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HomeMy WebLinkAbout920171 !f :~~m~~~¡~¡~~¡~ii~~ "',- " '..:~:.~ ,~~'. ',- . '-',',,'.:,'.~: ; ';·:¡:!:.'~I:m:..-mr.:t:¡:¡;¡;I;'~1'J:,~l':::7<J'l2:.ê;-~jJ~~"'S';I'f.<{~:;~.:!"-':.~:!.'::1~t;j::,:':.':::;:':!"~.'~:", .,' ¡,}:':'~':'·la"~J:i:I~':I':r."A;;:(,:· ,,":" ""}',~ ':'1!,~~~~~;-:,,!"1¡!.'1"~·':'~::',¡'i;.1'''·' RECEIVED 7/13/2006 at 11:16 AM RECEIVING # 920171 BOOK: 626 PAGE: 218 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, ~ GENERAl. OIJRABI.f<: POW¡;:R OF ATTORNF.\, '.. I, ?ySðI'1 , the ~r~#- ),n,,,.t. , Social Sccurity No. undersigned, domiciled at do hereby make conslilute, and appoint IIrky k-¡:;':I;"~I:Xi,:e~;,';<;'",- ,', .'., '..;"':.".""':0-"" 111LfIl¡ 000218 , Riverton, Fremont County, Wyoming, J?1t,mtf-, residing at.7391 "'~'4 ..1'J.-.... Ý ¡t¿ -' as my attorney-in·facl (herein called agent) or if he/she is unable 10 act such for any reason, I appoint # J?1¿rr,rll/- as such agenl, and I do hereby make, constitute and appoint /larky ~""I'"II- as my special and substitute allorney·in-fact (herein called special agenl with respect only to those powers described in #27 below), with the following powers to be exercised in my name and for my benefil. 1. G.t.lleral Grnfll.¡¡ilQ11l.IT. To exercise or perform any act, power, duty, right or obligation whatsoever Ihat fnow have or may hereafter acquire, relating to any person, malleI'.. transaction or property, real or personal, tangible or intangible, now owned or hereafter acquired by me, including, without limitation, the following speci fically enumerated powers. I grant to my agenlS full power and authority 10 do everything necessary in exercising any of the powers herein granted as fully as r might or could do ¡fpersonally present. with full power of subslitution or revocation, hereby ratifying and confirming all thai my agents shall lawfully do or CJusc to be done by vinue of this power of allorncy and the powers herein granted. 2. Collection Powers To forgive, request, demand, sue for, recover, collect, receiv.e, and hold all such sums of money, debts, dues, commercial paper, checks, drafts, accounts, deposits, legacies, bequests, devises, notes, interests, stock certificates, bonds, dividends, cenificates ofdeposil, annuities, pensions, profit sharing, retirement, social security, insurance and other contractual benefits and proceeds, all documents of title, all property, real or personal, inlangible or langible property and pmperly righls! and dcmands whalsoevèr,liquidaled or unliquidaled, now or hereafter owned by, or duc, owing, payable or belonging to, me or in which I have or may hereaner acquire an interesl; 10 have, use, and take all lawful means and equitable ,Ind legal remedies and proceedings in my name for the colleclion and recovery Ihereof, and to adjust. sell, compromise; and agrce for thc S¡lme, and to execute and delivcr for me, on my behalf, and in my name, all endorsements, releases, reccipts, or other sufficient discharges for the same. 3. Re..aUr.op.crt)' Powcrs To bnrgain, contract, agree for, option, purchase, N ", : "i.'~I":'~¡'~~'~'':;~¡~i',~..Jj~'~~¡'_ ~,\t.1:~~ '\:,"':":~,.!!,,~: ',; ',. ......" :"",-..: '~''': ':.',·.:...~~!Ü,-y.~~,;.)'i'., 'J'",;' r,r.'1·i~' ','.';"i"}~"~i~~S~;~.';'i~ ; ': - ;i~;;n."I;t:;:~µ-::!'¿E'Ä , '., '"~t;':,i.(~:~~f!'