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201800818 <br />LIMITATION ON AGENT'S AUTHORITY <br />If 1 did not check the "Power of Personal and Family Maintenance" or the "All Preceding <br />Subjects" in the Grant of General Authority above, my agent MAY NOT use my property to <br />benefit themselves or anyone they support except for those items listed below in the Special <br />Instructions. <br />SPECIAL INSTRUCTIONS (OPTIONAL) <br />You may give special instructions on the following lines: <br />NOMINATION OF [CONSERVATOR OR GUARDIAN] (OPTIONAL) <br />If it becomes necessary for a court to appoint a conservator of my estate, I nominate the <br />following person(s) for appointment: <br />Name of Nominee for conservator of my estate: <br />Address: <br />Telephone Number: <br />If it becomes necessary for a court to appoint a guardian of my person, I nominate the <br />following person(s) for appointment: <br />Name of Nominee for guardian of my person: <br />Address: <br />Telephone Number: <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 <br />copy of it unless that person knows it has terminated or is invalid. <br />EFFECTIVE DATE: This power of attorney is effective immediately unless I have stated <br />otherwise in the special Instructions. <br />Power of Attorney, DC 6:12 PSC, Rev. 08/12 §30 -4041 <br />Page 3 of 4 <br />