_____ Insurance and annuities
_____ Estates, trusts, and other beneficial interests
_____ Claims and litigation
_____ Personal and family maintenance
_____ Benefits from governmental programs or civil or military service
_____ Retirement plans
_____ Taxes
_____ All preceding subjects
GRANT OF SPECIFIC AUTHORITY (OPTIONAL)
My agent SHALL NOT do any of the following specific acts for me UNLESS I have
INITIALED the specific authority listed below:
(CAUTION: Granting any of the following will give your agent the authority to take actions that
could significantly reduce your property or change how your property is distributed at your
death. INITIAL ONLY the specific authority you WANT to give your agent. You should give
your agent specific instructions in the Special Instructions when you authorize your agent to
make gifts.)
_____ Create, fund, amend, revoke, or terminate an inter vivos trust
_____ Make a gift, subject to the limitations of O.C.G.A. § 10-6B-56 and any Special
Instructions in this power of attorney
_____ Create or change rights of survivorship
_____ Create or change a beneficiary designation
_____ Authorize another person to exercise the authority granted under this power of attorney
_____ Waive the principal's right to be a beneficiary of a joint and survivor annuity, including a
survivor benefit under a retirement plan
_____ Excise authority over the content of electronic communications sent or received by the
Principal
_____ Exercise fiduciary powers that the principal has authority to delegate and that are
expressly and clearly identified (including the persons for which the principal acts as a fiduciary)
in the Special Instructions