <br />My agent MAY NOT do any of the following specific acts for me UNLESS I have INITIALED the <br />specific authority listed below: <br />( ) <br />survivor <br />( ) <br />(CAUTION: Granting any of the following will give your a the authority to take actions that <br />could significantly reduce your property or change how r property is distributed at your death. <br />INITIAL ONLY the specific authority you WANT . - •'give your agent.) <br />( ) Create, amend, revoke, or termin. an intervivos trust <br />( ) Make a gift, subject to the lim ions of the Uniform Power of Authority Act [insert citation <br />to Section 217 of the act] and an • ecific Instructions in this power of attorney <br />Create or change ri of survivorship <br />Create or Chan beneficiary designation <br />Deleg i to other person to exercise the authority granted under this power of attorney <br />W principal's right to be a beneficiary of a joint and survivor annuity, including a <br />f b t under a retirement plan <br />ercise fiduciary powers that the principal has authority to delegate <br />Renounce or disclaim an interest in property, including a power of appointment <br />LIMITATION ON AGENT'S AUTHORITY <br />Except as otherwise authorized by the Power of Personal and Family Maintenance, an agent MAY <br />NOT use my property to benefit the agent or a person to whom the agent owes an obligation of <br />support unless I have included that authority in the Special Instructions or the Grant of Specific <br />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 />