Laserfiche WebLink
202606662 <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 />Av,I2R. YZey er <br />Address: ci 7 0'' S . 7 lc( £svav, Jui- (Pk'I Z3 <br />Phone Number: LfC) 2 3 0 5/ g 7 <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 />Address: <br />Phone Number: <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 />