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GRANT OF SPECIFIC AUTHORITY (OPTIONAL) <br />My agent MAY NOT do any of the following specific acts for me SS I have INITIALED the <br />specific authority listed below: <br />(CAUTION: Granting any of the following will give yo . agent the authority to take actions that <br />could significantly reduce your property or change h• your property is distributed at your death. <br />INITIAL ONLY the specific authority you WA ' to give your agent.) <br />) Create, amend, revoke, or termi . e an intervivos trust <br />( ) Make a gift, subject to the li tons of the Uniform Power of Authority Act [insert citation <br />to Section 217 of the act] and an pecific Instructions in this power of attorney <br />( ) Create or change ri: e s of survivorship <br />( ) Create or chang . beneficiary designation <br />( ) Delegate to . other person to exercise the authority granted under this power of attorney <br />( ) Waive t =, .rincipal's right to be a beneficiary of a joint and survivor annuity, including a <br />survivor bene under a retirement plan <br />) E. rcise fiduciary powers that the principal has authority to delegate <br />( <br />enounce 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 />201 801099 <br />This power of attorney is effective immediately unless I have stated otherwise in the Special <br />Instructions. <br />