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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 />Name of Nominee for [conservator and /or guardian] of my estate: <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 />/Q, <br />Nelson. <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <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 copy of <br />it unless that person knows it has terminated or is invalid. <br />SIGNATURE AND ACKNOWLEDGMENT <br />Name: Be M. Nelson <br />Address: c/o Golden Living Center - Park Place, <br />610 N. Darr Ave., Grand Island, NE 68803 <br />201801099 <br />0 7 — <br />Date <br />This document was acknowledged before me on this day of February, 2018 by Betty M. <br />B \PrDdiV 41 <br />NOT Y PUBLIC <br />GENERAL NOTARY - State of Nebraska <br />KEVIN A. BROSTROM <br />My Comm. Exp. September 25, 2018 <br />