¡¡;,~,,,:~v> :;,;;'< : ,- - 09201.tJl ~ 000219 acquire, receive, maintain, repair, insllre,plat, partition, safeguard, lease, demise, grant, bargain, sell, assign, transfer, remise, release, exchange, convey, mortgage and hypothecate real estate and any interestlherein (and including any interest which r hold with any other person as join~ tenanls with full rights of sllrvivorship, or as tenants by the entireties), lands, tenements and hereditaments, for such price, such terms and conditions, as my ilgent shall detel1lline, 4, Personili Pro(lITt~'..EIDY.c.L To bargain, contract, agree ror, pllrchase. option, acquire, receive, improve, maintain, repi1ir, insure, safeguard, lease, assign, sell, exchange, redeem, Iransr;r, mortgage, hypothecate and in any and every way and manner deal in and with goods, wares, n;erchandise, furniture i1nd furnishings, automobiles, bills, notes, debentures, bonds, stocks, Ii m i ted pilrtnersh i p interests, cert i [iciltes 0 r deposi t, commerc i al paper, money market inslruments, and other securities, choses in action and other tangible or intangible personal property in possession or in action, for such price, upon such temlS and conditions, as my agents shall detelmine, 5. l.Ontrilct Powers To make, do, and transact every kind of business o[whatever nature, and also for me and in my name, and as my act and deed, to sign, seal, execute, deliver and acknowledge such stock cel1i [icates, stock powers, assignments separate from certi [icales, deeds, conveyances, leases and assignments of leases, covenants, indentures, options, letters or intent, contracts, agreemenls, closing agreements, certificates, mortgages, hypothecations, bills of lading, bills, bonds, debentures, notes, receipts, evidence or debts, release and satisfaction or mortgage, judgements and other debts, waivers of statutes of limitalion, and such other documenls and instruments in writing of whatever kind and nalure as may be necessary or proper in the premises, as rully as [ might do if done in my own capacity. 6, Rankine Powers To make, draw, sign inmy name, deliver and execute checks, drafts, receipts for moneys, notes, or other ordcrs for the payment of money against, or otherwise make withdrawals [rom any commercial, checking or savings account which I may have in illY sole name or in joint name with other person(s), in any bank or financial institution, for any purpose which my agenls may think neccssary, advisable or propel'; and to cndorse and negotiatc in my name and to deliver checks, drafts, nOles, bi lis, cerli [icales or deposil, commercial paper. money market instruments, bills ofcxchangc or othcr instrul11cnls for Ihe payment of money and to deposit same, as cash or for collection, and inlo any COllll11crcial, chccking or savings .lccounl which I may have in my sole name or in joint namc with other pcrson(s), in any bank or financial :~]¡~~~~!ill¡ , " ;.:; ~ó'i'i·'!,j!.!'L~":',~!iJ¡.!i-~f:':·' '< ':' ,.;õ;, ¡.., ';' i'¡':';'¡.o-;';'¡~.~ ,to·.' , :!m!~~:m ·,"!'~'I""·t·"!·~"" ·~'I';''.:,''-''~.~!ct:'g.:!i.·.'~;':_ '...::J:~~~".~'~~:..:..'h..-:'3!.. ,.:,.!i.............!ÆLL'...._A.._'. . ::,;;' "......'"!.:o--:oJ,"!:':!.'.' ",!'.:>,., I>~;:,·;,r;;.~'..". ; ,": ',', ',':'p;"j",¡"'ô':~¡ :,,~, " ,","-;,..;..-......,.',', 09201.71. 000220 ~ institution; and to carryon all my ordinary banking business. 7. Tax ReIn rns. To prepare, execute, and file reports, retums, declarations, fom1s and statements ror any and all tax purposes il1cluding income tax, gift lax, real estate tax, . personal pròperty tax, intangible tax, single business tax, or any other kind of tax whatsoever, to pay such taxes and any interest or penally thereon or additions therelo; to make and file objections, protests, claims, or abatement, refund or crcelit in relation to any such tax proposed, levied or paid; to represent me "nd to institute and prosecute proceedings in court or before any administrative a,uthority to contest any such tax in whole or in part or for recovery of any amount paid in respect of any such tax, to defend or settle any amount paid in respect of any amount paid of such tax, to give full and final receipt for any refund or credit and to endorse and collect any checks or other vouchers therefor; to pay any and all such taxes and any interést, penalty or other additional amounts; to employ attomeys, accountants, or other representatives and grant powers of attomey or letters of appointment thereof for any of the purposes aforesaid. 