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201808221 ( ) Create or change rights survivorship ( ) Create or chat .e a 12,a, .ef ciary designation ( ) Delegate t• . ot•r person to exercise the authority granted under this power of attorney ( J Waive cipal's right to be a beneficiary of a joint and survivor annuity, including a survivor bene t e • er a retirement plan ( ) Exer•ci . fiduciary powers that the principal has authority to delegate ( ) Ret +once or disclaim an interest in property, including a power of appointment LIMITATION ON AGENT'S AUTHORITY Except as otherwise authorized by the Power of Personal and Family Maintenance, an agent MAY NOT use my property to benefit the agent or a person to whom the agent owes an obligation of support unless I have included that authority in the Special Instructions or the Grant of Specific Authority. SPECIAL INSTRUCTIONS (OPTIONAL) You may give special instructions on the following lines: EFFECTIVE DATE This power of attorney is effective immediately unless I have stated otherwise in the Special Instructions. NOMINATION OF [CONSERVATOR AND/OR GUARDIAN] (OPTIONAL) If it becomes necessary for a court to appoint a [conservator and/or guardian] of my estate or [guardian] of my person, I nominate the following person(s) for appointment: Name of Nominee for [conservator and/or guardian] of my estate: Nominee's Address: Nominee's Telephone Number: Name of Nominee for [guardian of my person: Nominee's Address: Nominee' s Telephone Number: