Nebraska Statutory Short Form Power of Attorney

NOTICE
                      The following statutory short form, when reproduced and used in the identical indicated words or in substantially the same or more similar than dissimilar formulation of words by means of printing, typing, writing, or other  method  of  reproduction  and  use  or  when appropriately adapted to particular circumstances, shall be  and  constitute a statutory  short  form  power  of attorney and, when completed by adoption by check or other clear mark of each included  provision desired  and  permitted  to  be  adopted  and  made operative, by deletion by line or other clear  obliteration  of  each  included provision desired and permitted  to  be  deleted  and  made inoperative, by inclusion by printing, typing, writing, or other clear presentation of each provision not included but desired and permitted  to be included and made operative, and by insertion by printing, typing, writing, or other  clear  presentation of all additional data and information required to be included and when effectuated  by  execution  by   or   for   the   principal, by acknowledgment  by or for the principal, and by delivery by or at the express direction of the principal to and acceptance by the agent of  at  least one so completed, executed, and acknowledged form, shall create and establish an agency relationship under a power of attorney in accordance with the Nebraska Short Form Act.

POWER OF ATTORNEY
         
____________________________ , a domiciliary of  _______________ County, Nebraska, Principal, desiring and intending to establish a  Power of  Attorney  operative  under  the Nebraska Short Form Act, does hereby appoint, constitute, and designate   ____________________________ , a _____________________  of  or  with  an  office  in  ______________________ County, Nebraska, and ______________________ , a _________________________ of or with an office in _________________ County,  Nebraska,  Agent, the lawful and true Agent and attorney in fact for Principal;  and  Principal does hereby further provide and stipulate in connection therewith as follows:
          1. This Power of Attorney is, as marked, a 
                  (  ) Durable Power of Attorney and a
                  (  ) Contingent Durable Power of Attorney, upon the contingency of,
                   
                  (  )  Incompetence of Principal, or
                  (  ) Other  Contingency: _____________________________, or
                  (  ) Present Durable Power of Attorney
                  (  ) Nondurable Power of Attorney.

          2. By this Power of Attorney, Principal confers upon and grants to Agent  plenary power,  plenary power subject to limitations, or all and each of the listed general powers  as individually marked:
                  (  ) Plenary Power; or
                  (  ) Plenary Power Subject to Limitations, exclusive of General Powers for Domestic and Personal Concerns and for Fiduciary Relationships and
                  (  ) No Other Restrictions, or
                  (  ) Other     Restrictions: _____________________________; or
                  (  ) General Power for Bank and Financial Transactions.
                  (  ) General Power for Business Interests.
                  (  ) General Power for Chattels and Goods.
                  (  ) General Power for Disputes and Litigation.
                  (  ) General Power for Domestic and Personal Concerns.
                  (  ) General Power for Fiduciary Relationships.
                  (  ) General Power for Governmental and Other Benefits.
                  (  ) General Power for Insurance Coverages and Policies.
                  (  ) General Power for Proprietary Interests and Materials.
                  (  ) General Power for Real Estate.
                  (  ) General Power for Securities.
                  (  ) General Power for Records, Reports, and Statements.

          3. By this Power of Attorney, Principal makes the following additional provision or provisions:
                   
______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
 
          4. This Power of Attorney revokes and supersedes all prior executed instruments of like import and  remains operative until revoked.

          EXECUTED AT ____________________ , _____________ County, Nebraska, on
_____________________ , 20______ .

________________________
Principal

STATE OF NEBRASKA	)
) ss.
COUNTY OF ____________	)

          The foregoing instrument was acknowledged before me on _____________, 20___, by the Principal ____________________ .

____________________________
Notary Public