8. £aíeJlJ:posit Bnx To have access to any safe deposit box of which I am a tenant or cotenant with full power to withdraw or change from time to time the contents 'thereof; and 10 exchange or sUlTender the box and keys thereto, renew any rental contract therefor, and to do all things which any depository, association, or bank or its agents may require, hereby releasing the lessor from all liability in connection therewith. 9. Employ Agellls.. To employ and compensate agents, accountants, attorneys, appraisers, financial consultants, real estate brokers and other professional assistants and to retain and compensate such persons for services rendered; and to waive any attorney/client privilege. . ' 10. Motor Vehicles. To apply for a Certificate of Title upon, and endorse and transfer title thereto, for any automobile, or other motor vehicle, and to represent in such transfer assignmentlhat the title to said motor vehicles is free and clear of all liens and encumbrances except those speci fically set forth in such transfer. II. Settlement Powers To adjust, settle, compromise, or submit to arbitration any accounts, debts, claims, demands, disputes, or matters which are not subsisting or may hereafter arise between me and my agents and any olher person or persons, or in which any property, right, title, interest or estate belonging to or claimed by me may be concerned. 12. Le.gal.A.c.1lu.n.s.. To coml11cnce. prosecutc, cnforce.or abandon, or to defend, answer, oppose, confes~, compromise or settle all claims, suits, actions or other judicial or ...:I!"......~;¡:r:J·'~. ,.,,'...,......'..,.......,. ~ 09201.71 000221 administrative proceedings in which I am or may hereafter be interested, or in which any property, right, title, interest or estate belonging to, coming to or claimed by me may be concerned. I J. Dividcnds To receive all dividends which are or shall be payable on any and all shares of stock in any corporation which may stand in my name on the books of such corporation or to which ¡ may be, in equity or otherwise, beneficially entitled; or to elect to reinvest such dividends, all as my agent may deem appropriate. 14. Vote Stock To vote at all stockholder meetings or corporations and otherwise to act as my proxy or representative in respect of any shares now held or which may hereafter be acquired by me therein and for that purpose 10 sign and execule any proxies or other instruments in my name and on my behalf. IS. Transrer of Stock. To sell, assign, transfer, and deliver all and any shares of stock standing inl11Y name on the books of any corporation, or which I may be, in equity or otherwise. beneficially entitled, and for that purpose to make and execute all necessary acts of assignment and transfer. 16. Insurance and Employee Benefit Plans To redeem, surrender, bOlTow, extend, cancel, amend, pledge, alter or change, including change of beneficiary, any insurance policies,in which Imay have an interest, as my agent may deem proper and expedient, and for such purpose to sign and execute any documents, affidavits or forms required in my name and on my behalf, except however, my agent shall ha,ve no power and authority over life insurance policies I may own on my agent's life; and to exercise all powers and options involving retirement programs, compensation plans, pension, profit sharing and other employee benefit plans. 17. Social Security and Government Benefits. To make application to any governmental agency for any benefits or government obligation 10 which I may be enti!led; to endorse any checks or drafts made payable to me from any government agency for my benefit, including any social security checks. 18. Business Interests To continue to conduct or participate in any business in which ¡may be engaged or 10 carry out, modify, or amend any agreement to whieh r may be a party, and to sell, exchange, modify, or terminate such inlerestto or with such person or persons as my agent may deem proper and on such terms and with such security as my agents may deem appropriate; to execute R}.rtnership agreements, and amendments thereto; to incorporate, ~]lli1i¡~~ili~m;; , "'.':'\ ..' r:¡';;-,: ~:..' ~::~::::::::;:;::;:::t ":,:.:.i".' ',',t.'i'. .. ",' ..