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RECEIVED
LINCOLN C0LINTY. 0LERK
A2OSd0
R205-04
GENERAL POWER OF ATTORNEY
(With Durable Provision)
NOTICE: THIS IS AN IMPORTANT DOCUMENT. BEFORE SIGNING THIS DOCUMENT,
YOU SHOULD KNOW THESE IMPORTANT FACTS. THE PURPOSE OF THIS PO%rER
OF ATTORNEY IS TO GIVE THE PERSON WHOM YOU DESIGNATE (YOUR "AGENT")
BROAD POWERS TO HANDLE YOUR PROPERTY, ~VI-IICH MAY INCLUDE POWERS
TO PLEDGE, SELL OR OTHERWISE DISPOSE OF ANY REAL OR PERSONAL PROP-
ERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU. YOU MAY
SPECIFY THAT THESE POWERS WILL EXIST EVEN AFTER YOU BECOME DIS-
ABLED, INCAPACITATED OR INCOMPETENT. THIS DOCUMENT DOES NOT AUTHO-
RIZE ANYONE TO MAKE MEDICAL OR OTHER HEALTH CARE DECISIONS FOR
YOU. IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDER-
STANDi YOU SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU. YOU MAY REVOKE
THIS POWER OF ATTORNEY IF YOU LATER %fISH TO DO SO.
TO ALL PERSONS, be it ~kn0wn that I,
of/200 /'oddd); x"'7-/z//,.,/~ .,~d', 7-~.,ay,,.,e,
the undersigned Grantor, do hereby make and grant a general power of attorney to
and do thereupon constitute and appoint said individual as my attorney-in-fact.
My attorney-in-fact shall act in my name, place and Stead in any way which I myself could do, if I were per-
sonally present, with respect to the following matters, to the extent that [ am permitted by law to act through an agent:
(NOTICE: The grantor must write hi~ or her ihit~]s in the" correstS0dding blank space of a box below with respect to
............... eagh of the subdivisiom-(A-)4hrough (O)beloW for~which thwGtant~r wants to give' the agent'aathori~.
space withy~ a box for an), particular Subdivision is NOT initialed, NO AUTHORITY WILL BE GRANTED for mat-
--.~ter' t.~a/~,.~ded in that subdivision. Cross out each power withheld.) .'
~ . '~,J¥ I (A) Real estatetransaction, . .
e--.~,--~ ~L.~-[~ ~ m) Tangible personal proper~y transactions
[~-." ' tV~t'P (C) Bond, share and conwnodity transactions
[~ (~Y (D) Banking transactions · .'. ·
[L.t',4,]x
(E)' Business operating transactions, : ' .' · '
(F) Insurance transactions
_ ~v4t~tll~,~l~l~lt~,~hvolved~r tax consequences are anticipated, consult an attorney.)
~ms ~:)igat~' t
(J) Benefits front military service
(K) Records, reports and statements
AFHH
088 05 4
114
(L) Full and unqualified authority to my attorney-in-fact to delegate any or all of the foregoing
powers to any person or persons whom my attorney-in-fact shall select
(M) Access to safe deposit box(es)
(N) Al1 other matters
Durable Provision:
(O) If the blank space in tim block to the left is initialed by the Grantor, tbis power of attor-
ney shall not be affected by !ll,e .~ul~sequent disability or incompetence of the Grantor.
Other Terms:
My attorney-in-fact hereby accepts this appointment subject to its terms and agrees to act and per-
form in said fiduciary capacity consistent with my best interests as he/she in his/her best discre-
tion deems advisable, and I affirm and ratify all acts so undertaken.
TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY
THIRD PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS
INSTRUMENT MAY ACT HEREUNDER, AND THAT REVOCATION OR TERMINATION
HEREOF SHALL BE INEFFECTIVE AS TO SUCH THIRD PARTY UNLESS AND UNTIL
ACTUAL NOTICE OR KNOWLEDGE OF SUCH REVOCATION OR TERMINATION
SHALL HAVE BEEN RECEIVED BY SUCH THIRD PARTY, AND I FOR MYSELF AND
FOR MY HEIRS, EXECUTORS, LEGAL REPRESENTATIVES AND ASSIGNS, HEREBY
AGREE TO INDEMNIFY AND HOLD HARMLESS ANY SUCH THIRD PARTY FROM AND
AGAINST ANY AND ALL CLAIMS THAT MAY ARISE AGAINST SUCH THIRD PARTY
BY REASON OF SUCH THIRD PARTY HAVING RELIED ON THE PROVISIONS OF THIS
INSTRUMENT.
to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed
the within instrument and acknowledged to me that he/she/they executed the same in his~er/thek authorized capac-.
ity(ies), and that by his/her/their signature(s) on fl~e instru~ tim =~&X ~r ~e emitzu~ BeMlf of wNch the
person(s) acted, executed the instrument. [--- ~-~ ~-~~-~ .... l
WITNES{~, hand and omcial sea[ ' } ~ ~ ~ ~ ~ ]
' " Affiant P~
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