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.. 1 • <br />Surro'.ate Decision Makih in Nebraska <br />DYes ONo ._.--•— Commodities and Options <br />DYes °No --- Banks and Other Financial institutions <br />DYes CiNo ---._ Operation of Entity or Business <br />COYes ONo _- Insurance and Annuities <br />Estates, Trusts, and Other Beneficial interests Claims and LiDYes oNo -----� <br />°Yes ONO ----- Personal and Family Maintenanc'� <br />DYes ONO —•---- <br />Benefits from Governmental Programs or Civil or Military Service <br />QYes ONO —•_— Retirement Plans <br />°Yes O No _.-•-- Taxes <br />Yes <br />ONo C. C-- All Preceding Subjects (includes all items listed above) <br />Nebraska State Unit on Akin <br />igation <br />GRANT OF SPECIFIC AUTHORITY (OPTIONAL) <br />Myagent MAY daany <br />of the following specific acts for me IF 1 have CHECKED the specific authority <br />listed below.ity to take <br />of the following will give your agent the authtrrbutod at your ons that <br />CHECK YES <br />could <br />(CAUTION: Granting change how your property is distributed significantly ce reduce your property or ou WANT to give your agent. NOTE: if you do not mark yes <br />AND INITIAL,te thor y, thelauthority is not granted.) <br />and initial #h <br />Check one: initials: <br />vos <br />DYe <br />s ONo Create, amend, revoke, or terminate an inter vi Nebraska Uniform Power of <br />Make a gift, subject special instructionstions of the <br />phis power of attorney <br />Oyes ONo �'-- Attorney Act andy <br />DYes ONo _ _ --• Create or change rights of survivorship <br />°Yes pNo Create or change a beneficiary designation <br />DYes 0 No Delegate to another person to exercise the authority granted under this <br />power of attorney f a Dint and survivor annuity, <br />Waive the principal'sright under beneficiary r irn pian <br />including a survivor benefit <br />O <br />rcise fiduciary powers that the principal has authority to dere# to pointment <br />❑Yes DNo -- Exe ert including a pow p <br />Yes ONO --- Renounce or disclaim an interest in property, <br />Subjects" in the <br />I 1 did not h ONkh "Power <br />AUTHORITY to benefit Preceding <br />Subj or anyonenh <br />r of Personal and Family Maintenance" or the "All Preceding J <br />agent MAY NOT use my property <br />If 1 did check the ,Pow above, my g <br />Granteof port except <br />Authority <br />xce t far those items listed below in the Special instr��• <br />they support e p <br />DYes DNo <br />MLTGPB-3 (99009) 2121 <br />MLTC•PB4 (99009) 2121 <br />