Fill and Sign the Nc Durable Form

SPECIAL DURABLE POWER OF ATTORNEY FOR BANK ACCOUNT MATTERS STATE OF NORTH CAROLINA COUNTY OF _________________ KNOW ALL MEN BY THESE PRESENTS:That I, ________________________________ of ____________________County, North Carolina, being of sound mind and memory, do hereby make, constitute and appoint ________________________________ as my true and lawful agent and attorney in fact (hereinafter sometimes called "my agent"), with full power and authority to act for m e, individually, and in my name, place and stead, with reference to the transacti on of any and all business related to or connected with my bank accounts at __________________________ Bank, _______________________________________________________________ (Address), ____________________ (City), North Carolina, __________ (Zip Code) hereinafter “Bank”, including, but not limited to, the following: 1. Making deposits, transfers and withdrawals to or from any of my bank accounts at Bank. 2. Writing, making and endorsing checks, drafts and other instruments in connection with my bank accounts at Bank. 3. Opening new checking, savings, money market, certificates of deposit, IRA’s or other accounts in my name and maintaining same. 4. Approving and authorizing automatic withdrawals from my accounts. 5. Executing signature cards for accounts maintained or opened by my agent in my name. 6. Performing any and all other matters relating to, or in connection with, my bank accounts at Bank. I direct that the above-related powers and authority of my said agent shall be so exercisable and effective regardless of the fact that I may be mentally or physica lly incapacitated or incapable of understanding or unable to express myself or act in my own behalf at the ti me of any action on my behalf by said agent. Such incapacity, whether mental or physical, tha t I may exhibit shall not in any way interfere with the authority of my agent herein to act fully on my behalf according to the terms hereof. In other words, this Power of Attorney shall not be affected by the subsequent disability, incompetence or incapacity of the principal. And I do hereby undertake to ratify and confirm, all and singular, the acts heretofore performed and to be hereinafter performed by my said agents, acting in my name and on m y behalf. Bank shall honor this Power of Attorney until and unless Bank receives written notice of revocation of same signed by me. Bank is hereby indemnified and shall be held harmless by the undersigned for any and all actions taken by my agent regarding my accounts at Bank, regardle ss of whether within the intended scope of this Power of Attorney or not; therefore, Bank shall ha ve no liability for the actions of my agent or for following the directions of my agent in connection with my bank accounts at Bank. IN WITNESS WHEREFORE, I have executed this Special Power of Attorney on this the _____ day of ____________________, 20___. _________________________________________ PRINCIPAL ______________________________ Witness ______________________________ Witness ATTESTATION The hereinafter named Witnesses, each declare under penalty of perjury under the laws of the State of North Carolina, that the principal is personally known to us, that the principal signed and acknowledged this special power of attorney in our presence, that the principal appears to be of sound mind and under no duress, fraud or undue influence, that we are not the person appointed as attorney-in-fact by this document and that we witnessed this power of attorney in the presence of the principal. We are not related to the principal by blood, marria ge or adoption, and to the best of our knowledge, are not entitled to any part of the estate of the pri ncipal upon the death of the principal under a will now existing or by operation of law. WITNESSES: ______________________________ Signature Print Name: __________________________ Address: _____________________________ City: _________________State: __________ Zip: __________ WITNESSES: ______________________________ Signature Print Name: __________________________ Address: _____________________________ City: _________________State: __________ Zip: __________ State of North Carolina County of ____________________ I, __________________________________________, a Notary Public for ____________________ County, North Carolina, do hereby certify that __________________________, attorney in fact for __________________________, personally appeared before me this day, and being by me duly sworn, say that he/she executed the foregoing and annexed instrument for and in behalf of the said __________________________, and that his/ her authority to execute and acknowledge said instrument is contained in an instrument duly executed, acknowledged and recorded in the office of __________________________ in the County of __________________________, State of __________________________, on the _______ day of ____________________, 20___, and that this instrument was executed under and by virtue of the authority given by said instrument granting him/her power of attorney. I do further certify that the said __________________________ acknowledged the due execution of the foregoing and annexed instrument for the purposed therein expressed for and in behalf of the said __________________________. Witness my hand and official seal, this _______ day of _________________, 20___. __________________________ (Official Seal) Official Signature of Notary __________________________ Notary’s printed or typed name Notary Public My commission expires: __________________________ Principal Name and Address Attorney-in-Fact Name and Address Name: Name: Address: Address: City: City: State: Zip: State: Zip: Phone: Phone: