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`,:o21OO578 <br />( ) Create or change rights of s ivorship <br />( ) Create or ch. s ge a ben- ciary designation <br />( ) Delegate to oth .erson to exercise the authority granted under this power of attorney <br />( ) Waive e ipal's right to be a beneficiary of a joint and survivor annuity, including a <br />survivor ben- fit • • er a retirement plan <br />( ) Exer ' e fiduciary powers that the principal has authority to delegate <br />( ) ' ounce 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 agent MAY <br />NOT use my property to benefit the agent or a person to whom the agent owes an obligation of <br />support unless I have included that authority in the Special Instructions or the Grant of Specific <br />Authority. <br />SPECIAL INSTRUCTIONS (OPTIONAL) <br />You may give special instructions on the following lines: <br />EFFECTIVE DATE <br />This power of attorney is effective immediately unless I have stated otherwise in the Special <br />Instructions. <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 />