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202305626 <br />Surrogate Decision Making in Nebraska Nebraska State Unit on Aging <br />SPECIAL INSTRUCTIONS (OPTIONAL) <br />You may give special instructions on the following lines: <br />NOMINATION OF [CONSERVATOR OR GUARDIAN] (OPTIONAL) <br />If it becomes necessary for a court to appoint a conservator of my estate, I nominate the following <br />person(s) for appointment: <br />Name of Nominee for conservator of my estate: <br />Address. <br />Phone Number <br />If it becomes necessary for a court to appoint a guardian of my person, I nominate the following <br />person(s) for appointment: <br />Name of Nominee for guardian of my person: <br />b S <br />Address: tal L fr �`�� at/MA.4110d 4110d Z© <br />Phone Number: 2.C) - fit'l <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 copy of it unless <br />that person knows it has terminated or is invalid. <br />EFFECTIVE DATE: This power of attorney is effective immediately unless I have stated otherwise in <br />the special Instructions. <br />MLTC-PB-3 (99009) 2/21 <br />