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201805084 <br /> LIMITATION ON AGENT"S AUTHORITY-- <br /> If I did not check the"Power of Personal and Family Maintenance"or the"All Preceding <br /> Subjects" in the Grant of General Authority above, my agent MAY NOT use my property to <br /> benefit themselves or anyone they support except for those items listed below in the <br /> Special Instructiolns. <br /> SPECIAL INSTRUCTIONS (OPTIONAL) <br /> You may give special instructions on the following lines: <br /> NOMINATION OF[CONSERVATOR OR GUARDIAN](OPTIONAL) <br /> If it becomes necessary for a court to appoint a conservator of my estate, I nominate <br /> the following person(s)for appointment: <br /> Name of nominee for conservator of my estate: <br /> Address: <br /> • Telephone Number: <br /> If it becomes necessary for a court to appoint a guardian of my person,I nominate the <br /> following person(s)for appointment <br /> Name of nominee for guardian of my person: <br /> Address: <br /> 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 <br /> copy of it unless that person knows it has terminated or is invalid. <br /> EFFECTIVE DATE: This power of attorney is effective immediately unless I have stated <br /> otherwise in the special Instructions. <br /> Power of Attorney,DC 6:12 PSC,Rev.03/16§30-4041 Page 3 of 4 <br />