Partial Power of

Attorney

I, ________________________________being of sound mind and judgment

do hereby authorize,__________________________________ on this the

______day, in the month of______________ and the year of_______, to stand on my behalf, as my Partial Power of Attorney, and hereby grant the full authority to the person named herein, the ability to facilitate the duties listed in the addendum to this document, titled Addendum to Partial Power of Attorney. The authorization as my Partial Power shall be limited to the specific duties listed in said addendum only. The individual listed herein shall have full said authority as described, beginning on the date indicated on this document and shall continue unless otherwise made null and void by me, to perform all applicable and necessary actions to facilitate the specific duties as described within the Addendum to Partial Power of Attorney. The document titled Addendum to Partial Power of Attorney shall remain attached to this document at all times. The document titled Addendum to Partial Power of Attorney is to be considered null and void if alterations and additions are suspected and/or if my signature,_______________________,

is not notarized on said document.

______________________________________________ ____/____/____

Signature of Authorizing Party Date

Printed name of authorizing Party; _________________________________

______________________________________________ ____/____/___

Signature of Notary Date

Notary Seal: __________________________

Addendum to Partial Power of

Attorney

This document shall remain as an attachment to the notarized Power of Attorney, by which partial power of attorney has been given to

__________________________by ___________________________on

____/____/____. This document shall provide the limited duties and the authority of the Partial Power of Attorney.

Duties and Responsibilities of the Partial Power of Attorney

1. To;____________________________________________

2. To;____________________________________________

3. To:____________________________________________

4. To;____________________________________________

5. To;____________________________________________

Limitations of authorization powers of the Partial Power of Attorney

• Authorization to; ____________________________________

The authorizing party of this document shall reserve all rights to render this document and any other documents null and void at anytime and/or to grant override authority to any beneficiary, partial or full power of attorney or legal representative given such authority by authorizing party listed herein to do so.

_________________________________________ ____/____/____

Signature of Authorizing Party Date

Printed Name of Authorizing Party: ________________________________

_________________________________________ ____/____/____

Signature of Notary Date

Notary Seal: ___________________

STATE OF NORTH CAROLINA ►File No._________________________

In The General Court of Justice

___________________________County  District  Superior Court Division

Name And Address of Defendant (Type Or Print)