~, . . ,'·,,:..·.~~~~~~~I.,,::':O"~~!.·-'-':~.:!iiJo::C!:,¡;;r.~~.'!r.·,....,,'r'.'::.. ,:!I::.~..:.ic._:Jo,:;.,:"i:.:"4.:~...!'~':.:.!i:. ¡.-, 'I.'.. ',·,r'1~~:<ò¡1!i.t;'1':,'. ,,",!.-:"<.1' ,'i....1".r...,.!:"'.,~.¡¡:',. ,f,;': '~ h ,"',., -,~,' . ',.J..'...'...,....¿o"'"i'...~i".~¡:. 0920:t 71. 000222 "" reorganize, merge, consolidate, recapitali~e, sell, liquidate or dissolve any business; to elect to employ officers, directors, agents; and to carry out the provisions of any agreement for the sale of any business interest or the slock therein. 19. .I3Ju:r.aly. To borrow from time to lime such sums of money and upon such temlS as my said agent may think expedient for or in relation to any purpose or object which my agents may deem proper or expedient, unsecured or upon the security of any of my property, whether real or personal or otherwise, and for such purpose to give, execute in my name, deliver, and acknowledge promissory notes and/or renewals thereof, ill0rtgages, pledges and guarantee with such powers and'provisions as my agents my think proper or requisite. 20. Dehts and F.x~ To pay, compromise, and seltle any and all bills, loans, noles, or other forms of indebtedness owcù by mc at the present time, or which n~ay be owed by l;le or incurred by my agent hereunder for my benefit at any time in the future, and incur and pay from any of my assets or property all reasonable expenses in connection with control, management, and supervision of my property, and the maintenance, support, care,and comfort of mysel f and those dependent upon me, includi ng reasonable compensation for the service of my agenls. and including the fees and charges of such agents. attorneys, accountants, or others as my agent may, in the exercise or discretion, employ in the management of my affairs. 21. Inve~tments. To invest and reinvest in loans, stocks, bonds, including United States Bonds purchased at a discount but redeemablc at face value, securities, real estate, life insurance, annuities, or endowment policies or combinations thereof, or in any other investment which my agent may deem proper; to reduce the interest rate at any time and from time to time on any mortgage or land contract; to deal wilh and give instructions to any brokerage firm with respect to the purchase, sale or other disposition of securities and other assets; to add assets to or withdraw assets from my account in my name and sign any representation, certification or agreement, including agreemenls regarding margin, option trading, or commodities accounts, that my agents deem advisable. 22. Per~onal ann Medical Care To the extent renl1ilted by Wyoming law governing powers of attorney for health care, to make each and every judgmenlnecessary Jor the proper and adequate care and custody of me and my family; to hire, fire, emr1oy, ray for and discharge šuch domestic help, nursing services, and practical and/or registered nurses as my agent may detcrmine to be in the best interest of my heallh; and to give inrormeu consent or an ,.. ::' . ~,';!~;.o,' ,..'., ,~, ,::1 :"'... '. ' .;- ,~{i"a.TI:t:a:.:t:I;f::-;-\;I;I;;; ::;,',' ,!i.';:'..2,,:?'.i~¡l'.ài.t'~:;:,~r~'.,,;,,"" , '!T:,~t!:¡:¡-.:;~"'X;;:' ,,' .. ·'·;';;,1·"·', ":':1;';1:':,(':':));':':' ··-'_:t·':.~"'!!"'..,,~#1rI:IX!t;·,~,.':'!'~";>"::u"¡tr... :',iJ,."i"":~>"":,::','" .:,':~"t, .- ,.';~".f,<: '<>I;~(.~'I,'!õ''''''''''\':''' '\õ', ,;, ',:,r;'",.~.,.~!~...;.;,;..., '. ; 09201.71 .......... 