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202105682
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7/2/2021 4:22:44 PM
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7/2/2021 4:22:44 PM
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202105682
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20210568c <br />NEBRASKA STATUTORY FORM <br />POWER OF ATTORNEY <br />LAVONNE K. HOLST <br />IMPORTANT INFORMATION <br />This power of attorney authorizes another person (your agent) to make decisions <br />concerning your property for you (the principal). Your agent will be able to make <br />decisions and act with respect to your property (including your money) whether or not <br />you are able to act for yourself. The meaning of authority over subjects listed on this <br />form is explained in the Nebraska Uniform Power of Attorney Act. <br />This power of attorney does not authorize the agent to make health care • <br />decisions for you. <br />You should select someone you trust to serve as your agent. Unless you specify <br />otherwise, generally the agent's authority will continue until you die or revoke the power <br />of attorney or the agent resigns or is unable to act for you. <br />This form will not revoke a power of attorney previously executed by you unless <br />you add that the previous power of attorney is revoked or that all other powers of <br />attorney are revoked by this power of attorney. <br />Your agent is entitled to reasonable compensation unless you state otherwise in <br />the Special Instructions. <br />This form provides for designation of one agent. If you wish to name more than <br />one agent you may name a co -agent in the Special Instructions. Co -agents are not <br />required to act together unless you include that requirement in the Special Instructions. <br />If your agent is unable or unwilling to act for you, your power of attorney will end <br />unless you have named a successor agent. You may also name a second successor <br />agent. <br />This power of attorney becomes effective immediately unless you state otherwise <br />in the Special Instructions. <br />DESIGNATION OF AGENTS <br />I, LaVonne K. Hoist, name the following person as my agents: <br />Name of Co -Agent: Kristin Forsstrom <br />Co -Agent's Address: 8155 Lodge Pole Trail, Lone Tree, Colorado 80124 <br />Co -Agent's Telephone Number: 303-799-0915 <br />Name of Co -Agent: Keith Braun <br />Co -Agent's Address: 11 W. 18th St. Apt.4E, New York City, New York 10011 <br />Co -Agent's Telephone Number: 212-242-2299 <br />RELEASE OF INFORMATION <br />I agree to, authorize, and allow full release of information, by any governmental <br />agency, business, creditor, or third party who may have information pertaining to my <br />assets or income, to my agent named herein. <br />1 <br />
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