NCC241787_FRO Submitted (2)_20240612

POWER OF ATTORNEY
IMPORTANT INFORMATION
This power of attorney authorizes another person (your agent)to make decisions concerning your
property for you (the principal).Your agent will be able to make decisions and act with respect to your
property(including your money)whether or not you are able to act for yourself.
This power of attorney does not authorize the agent to make medical and health care decisions for you.
You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the
agent's authority will continue until you die or revoke the power of attorney or the agent resigns or is
unable to act for you.
Your agent is entitled to reasonable compensation unless you state otherwise in the Special Instructions.
This form provides for designation of one agent. If you wish to name more than one agent you may name
a co-agent in the Special Instructions.Co-agents are not required to act together unless you include that
requirement in the Special Instructions.
If your agent is unable or unwilling to act for you,your power of attorney will end unless you have named
a successor agent.You may also name a second successor agent.
This power of attorney becomes effective immediately unless you state otherwise in the Special
Instructions.
If you have questions about the power of attorney or the authority you are granting to your agent,
you should seek legal advice before signing this form.
DESIGNATION OF AGENT
I, t\4E W "frtk5►A ?, Ilia.-of 3t 1 DG„upp��ba0 C-n
[Address],
authorize r'st, F,Grh' kE,Z ,SIL-of 1-4 Q.t.) woo0 RR) [Address],
as my agent(attorney-in-fact)to act for me and in my name and for my use and benefit.
. 4 ble-or_uuwilling to of

GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me with respect to the following
subjects:
INITIAL each subject you want to include in the agent's general authority.
INITIAL the line in front of"(N)All Preceding Subjects"if you wish to grant general authority over all of the
subjects instead of initialing each subject.
aM 8 (A) Real property
M-(8 (B) Tangible personal property
(C) Stocks and bonds
(D) Commodities and options
(E) Banks and Other Financial Institutions
O"f tS (F)Operation of Entity or Business
(G) Insurance and Annuities
(H) Estates,Trusts, and Other Beneficiary Interests
(I) Claims and Litigation
— (J) Personal and Family Maintenance
(K) Benefits from Governmental Programs or Civil or Military Service
(L) Retirement Plans
(M)Taxes
(N) All Preceding Subjects
GRANT OF SPECIFIC AUTHORITY(OPTIONAL)
My agent may not do any of the following specific acts for me unless I have INITIALED the specific
authority listed below:
CAUTION: . anting any of the following will give your age, the authority to take actions that could
significantly re, 6 e your property or change how your . •perty is distributed at your death.
INITIAL only the spec" • -uthority you want to gi - your agent.
(A)Create, a -nd, revo. -, or terminate an inter vivos trust
(B) Make a gift
(C) Create or cha.•e is of survivorship
(D) Create or ange a ben. ciary designation
(E)Author' e another person to - ercise the authority granted under this power of
att. ey
(F) aive the principal's right to be a ben- uciary of a joint and survivor annuity,
including a survivor benefit under a retire t plan
(G) Exercise fiduciary powers that the principal has : thority to delegate

LIMITATION ON AGENT'S AUTHORITY
An agent that is not my ancestor, spouse,or descendant may not use my property to benefit the agent or
a person to whom the agent owes an obligation of support unless I have included that authority in the
Special Instructions.
SPECIAL INSTRUCTIONS (OPTIONAL)
You may give special instructions on the following lines:
EFFECTIVE DATE
This power of attorney is effective immediately unless I have stated otherwise in the Special Instructions.
TERMINATION (Check one and strike out the other)
12 DURABLE Power of Attorney.This power of attorney shall not be affected by my subsequent
disability or incapacity,or lapse of time.
REGULAR Power of Attorney.This power of attorney shall terminate if 1 become disabled or
capacitated.
NOMINATION OF GUARDIAN (OPTIONAL)
If it becom- necessary for a court to appoint a guardian of my estate o y person, 1 nominate the
following person( ,sr appointment:
Name of Nominee for guardian of m• -te:
Nominee's Address:
Nominee's Telephone Number:
Name of Nominee for guars'. of my person:
Nominee's Address:
Nominee's Tele I '.ne Number:

RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of attorney or a copy of it unless
that person knows it has terminated or is invalid.
SIGNATURE AND ACKNOWLEDGMENT
Signature of Principal Date
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Name Printed
3ci T)c., woo° 20 Kti 56oe.o0G H tics 2? z
Address
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Telephone Number

State/Commonwealth of t\Or tik &NV(1`ik
County of —D i1.0.W1i
On this day of S1 ,20 23 , before me, 1)K k« t• 'EWA , personally
appeared kk LA-2,/riINl_lre, personally known to me or who proved to me on the basis of
satisfactory evidence to be the person whose name is subscribed to this instrument and acknowledged to
me that he/she executed the same and that by his/her signature on this instrument the person executed
this instrument.
4
trir4-4 � (Seal, if any)
i• re of Nota
My commission expires: 11 Wi M 23121i29 I t.t..4
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