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202103066 <br />NOMINATION OF (CONSERVATOR OR GUARDIAN) (OPTIONAL) <br />If it becomes necessary for a court to appoint a conservator or guardian of my estate or of <br />my person, I nominate the following person(s) for appointment: <br />Name of Nominee: <br />Nominee's Address: <br />Nominee's Telephone Number: <br />Kirk A. Schmidt <br />1405 W. Louise St., Grand Island, NE 68801 <br />(308) 382-4364 <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 />SIGNATURE AND ACKNOWLEDGMENT <br />°_jAaturA <br />ie <br />Date <br />Printed Name Jan Lee Schmidt <br />Address 2815 Stagecoach P1., Grand Island, NE 68801 <br />Telephone Number (308) 384-0478 <br />STATE OF NEBRASKA <br />SS: <br />COUNTY OF HALL <br />This document was acknowledged before me on 111x5 / 'LC) Z- ("-) by <br />Jan Lee Schrnidt. <br />Notary F' blic <br />My commission expires: <br />This document prepared by: <br />Ronald S. Depue #15936 <br />SHAMBERG, WOLF, McDERMOTT <br />& DEPUE <br />308 N. Locust St., Suite 501 <br />Grand Island, NE 68801 <br />(308) 384-1635 <br />(Seal, if any) <br />GENERAL NOTARY - State bi Nebraska <br />riU17ALD S. DEPUE <br />My Comm, Exp. September 26, 2023 <br />