Laserfiche WebLink
Check one: Initials: <br />I$Yes ❑ No J3 ' Real Property <br />[Yes 0 No 13d Tangible Personal Property <br />El Yes 0 No ash Stocks and Bonds <br />® Yes ❑ No -gig' Commodities and Options <br />($Yes 0 No sad! Banks and Other Financial Institutions <br />c] Yes 0 None Operation of Entity or Business <br />(a Yes 0 No VW Insurance and Annuities <br />fa Yes 0 No nif Estates, Trusts, and Other Beneficial Interests <br />® Yes 0 No sag , Claims and litigation <br />®Yes 0 No 3-7C Personal and Family Maintenance <br />fa Yes 0 No S36 Benefits from Governmental Programs or CMI or Military Service <br />© Yes ❑ No SZ I Retirement Plans <br />® Yes ❑ No sac Taxes <br />Q Yes 0 No 6-64 All Preceding Subjects (indudes all items listed above) <br />2024029181 <br />GRANT OF SPECIFIC AUTHORITY (OPTIONAL) <br />My agent MAY do any of the following specific acts for me IF I have CHECKED the specific <br />authority listed below: <br />(CAUTION: Granting any of the following will give your agent the authority to take actions that <br />could signilfcantly reduce your property or change how your property is ctributed at your <br />death. CHECK YES AND INTIAL ONLY the specific authority you WANT to give your <br />agent. NOTE: If you do not mark yes and initial the authority, the authority is not granted.) <br />Check one: Initials: <br />® Yes 0 No 158° Create, amend, revoke, or terminate an inter vivos trust <br />0 Yes US No s?k Make a gift, subject to the limitations of the Nebraska Uniform <br />Power of Attorney Act and any special instructions in this power of attorney <br />Ea yes ❑ No S $6 Create or change rights of survivorship <br />® Yes 0 No $ 16 Create or change a benetidary designation <br />El Yes 0 No sZP Delegate to another person to exercise the authority granted <br />under this power of attorney <br />)(] Yes ❑ No SIV Waive the prindpai's right to be a beneficiary of a joint <br />and survivor annuity, including a survivor benefit under a retirement plan <br />la Yes ❑ No Exercise fiducary powers that the principal has authority to <br />delegate <br />al Yes ❑ NoSol Renounce or disclaim an interest In property, Induding a <br />power of appointment. <br />Power of Attorney, DC 6:12 PSC, Rev. 11/2023 § 30-4041 Page 2 of 4 <br />