202304679 - Laserfiche WebLink

Browse

202304679 Surrogate E ecision Making in Net. <a Nebraska State Unit on Aging OYes ONo Commodities and Options ❑Yes ❑No Banks and Other Financial Institutions ❑Yes ONo Operation of Entity or Business E]Yes ONo Insurance and Annuities ❑Yes ONo Estates, Trusts, and Other Beneficial Interests Claims and Litigation ❑Yes ONo Personal and Family Maintenance ❑Yes ONo Benefits from Governmental Programs or Civil or Military Service Oyes ONo Retirement Plans ❑Yes ❑No Taxes 0Yes ONo All Preceding Subjects (includes all items listed above) GRANT OF SPECIFIC AUTHORITY (OPTIONAL) My agent MAY do any of the following specific acts for me IF I have CHECKED the specific authority listed below: (CAUTION: Granting any of the following will give your agent the authority to take actions that could significantly reduce your property or change how your property is distributed at your death. CHECK YES AND INITIAL ONLY the specific authority you WANT to give your agent. NOTE: If you do not mark yes and initial the authority, the authority is not granted.) Check one: Initials: O Yes ❑ No Create, amend, revoke, or terminate an inter vivos trust OYes O No Make a gift, subject to the limitations of the Nebraska Uniform Power of Attorney Act and any special instructions in this power of attorney 0Yes LINO Create or change rights of survivorship J V Yes O No Create or change a beneficiary designation i Yes ❑ No Delegate to another person to exercise the authority granted under this power of attorney ❑ Yes O No Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a survivor benefit under a retirement plan Yes ❑ No Exercise fiduciary powers that the principal has authority to delegate lYes O No Renounce or disclaim an interest in property, including a power of appointment LIMITATION ON AGENTS AUTHORITY If I did not check the "Power of Personal and Family Maintenance" or the "All Preceding Subjects" in the Grant of General Authority above, my agent MAY NOT use my property to benefit themselves or anyone they support except for those items listed below in the Special Instructions. MLTC-PB-3 (99009) 2121