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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 />(CAUTION: Granting any of the following will give your agent the authority to take actions that <br />could significantly reduce your property or change how your property is distributed at your death. <br />INITIAL ONLY the specific authority you WANT to give your agent.) <br />( ) Create, amend, revoke, or terminate an intervivos trust <br />( ) Make a gift, subject to the limitations of the Uniform Power of Authority Act [insert citation <br />to Section 217 of the act) and any specific Instructions in this power of attorney <br />( ) Create or change rights of survivorship <br />( ) Create or change a beneficiary designation <br />( ) Delegate to another person to exercise the authority granted under this power of attorney <br />( ) Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a <br />survivor benefit under a retirement plan <br />( ) Exercise 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 />Pursuant to the provisions of the Nebraska Uniform Durable Power of Attorney Act, I declare <br />that this power of attorney shall become effective immediately and shall not be affected by my <br />disability or incapacity, and that the authority granted herein shall continue during any period <br />while I am disabled or incapacitated. Further, pursuant to said Sections, all such authority shall <br />continue after my death, until notice of such death shall have been received by my attorney so <br />201800167 <br />