North Carolina Power of Attorney Template
This Power of Attorney ("POA") document grants authority to an individual (hereinafter referred to as the "Agent") to act on behalf of the principal (the person making the POA) in matters specified within. It is governed by the North Carolina General Statutes, Chapter 32C, known as the North Carolina Uniform Power of Attorney Act.
Please fill in the required information where blank spaces are provided and review all sections thoroughly to ensure they reflect your wishes accurately.
1. Principal Information
Name: _________________________________________
Address: ______________________________________
City/State/ZIP: _________________________________
Phone Number: __________________________________
2. Agent Information
Name: _________________________________________
Address: ______________________________________
City/State/ZIP: _________________________________
Phone Number: __________________________________
3. Powers Granted
This POA grants the Agent authority to act on the Principal’s behalf in the following matters (initial next to each power you are granting):
- ____ Real Property Transactions
- ____ Banking and Other Financial Institution Transactions
- ____ Personal and Family Maintenance
- ____ Government Benefits
- ____ Retirement Plan Transactions
- ____ Taxes
- ____ Gifts
- ____ Legal Matters
- ____ Health Care Billing and Payment Matters
- ____ All of the Above
4. Duration
This Power of Attorney ____ be durable, meaning it ____ remain in effect if I become disabled or incapacitated. If not durable, it will terminate upon my disability or incapacity.
5. Third Party Reliance
Any third party who receives a copy of this document may act under it. Revocation of this POA is effective as to a third party only upon the third party receiving actual notice of the revocation.
6. Signatures
I, the Principal, hereby revoke any previous Powers of Attorney granted and affirm that this POA reflects my wishes. This document is signed on this day, ____________________, 20____, under the laws of the State of North Carolina.
Principal’s Signature: ___________________________
Agent’s Signature: ______________________________
Witness #1 Signature: ___________________________
Witness #2 Signature: ___________________________
7. Notarization
This document was acknowledged before me on this day, ______________________, 20____, by the Principal.
Notary Public: _________________________________
Commission Expiration: _________________________