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LIMITATION ON AGENT'S AUTHORITY <br /> An agent that is not my ancestor, spouse, or descendant MAY NOT use my property to benefit <br /> the agent or a person to whom the agent owes an obligation of support unless I have included <br /> that authority in the special instructions. <br /> SPECIAL INSTRUCTIONS (OPTIONAL) <br /> You may give special instructions on the following lines: <br /> EFFECTIVE DATE <br /> This power of attorney is effective immediately unless I have stated otherwise in the special <br /> instructions. <br /> NOMINATION OF CONSERVATOR <br /> OR GUARDIAN (OPTIONAL) <br /> If it becomes necessary for a court to appoint a conservator of my estate or guardian of my <br /> person,I nominate the following person(s) for appointment: <br /> Name of nominee for conservator of my estate: <br /> Nominee's address: <br /> Nominee's telephone number: <br /> Name of nominee for guardian of my person: <br /> Nominee's address: <br /> Nominee's telephone number: <br /> Principal's initials and date .; Page 3 of 5 <br />