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201804149 <br /> GRANT OF SPECIFIC AUTHORITY (OPTIONAL) <br /> My agent MAY NOT do any of the following specific acts for me UNLESS I have <br /> INITIALED the specific authority listed below: <br /> (CAUTION: Granting any of the following will give your agent the authority to take <br /> actions that could significantly reduce your property or change how your property is distributed <br /> at your death. INITIAL ONLY the specific authority you WANT to give your agent.) <br /> Create, amend,revoke, or terminate an inter vivos trust <br /> Make a gift, subject to the limitations of the Nebraska Uniform Power of Attorney <br /> Act and any special instructions in this power of attorney <br /> Create or change rights of survivorship <br /> Create or change a beneficiary designation <br /> Delegate to another person to exercise the authority granted under this power of <br /> attorney <br /> Waive the principal's right to be a beneficiary of a joint and survivor annuity, <br /> including a survivor benefit under a retirement plan <br /> g P <br /> Exercise fiduciary powers that the principal has authority to delegate <br /> Renounce 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 <br /> agent MAY NOT use my property to benefit the agent or a person to whom the agent owes an <br /> obligation of support unless I have included that authority in the Special Instructions or the Grant <br /> of Specific Authority. <br /> SPECIAL INSTRUCTIONS: <br /> /V_Lp This power of attorney is effective immediately. <br /> This Power of Attorney is effective only in the event of my mental incapacity <br /> and inability to make my financial decisions as confirmed by my treating <br /> physician. <br /> EFFECTIVE DATE <br /> • <br /> This power of attorney is effective immediately unless I have stated otherwise in the <br /> Special Instructions. <br /> Page 2 of 3 <br />