Each of the following provisions may be included in a statutory form power of attorney:



(1) Repealed, Sec. 15 ch 83 SLA 2004.


(2) YOU MAY DESIGNATE AN ALTERNATE ATTORNEY-IN-FACT. ANY ALTERNATE


YOU DESIGNATE WILL BE ABLE TO EXERCISE THE SAME POWERS AS THE AGENT(S)


YOU NAMED AT THE BEGINNING OF THIS DOCUMENT. IF YOU WISH TO DESIGNATE


AN ALTERNATE OR ALTERNATES, COMPLETE THE FOLLOWING:


If the agent(s) named at the beginning of this document is unable or


unwilling to serve or continue to serve, then I appoint the following


agent to serve with the same powers:


First alternate or successor attorney-in-fact


_______________________________________________________________


(Name and address of alternate)


_______________________________________________________________


Second alternate or successor attorney-in-fact


_______________________________________________________________


(Name and address of alternate)


(3) YOU MAY NOMINATE A GUARDIAN OR CONSERVATOR. IF YOU WISH TO NOMINATE A GUARDIAN OR CONSERVATOR, COMPLETE THE FOLLOWING:


In the event that a court decides that it is necessary to appoint a guardian or conservator for me, I hereby nominate (Name and address of person nominated) to be considered by the court for appointment to serve as my guardian or conservator, or in any similar representative capacity.