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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 [guardianj of my person: <br />Nominee's Address: <br />Nominee's 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 copy of <br />it- oat ess person knows it has terminated Or it <br />SIGNATURE AND ACKNOWLEDGMENT <br />0 -t bit <br />Name: Vivian I. Owen Date <br />Address: 621 S. Eddy, Grand Island, NE 68801 <br />Phone Number: (308) 382-3537 <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL <br />This document was acknowledged before me on this 1 day of September, 2017 by Vivian I. <br />Owen. <br />NO AR PUBLIC <br />;1: 'WARY -Sate ci Nebraska <br />KEVIN A. BROSTROM <br />4 <br />Cosa Exp. September 25, 2018 <br />201801667 <br />