NORTH CAROLINA POWER OF ATTORNEY
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE DEFINED IN CHAPTER 32C 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.
This power of attorney authorizes another person (your agent) to make decisions concerning your property for you (the principal). Your agent will be able to make decisions and act with respect to your property (including your money) whether or not you are able to act for yourself. The meaning of authority over subjects listed on this form is explained in the North Carolina Uniform Power of Attorney Act.
This power of attorney does not authorize the agent to make healthcare decisions for you.
You should select someone you trust to serve as your agent. Unless you specify otherwise, generally the agent's authority will continue until you die or revoke the power of attorney or the agent resigns or is unable to act for you.
Your agent is entitled to reasonable compensation, unless you state otherwise in the Additional Provisions and Exclusions.
This form provides for designation of one agent, successor agent, and second successor agent. If you wish to name more than one agent, successor agent, and second successor agent, you may name a co-agent, successor co-agent, or second successor co-agent in the Additional Provisions and Exclusions.
Co-agents, successor co-agents, or second successor co-agents are not required to act together unless you include that requirement in the Additional Provisions and Exclusions.
If your agent is unable or unwilling to act for you, your power of attorney will end unless you have named a successor agent. You may also name a second successor agent.
This power of attorney becomes effective immediately.
If you have questions about the power of attorney or the authority you are granting to your agent, you should seek legal advice before signing this form.
I, _________, _________, telephone number _________, and email address _________, name the following person _________ of _________, telephone number _________, and email address _________, as my Agent, to act for me and exercise the powers and discretions defined in Chapter 32C of the North Carolina General Statutes.
GRANT OF GENERAL AUTHORITY
I grant my agent and any successor agent general authority to act for me with respect to the following subjects as defined in the North Carolina Uniform Power of Attorney Act, Chapter 32C of the General Statutes:
(INITIAL each subject you want to include in the agent's general authority.)
________ - Real Property
________ - Tangible Personal Property
________ - Stocks and Bonds
________ - Commodities and Options
________ - Banks and Other Financial Institutions
________ - Operation of Entity or Business
________ - 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
ADDITIONAL PROVISIONS AND EXCLUSIONS
________ - My Agent is entitled to reasonable compensation for services provided under this Power of Attorney. My Agent is entitled to reimbursement of all reasonable expenses incurred in acting under this Power of Attorney.
This power of attorney will not be terminated by my incapacity.
This Power of Attorney is a Durable Power of Attorney and takes effect immediately. This Power of Attorney shall not be affected by my subsequent incapacity or mental incompetence. This Power of Attorney will continue to be effective until my death.
This power of attorney is effective immediately, unless I have stated otherwise in the Additional Provisions and Exclusions section.
RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this Power of Attorney or a copy unless that person knows it has terminated or is invalid.
The meaning and effect of this Power of Attorney shall for all purposes be determined by the law of the State of North Carolina.
SIGNATURE AND ACKNOWLEDGMENT
______________________________ | _______________________ |
_________ | Date |
STATE OF NORTH CAROLINA,
_________ COUNTY, ss:
I certify that the following person personally appeared before me this day, acknowledging to me that he or she signed the foregoing document: ______________________________.
______________________________ | _______________________ |
Signature of Notary Public | Date |
______________________________, Notary Public
Printed or typed name
My commission expires: ______________________________
IMPORTANT INFORMATION FOR AGENT
Agent's Duties
When you accept the authority granted under this power of attorney, a special legal relationship is created between you and the principal. This relationship imposes upon you legal duties that continue until you resign, or your authority is terminated or the power of attorney is terminated or revoked. You must:
(1) Do what you know the principal reasonably expects you to do with the principal's property or, if you do not know the principal's expectations, act in the principal's best interest;
(2) Act in good faith;
(3) Do nothing beyond the authority granted in this power of attorney; and
(4) Disclose your identity as an agent whenever you act for the principal by writing or printing the name of the principal and signing your own name as "agent" in the following manner:
________________________________________________________________________
(Principal’s name) by (Your signature) as agent
Unless the Additional Provisions and Exclusions in this power of attorney state otherwise, you must also:
(1) Act loyally for the principal's benefit;
(2) Avoid conflicts that would impair your ability to act in the principal's best interest;
(3) Act with care, competence, and diligence;
(4) Keep a record of all receipts, disbursements, and transactions made on behalf of the principal;
(5) Cooperate with any person that has authority to make health care decisions for the principal to do what you know the principal reasonably expects, or if you do not know the principal's expectations, to act in the principal's best interest;
(6) Attempt to preserve the principal's estate plan if you know the plan and preserving the plan is consistent with the principal's best interest; and
(7) Account to the principal, or a person designated by the principal (if any), in the Additional Provisions and Exclusions.
TERMINATION OF AGENT'S AUTHORITY
You must stop acting on behalf of the principal if you learn of any event that terminated or revoked this power of attorney or your authority under this power of attorney. Events that terminate a power of attorney or your authority to act under a power of attorney include:
(1) Death of a principal;
(2) The principal's revocation of the power of attorney or the termination of your authority;
(3) The occurrence of a termination event stated in the power of attorney;
(4) The purpose of the power of attorney is fully accomplished; or
(5) If you are married to the principal, your divorce from the principal unless the Additional Provisions and Exclusions in this power of attorney state that your divorce from the principal will not terminate your authority.
LIABILITY OF AGENT
The meaning of the authority granted to you is defined in the North Carolina Uniform Power of Attorney Act. If you violate the North Carolina Uniform Power of Attorney Act or act outside the authority granted, you may be liable for any damages caused by your violation.
If there is anything about this document or your duties that you do not understand, you should seek legal advice. (2017-153, s. 1; 2018-142, s. 30(b).)
AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY
(G.S. 32C-3-302)
I, ______________________________ (Name of Agent), do hereby state and affirm the following under penalty of perjury:
(1) ______________________________ (Name of Principal) granted me authority as an agent or successor agent in a power of attorney dated ________________________.
(2) The powers and authority granted to me in the power of attorney are currently exercisable by me.
(3) I have no actual knowledge of any of the following:
(a) The principal is deceased.
(b) The power of attorney or my authority as agent under the power of attorney has been revoked or terminated, partially or otherwise.
(c) The principal lacked the understanding and capacity to make and communicate decisions regarding his estate and person at the time the power of attorney was executed.
(d) The power of attorney was not properly executed and is not a legal, valid power of attorney.
(e) (Insert other relevant statements)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
(4) I agree not to exercise any powers granted under the power of attorney if I become aware that the principal is deceased, that the power of attorney has been revoked or terminated, or
that my authority as agent under the power of attorney has been revoked or terminated.
AGENT SIGNATURE AND ACKNOWLEDGMENT
______________________________ | _______________________ |
Agent's Signature | Date |
______________________________ | |
Agent's Name Printed | |
______________________________ | |
Agent's Address | |
______________________________ | |
Agent's Telephone Number | |
| |
STATE OF NORTH CAROLINA,
_________ COUNTY, ss:
I certify that the following person personally appeared before me this day, acknowledging to me that he or she signed the foregoing document: ______________________________.
Sworn to or affirmed and subscribed before me this day by: | _______________________ |
| Date |
______________________________
Signature of Notary Public
______________________________
(Official Seal)_______________________________, Notary Public
Printed or typed name
My commission expires: _______________________________