0,111 11\,~ ·1)3' 7iU\lJ,~ informed refusal on my behalf with respect 10 my physical and mental health care and comfort, including specifically, by way of illustration only and not by way of limitati~¡'. A. Any medical care, diagnosis, surgical procedure, ther.lpeulic procedure and/or o~her treatment of any type Or nature except convulsive treatment or psychosurgery (or any other treatment which may from time to time be listed as a treatment which may not be authorized by an attomey in facl for health care under Wyoming law); b. Any physical rehabilitation program; c. Any dental procedure; d. Any psychiatric or psychological care or treatment except convulsive treatment or psychosurgery; e. The admission to any hospital, medical center, nursing home, but not including a mental heaJth treatment facility; f. The use of any drugs, medication, therapeutic devices, or other medicines or items related to my health; g. The execution of waivers, medical authorizations and such ot'her approval as may be required to permit or authorize care which r may need; h. The waiver of any doctor/patient privilege; and in general to take and authorize all acts with respect to my health and well being, and to expend all amounts in connection therewith, to the same extent as 1 could, ¡fmenlally competent to do so. The prices, costs, expenses and compensation incurred in furtherance of the foregoing are all to be within the sole and absolute discretion of my agent. 23. Anatomical Gifts To donate my blood, a kidney, or other organ or body pan during my lifetime to a relotive of mine, and upon my death, to any needful donee. However, my body is not to be donated for use as a cadaver. 24. G.iL.ti.ng Powpr To continue any annual girling program ¡ have begun prior to my pemlanent incapacity, to individuals to whom ¡ have made, or have expressed an intention in writing to make, at least one gift prior to that permanent incapacity. My agent shall decide from year to year, in her discretion, the persons to whom sllch gifts should be made, which may include my agent, and may make gifts in amounts up 10 the 1TI0ximum amount which may be gifted 10 each such person without the imposition ofo gift tax. 25. Iumil1ate I ire SUfl!lJ).l:.l.Sp.tJ:lI1s. To detcr'mine whether and when life support l:f!~mi~~~~¡~!im (.:~d,':':·.' i"".1 :::::~:::::~::::':: , , .·,~,·.;r;f:.:i~~Y:'f·':", '" """'~':f~!.~'·".·.'.~ . ¡~',~~;::;:SlL*'~i~;'i;·"":""~;fI;J;!'·'··: ' 09Z01.~'1 000224 ~ treatment facility; h. My agent cannot consent to any convulsive treatment on my behalf; I. My agent cannot consent to psycho surgery on my behalf. 27. s.pJ:.ClaLAgent rnr Bencfit Planning.. My special agent shall be authorized on my behalf to lake such steps as shall be nccess¡lry to ensurc or cnhance my eligibility for governmental, medical and other benefits. The power of my special agent shall arise only with respect to transactions which might involve transfers to my agent or the entry into contractual relationships with my agent in my agent's individual rather than fiduciary capacity. My special agent's power sl1ß11 include but not be limited to: to enter into an agreement with my agent with respect to the division of assets which might be jointly owncd by myselfand my.agent; to make transfers of property to my agent; to discharge any legal obligation of support I might have with respect to my agent; to acquire assets jointly with my agent; to convert assets which might be considered in reducing available govemmental benefits into assets which would be exempt from such consideration; to expend or acquire assets for the joint benefit of myself and my agent; and to take any and all other actions which might retain, secure or enhance my eligibi.lity for governmental benefit regardless of whether my agent might incidentally benefit as well. 28. illt.e.r.pretatinn and Gnverning Law. This instrument is to be construed and interpreted as a general durable powcr ofattol11ey. The enumeration of specific powers is not intended to, nor does it, limit or restrict the general powers herein granted to my agent. Paragraph headings are for convenience only and are not to be deemcd to be part of this instrument. This instrument is executed and delivered in the State of Wyoming, and the laws of the State of Wyoming shall govern all questions as to the validity of this power and construction of its provision. 