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201845084 Chec one: Initials: Yes ❑ No Real Property ❑v Yes ❑ No Tangible Personal Property [ Yes 0 No Stocks and Bonds 2''Yes ❑No Commodities and Options v[rYes ❑ No Banks and Other Financial Institutions ages ❑No Operation of Entity or Business El'S(es ❑ No Insurance and Annuities Q Yes ❑ No Estates,Trusts, and Other Beneficial Interests [94es ❑ No Claims and Litigation ( 'Yes ❑ No Personal and Family Maintenance ages ❑ No Benefits from Governmental Programs or Civil or Military Service [Iles ❑ No_ Retirement Plans ErYes ❑ No Taxes I2 es 0 No All Preceding Subjects(includes all items listed above) GRANT OF SPECIFIC AUTHORITY(OPTIONAL) My agent MAY do any of the following specific acts for me IF I have CHECKED the specific authority listed below: (CAUTION: Granting any of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death. CHECK YES AND INTIAL ONLY the specific authority you WANT to give your agent. NOTE: If you do not mark yes and initial the authority,the authority is not granted.) Check one: Initials: [des ❑ No Create, amend, revoke, or terminate an inter vivos trust a/es ❑ No Make a gift, subject to the limitations of the Nebraska Uniform Power of Attorney Act and any special instructions in this power of attorney (/Yes ❑ No Create or change rights of survivorship [' Iles ❑ No Create or change a beneficiary designation [des ❑ No Delegate to another person to exercise the authority granted under this power of attorney •' CO/Yes ❑ No Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan [ Yes ❑ No Exercise fiduciary powers that the principal has authority to delegate ['Yes ❑ No Renounce or disclaim an interest in property, including a power of appointment. Power of Attorney,DC 6:12 PSC,Rev.03/16§30-4041 Page 2 of 4