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Nebraska Power of Attorney Form

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Nebraska Power of Attorney Form Page 2
Nebraska Power of Attorney Form
Page 2 of 4
Power of Attorney, DC 6:12 PSC, Rev. 08/12 ยง30-4041
( ) Stocks and Bonds
( ) Commodities and Options
( ) Banks and Other Financial Institutions
( ) Operation of Entity or Business
( ) Insurance and Annuities
( ) Estates, Trusts, and Other Beneficial Interests
( ) Claims and Litigation
( ) Personal and Family Maintenance
( ) Benefits from Governmental Programs or Civil or Military Service
( ) Retirement Plans
( ) Taxes
( ) All Preceding Subjects (includes all items listed above)
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)
My agent MAY do any of the following specific acts for me IF I have CHECKED the specific
authority listed below:
(CAUTION: Granting any of the following will give your agent the authority to take actions that
could significantly reduce your property or change how your property is distributed at your
death. CHECK ONLY the specific authority you WANT to give your agent.)
( ) Create, amend, revoke, or terminate an inter vivos trust
( ) Make a gift, subject to the limitations of the Nebraska Uniform Power of Attorney
Act and any special instructions in this power of attorney
( ) Create or change rights of survivorship
( ) Create or change a beneficiary designation
( ) Delegate to another person to exercise the authority granted under this power of
attorney
( ) Waive the principal's right to be a beneficiary of a joint and survivor annuity,
including a survivor benefit under a retirement plan
( ) Exercise fiduciary powers that the principal has authority to delegate
( ) Renounce or disclaim an interest in property, including a power of appointment
Nebraska Power of Attorney Form