29. Third-Parry ReliaJ.l£.C.. Third parties may rely upon the representation of my agents as to all malleI's relating to any power granted to 'my agent, and no person who may act in reliance upon the representations of my agent or the authority granted to may agent shall incur any liability to me or my estate as a result ofpermitling my ~gent to exercise any power, and for the purposc of inducing third parties to rely on the powcr of atlorncy, I warrant Ihal, if this power is revoked by me or otherwise terminated, I will indemnify ancl save sllch third pal1y harmless rrom ~ny ioss sufrered or liability incurred by such third party in good faith reliance on the authority of my ~gent prior to such third pal1y's' actual knowledge of revocation or termination ¡'.' ,,"'!i ;':":( ':~;,i¡:';';","'~1' ,',...,..',., "':~ç_ :,;l:"<'.-¡':'i';','.', . . . '"'"1, ':1," ", ': ·.·I·,;t:'~I:~:t.'''''~I:~:j~!;m;:;::Uj~~~ß~í.BHm·;~:,!¡<;I,~,.:'~____~,'...,~r""~;':f,' ','"i:.;¡;,.g1'1'£,,'¡i::;. '''''·'.~",::,.'",-,!."..!,:I,:.:'~ñ"..~.n;.=,~t¡.. ," "::..', i : ",~"~~·'~N~~~-F.L·t,'¡~;':\-'1t:-.t~..,Imn-.:::t'~!f~~..{4'~,·~f'ÿ.:,(,, '-", "f',\,":"; ~/¡~~}O:~O:' :~;:¡;*i:'",.;¡:~':¡~,',~''<-:·:-'~'''::"' ':!-."i~a~~' j~. 0320171, ~ 000225 or this power ofallorney whcther such lenllinalion ifby operalion ofl¡¡w or otherwise. This warranty sh¡¡1I bind my heirs, devisees and person¡¡1 representatives. 30. D.i5.ahilliy or Prillcip.;¡L This power of attorney shall become erfective upon my disability or incapacity. The ¡¡uthority of my agents shall be exercisable notwithstanding any uncertainty as to whether I am alive. I shull be deemed disable or incapacitated upon the election by my agenls to accept the written opinion of two licensed physicians, one of which shall be my attending physician or otherwise shall have previously rendered services to me, stating that I am incapacitated through illness, age, or other cause and that I am therefore incapable of attending to my business ¡¡ffairs. Any act done by my agent during any period of my disability or incompetency or during any period of uncertainty as to whether I am alive shall. have the same effect as though I were able, competent and not disabled, and shall inure to tIle benefit of and by me, my heirs, devisees, and pel'sonal representatives. 31. Ph olograph ic Co¡llü. Photographic or other facsimile reproductions of this' executed power may be made and delivered by my agents and may be relied upon by any person to the same extent as though the copy were an original. Anyone who acts in reli.ance upon the representation or certificate of my agent, or upon a reproduction of this power, shall not be liable for permitting my agent to perforTll any act pursuant to this power. 32. Revocation This durable power of attorney shall be nondelegable and shall be valid until such time as I revoke this power in writing. 33. D.i5.ahility and/or IlIca~ This durable power of attorney shall not be affected by any subsequent dis¡¡bility or incapacity from which I may suffer, except as provided by Ihe stalutes of Wyoming. J ~. ~::~~NESS WHEREOF, I ';'0 ";'~ & 0- STATE OF WYOMINO COUNTY OF ~s-8tk-) ss. , \ fñ ...lQis Durable P er of Attorney was ¡¡cknowledgcd 10 before me by ~#I.- t<.h \.. ~\)~\~\ t his ...D.U... day 0 f ,-rtìö1": :t;li.:JJ (, ( \ ~m*~~}tift~t,~¡ 4::¡;;~~:?J.:;~:;:'¡: '1,,~9'.·,~!.·~.""· (ilik;:;:N!:~:!~N . . ?,~:('ìí\;¡¡~¡;~f.~N1 t;;4~~~rfìif~'?x~ ~<;~':' '~~"~. :'~!¡~'!~'~I!O:.i!1!I'''1'''<~ ·t:L':';:1~':,",,-~::':'~~':;;:;':!i'iã.:~ ,.,;,~,;>:::;,__'.L; ':', ~::.,-. '.,~,,,,,~:,",. 'I·" " 'I _' . .', 'I "!I!.!