NEBRASKA LIMITED POWER OF ATTORNEY
In Accordance with NE Revised Statutes §§ 30-3401 to 30-3432

I, __________________________ , residing at ____________________ ,
_____________________________ , _____________________, hereby appoint 
_______________ of _______________ , _________________ , as my Attorney-in-Fact (“Agent”) for the purposes expressed herein.
I hereby revoke any and all powers of attorney that previously have been signed by me only to the extent that any such power of attorney covers the same subject matter of this power of attorney.
My Agent shall have full power and authority to act on my behalf but only to the extent permitted by this Special Power of Attorney. My Agent’s powers shall include the power to:
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This Special Power of Attorney starts to be effective on ____________ , ____ , 20___ .
I grant my Attorney-in-Fact full authority to act in any reasonable and necessary manner for the purpose of exercising the above powers. I ratify all lawfully performed acts by my Attorney-in-Fact in exercising those powers.
This Special Power of Attorney is governed by the laws set forth under the State of Nebraska.
This Special Power of Attorney is effective upon execution. This Special Power of Attorney may be revoked at any time by me, and shall automatically be revoked upon my death, provided any person relying on this Special Power of Attorney shall have full rights to accept and reply upon authority of my Attorney-in-Fact until in receipt of actual notice of revocation.
SIGNATURE AND ACKNOWLEDGMENT
Signature ______________________________________   Date _________________
Printed Name __________________________________________________________
Acknowledged  before  me  in  ________ ,  Nebraska,  on ____________________ .
Agent’s signature _______________________________	Date _________________
Agent’s Printed Name ____________________________________________________
Agent’s Address ________________________________________________________
Agent’s Telephone Number _______________________________________________
Acknowledged  before  me  in  ________ ,  Nebraska,  on ____________________ .

(Seal, if any)

Signature of Notary ____________________________________________________________

Signed on this _____ day of ___________________ , 20___ , in _________ , _____________ .

Name of Notary _______________________________________________________________

My Commission Expires: __________________________