Laserfiche WebLink
Name of Nominee for [conservator and/or guardian] of my estate: <br />RELIANCE ON THIS POWER OF ATTORNEY <br />20170877 <br />NOMINATION OF [CONSERVATOR AND /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(s) for appointment: <br />Nominee's Address: <br />Nominee's Telephone Number: <br />Name of Nominee for [guardian] of my person: <br />Nominee's Address: <br />Nominee's Telephone Number: <br />Any person, including my agent, may rely upon the validity of this power of attorney or a copy of <br />it unless that person knows it has terminated or is invalid. <br />S IGNATURE AND ACKNOWLEDGMENT <br />Name: Laura R. Boersen Date <br />Address: 3551 Laura Ave., Grand Island, NE 68803 <br />Phone Number: (308) 381 -2568 <br />STATE OF NEBRASKA <br />COUNTY OF HALL <br />) ss: <br />afi <br />This document was acknowledged before me on this o Z \ day of November, 2017 by Laura R. <br />Boersen. <br />//"" alitc4tA <br />N TA Y PUBIC <br />GENERAL NOTARY • State of Nebraska <br />KEVIN A. BROSTROM <br />My Comm. Exp. September 25, 2018 <br />