¡","..!I!II", "t' ~ '¡' , " ':~',:·.';',!t~~~~D:I9?"t.;ø.!j:¡'~-", l!'Irrj,,'.');'If.:,' '~',:. ",~;",., ,-~ "','~I:'::o¡""i;'~Ii·i'<I;·ì'i\i·"·';;';''''i:'' :;:,',~,,:,:,~ ;"!'":'o:t':,;,j".,,;' 09201~~;'1 OQOr,96 .; í.; I.. .....- slÌall be withdrawn from me. In lhis connection, I may hav~ executed a "Living Will," in accordance wilh the laws of the State of Wyoming, and it is my i.ntent by this'Durable Power of AlIorney and by any such "Living Will" 10 granllo my agent all authority pennilled by Wyoming law to give directions regarding the use 0 f Ii fe-sustaining procedures, and to contest the fees and charges of any health care providers for services rendered by them contrary to my desire thaI lire-sustaining pr.ocedures be withheld irthey only serve to prolong the dying process. With respect to lhe application of Ii fe-sustaining procedures which would serve only to arti ficially prolong the dying process, by way of direction and inclusion, but not limitation, should I ever ha<ve an incurable injury, disease or other illness or condition certified to be a temlinal condition as provided for herein above, including irreversible brain damage that makes me unable to recognize people or swallow or I am in an untreatable coma with ,no chance of . recovery, I would not want these measures taken or I would want them to be discontinued ¡fthere is not improvement within a short time: · Involuntary nourishment and hydration; · Cardiopulmonary resuscilation to starl my heart beating; . Use of a respirator if I cannot breathe; · Feeding by a tube into the stomach; or · Treatment with antibiotics if pneumonia or other infections develop. 26. Restrictions on Agent's Powers. a. My agent cannot execute a Will or Codicil on my behalf; b. My agent cannot execute any trust on my behalf; however, my agent can enter into a custodial agreement with a financial institution having trust powers; c. My agent cannot divert the beneficial use of my assets to him/herself, hislher creditors, or his/her estate (although my agents may have legal title the same by virtue ofjoinr ownership or otherwise); d. My agent shall not exercise, and shall not be vested with an incident of ownership as to insurance. policies insuring my agent's life, owned by me; e. My agent is a fiduciary, possessing no general or limited powers of appointment; f. My agent shall not execute any power which I have received in a fiduciary capacity, and my agent shall have no authority to exercise any power, the exercise of which would cause assets of mine 10 be considered as taxable in my agent's estate for the purpose of fcderal e~l¡¡te law; g. My agent cannot consent to my commitmenl 10 or placement in a mental health · '- . ,- '-'-'.._...........,,'":,~, - ~,-'......, ...~~._, ~,->.,~... ....\;~;.!..!':~,", ~:.'$,:..,r~~i:.i.3.1~\1L!.'I;I't.1~~<!~:1:::~;:~L:~." "Ú', .:. ·~;::..: ,.:.;:.'j.!J.Jß~E~~."i:~ ; :', :L'o,:~::\~:;,:l;':(.:~i):~.j.:,::,. 0920j..~-1 000227 -----1-·· ., State/Commonwealth. of } L \ ss. County of \ V\ ~ l'I I" me, ~~ dO 0 l., , before Month Year Public, personally appeared Name(s) of Signer(s) o personally known to me - OR - 1M proved to me on the basis of satisfactory .' I'~idence to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged to me that he/she/they executed the same for the purposes therein stated. '~~~~;$ji;1.~.·~t~~~~".,~:"f~(t! ,--'Jm~:~~k MARY CAUGHEY - NOTARY PUBLIC County of State of Lincoln WyomIng M CommissIon ExpIres é1 &D I 6 ':".,~"'" !, -;;:1,~-' , ~ ~ ~"...:~r',,:: ~ '~' ~ Ì1i t_'~';:.· "~:~ ~~.: ~':{¡i OPTIONAL Although the information in this section is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Right Thumbprint of Signer Top of thumb here Description of Attached Document n Title or Type of Document: a&.\\ Q "A.. ~ ~ lAh0 ~ l_ V~.mlÀ J ~~~ ~ Document Date: - Number of Pages: q . Signer(s) Other Than Named Above: .- © 2002 National Notary Association. 9350 D~S~~·¡'~:PD.B~== Item No. 5936 Reorder: Call Toll-Free 1-800 US NOTARY (1-800-876-6827) ~;jl~~j~~: