North Carolina Statutory Power of Attorney Form

North Carolina Statutory Short Form of General Power of
Attorney
NOTICE
THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING.
THEY ARE DEFINED IN CHAPTER 32A OF THE NORTH CAROLINA GENERAL
STATUTES WHICH EXPRESSLY PERMITS THE USE OF ANY OTHER OR
DIFFERENT FORM OF POWER OF ATTORNEY DESIRED BY THE PARTIES
CONCERNED.
State of ______________
County of ____________
I ____________________________, appoint __________________ to be my
attorney-in-fact, to act in my name in any way which I could act for myself, with respect
to the following matters as each of them is defined in Chapter 32A of the North Carolina
General Statutes. (DIRECTIONS: Initial the line opposite any one or more of the
subdivisions as to which the principal desires to give the attorney-in-fact authority.)
______ (1)
Real property transactions
______ (2)
Personal property transactions
______ (3)
Bond, share, stock, securities and commodity transactions
______ (4)
Banking transactions
______ (5)
Safe deposits
______ (6)
Business operating transactions
______ (7)
Insurance transactions
______ (8)
Estate transactions
______ (9)
Personal relationships and affairs
______ (10) Social security and unemployment
______ (11) Benefits from military service
______ (12) Tax matters
______ (13) Employment of agents
______ (14) Gifts to charities, and to individuals other than the attorney-in-fact
______ (15) Gifts to the named attorney-in-fact
(If power of substitution and revocation is to be given, add: 'I also give to such person
full power to appoint another to act as my attorney-in-fact and full power to revoke such
appointment.')
(If period of power of attorney is to be limited, add: 'This power
terminates______________, ________')
(If power of attorney is to be a durable power of attorney under the provision of Article 2
of Chapter 32A and is to continue in effect after the incapacity or mental incompetence of
the principal, add: 'This power of attorney shall not be affected by my subsequent
incapacity or mental incompetence.')
(If power of attorney is to take effect only after the incapacity or mental incompetence of
the principal, add: 'This power of attorney shall become effective after I become
incapacitated or mentally incompetent.')
(If power of attorney is to be effective to terminate or direct the administration of a
custodial trust created under the Uniform Custodial Trust Act, add: 'In the event of my
subsequent incapacity or mental incompetence, the attorney-in-fact of this power of
attorney shall have the power to terminate or to direct the administration of any custodial
trust of which I am the beneficiary.')
(If power of attorney is to be effective to determine whether a beneficiary under the
Uniform Custodial Trust Act is incapacitated or ceases to be incapacitated, add: 'The
attorney-in-fact of this power of attorney shall have the power to determine whether I am
incapacitated or whether my incapacity has ceased for the purposes of any custodial trust
of which I am the beneficiary.')
Dated___________, _______.
(Seal)
Signature __________________
STATE OF ____________________ COUNTY OF _______________
On this ______ day of___________, ______, personally appeared before me, the said
named ______________________________ to me known and known to me to be the
person described in and who executed the foregoing instrument and he (or she)
acknowledged that he (or she) executed the same and being duly sworn by me, made oath
that the statements in the foregoing instrument are true.
My Commission Expires ______________________.
__________________________ (Signature of Notary Public)
Notary Public (Official Seal)