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201808210 <br />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 [guardian] 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 unless that person knows it has terminated or is invalid. <br />SIGNATURE AND ACKNOWLEDGMENT <br />1.4.44:0.....e...,X0,01, ) (41 /01 <br />Na e� . Wiese <br />Date <br />Address: 1916 West 10`h St., Grand Island, NE 68803 <br />Phone Number: (308) 382-6184 <br />STATE OF NEBRASKA <br />) ss: <br />COUNTY OF HALL <br />This document was acknowledged before me on this `� day of March, 2018 by Susan L. <br />Wiese. <br />GENERAL NOTARY - State of Nebraska <br />KEVIN A. BROSTROM <br />na,,4 <br />go% My Comm. Exp. September 25, 2018 <br />