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If my successor agent is unable or unwilling to act for me, I name as my second successor <br />agent: <br />n <br />Name of Second Successor Agent: /14/71 1t" i • Ldf ,7p/7 7 S j <br />Second Successor Agent's Address: <br />Second Successor Agent's Telephone Number: . �% c � �.. <br />Release of Information <br />I agree to, authorize, and allow full release of information, by any governmental agency, <br />business, creditor, or third party who may have information pertaining to my assets or income, to my <br />agent named herein. <br />GRANT OF GENERAL AUTHORITY <br />I grant my agent and any successor agent general authority to act for me with respect to the <br />following subjects as defined in the Nebraska Uniform Power of Attorney Act: <br />(INITIAL each subject you want to include in the agent's general authority. If you wish to grant <br />general authority over all of the subjects you may initial "Ali Preceding Subjects" instead of initialing <br />each subject.) <br />( ) Real Property <br />( ) Tangible Personal Property <br />( ) Stocks and Bonds <br />( ) Commodities and Options <br />( ) Banks and Other Financial Institutions <br />( ) Operation of Entity or Business <br />( ) insurance and Annuities <br />( ) Estates, Trusts, and Other Beneficial Interests <br />( ) Claims and Litigation <br />( ) Personal and Family Maintenance <br />( ) Benefits from Governmental Programs or Civil or Military Service <br />( ) Retirement Plans <br />( ) Taxes <br />()6) <br />All Preceding Subjects <br />Page 2 <br />201801818 <br />"73 2-2- "A V 6., m LLO w <br />