48-15 Renewal Case, Clyde

Permit Class
RENEWAL
STATE OF NORTH CAROLINA
Department of Environmental Quality
and
Coastal Resources Commission .
Permit
for
X Major Development in an Area of Environmental Concern
pursuant to NCGS 113A-118
_ Excavation and/or filling pursuant to NCGS 113-229
Permit Number
48-15
Issued to Melanie Case 233 Deep Bay Drive, Newport, NC 28570
Authorizing development in Carteret County at adi. to Bogue Sound, at 233 Deep Bay
Drive, in Newport , as requested in the permittee's application dated letter dated
12/12/18.
This permit, issued on January 4, 2019 is subject to compliance with the application (where consistent
with the permit), all applicable regulations, special conditions and notes set forth below. Any violation of these terms may
1) This renewal shall be attached to Permit No. 48-15, which was issued to Clyde B. Case III on
4/14/15, and copies of both documents shall be readily available on site when a Division
representative inspects the project for compliance.
2) All conditions and stipulations of the active permit remain in force under this renewal.
NOTE: The N.C. Division of Water Resources has assigned the proposed project DWR Project No.
2015-0200.
NOTE: The U.S. Army Corps of Engineers has assigned the proposed project SAW Action Id. No.
2015-2015-00481.
NOTE: A permit renewal application processing fee of $100 was received by DCM for this project.
This permit action may be appealed by the permittee or
other qualified persons within twenty (20) days of the issuing
date.
This permit must be accessible on -site to Department
personnel when the project is inspected for compliance.
Any maintenance work or project modification not covered
hereunder requires further Division approval.
All work must cease when the permit expires on
December 31, 2020
In issuing this permit, the State of North Carolina agrees
that your project is consistent with the North Carolina Coastal
Management program.
Signed by the authority of the Secretary of DEQ and the
Chairman of the Coastal Resources Commission.
�/ &we
Braxton e.Davis, Director
Division of Coastal Management
This permit and its conditions are hereby accepted.
Signature ofPermittee

Coastal Management
ENVIRONMENTAL QUALITY
Melanie Case
233 Deep Bay Drive
Newport NC, 28570
Dear Mrs. Case:.
January 4, 2019
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRAXTON C. DAVIS
Director
The enclosed permit constitutes authorization under the Coastal Area Management Act,
and where applicable, the State Dredge and Fill Law, for you to proceed with your project
proposal. The original (buff -colored form) is retained by you and it must be available on site
when the project is inspected for compliance. Please sign both the original and the copy and
return the copy to this office in the enclosed envelope. Signing the permit and proceeding
means you have waived your right of appeal described below.
If you object to the permit or any of the conditions, you may request a hearing pursuant
to NCGS 113A-121.1 or 113-229. Your petition for a hearing must be filed in accordance with
NCGS Chapter 150B with the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, NC 27611-6714, [phone] within twenty (20) days of this decision on your
permit. You should also be aware that another qualified party may submit an objection to the
issuance of this permit within twenty (20) days.
The project plan is subject to those conditions appearing on the permit form. Otherwise,
all work must be carried out in accordance with your application. Modifications, time extensions,
and future maintenance requires additional approval. Please read your permit carefully prior to
starting work and review all project plans, as approved. If you are having the work done by a
contractor, it would be to your benefit to be sure that he fully understands all permit
requirements.
From time to time, Department personnel will visit the project site. To facilitate this
review, we request that you complete and mail the enclosed Notice Card just prior to work
initiation. However, if questions arise concerning permit conditions, environmental safeguards,
or problem areas, you may contact Department personnel at any time for assistance. By
working in accordance with the permit, you will be helping to protect our vitally important coastal
resources.
Enclosure
incerely,
Douglas V. Huggett
Major Permits Manager
N.C. Division of Coastal Management
State of North Carolina i Environmental Quality I Coastal Management
Morehead City Office 1400 Commerce Avenue I Morehead City, NC 28557
252 8082808

COASTAL PLANNING SERVICES, INC.
Kathy B. Vinson, AICP
Comprehensive Land Use Planning and Development Assistance
P.O. Box 827 Office 252.354.4916
Morehead City, NC 28557 Fax [phone]
kbvinsonCa.ec.rr.com Mobile [phone]
December 12, 2018
Ms. Heather Styron C E I V E D
NC Division of Coastal Management RECEIVED
400 Commerce Avenue 1 O 1
Morehead City, NC 28557 O E C 13 _' 018
D CITY
Re: Major Permit 48-15 DCM-MHD CITY
Clyde B. Case, III and Melanie Case
Dear Heather:
Major CAMA permit 48-15 was issued to Clyde B. Case, III on April 14, 2015 and will expire on
December 31, 2018. The permit authorizes improvements to an existing pier, including an extension of
the main pier, construction of an additional platform, relocation of an existing boatlift, and installation of
a new boatlift and a single -pole jet -ski lift. The project site is located at 233 Deep Bay Drive, Newport,
North Carolina. Work authorized by the permit has not been constructed.
Mr. Case passed away in November 2018. His wife, Melanie Case, is the executor of his estate and holds
his power -of -attorney. She is requesting that the permit be renewed and transferred to her name. Please
also change the address of the permit holder on the permit document and mail the renewed permit to Mrs.
Case at 233 Deep Bay Drive, Newport, NC 28570.
Enclosed with this request are copies of the original permit and an agent letter authorizing me to act on
behalf of Mrs. Case. Also included are copies of the power -of -attorney and the executor decree. Check
# 1208 in the amount of $100.00 written on the account of Coastal Planning Services, Inc. is included to
cover the renewal fee.
Thank you for your assistance. Please let me know if you have questions or need additional information.
Sincerely,
Kathy B. Vinson, AICP
Enclosures co
00
oOK

DCM Coordinator: ;JOB "J Permit SD
MAH ING DISTRIBUTION SHEET
Permittee:
DCM Field Offices
Elizabeth City U (with revised work plan drawings)
1,Morehead City �1M7 /b✓I
Washington
Wilmington
Li�y:IKi]�i3 rf�'F
Washington: Raleigh Bland (Beaufort, Camden, Chowan, Craven, Hertford, Hyde, Perquimans,
Tyrrell)
Josh Peletier (Bertie, Currituck, Dare, Gates, Pamlico, Pasquotank, Washington)
Tom Steffans (NC DOT- Beaufort, Carteret, Craven, Pamlico)
Bill Biddlecome (NC DOT -Remainder ECity/Washington District)
Wilmington: Tyler Crumbley (Brunswick, New Hanover)
*Liz Hair (Carteret, Onslow, Pender)
Brad Shaver (NCDOT-Brunswick, New Hanover, Onslow, Pender)
Cultural Resources:
Public Water Supply:
Marine Fisheries:
NC DOT:
Shellfish Sanitation:
State Property:
DEMLR/DWR:
Renee Gledhill -Earley at [e-mail]
Heidi Cox (WIRO)
Shane Staples
David Hams
Shannon Jenkins / Sharron Gupton
Tim Walton / Mike Moser
Sheri Montalvo
Clif Whitfield (WARD)
Curt Weychert
Washington: Anthony Scarbraugh401
Roger Thorpe-Stormwater
Garcy Ward- (NCDOT-Beaufort, Bettie, Camden, Carteret, Chowan, Craven, Currituck,
Dare, Gates, Hertford, Hyde, Pamlico, Pasquotank, Perquimans, Tyrrell, Washington)
Wilmington: Robb Mairs — 401 (Carteret, Onslow, Ponder)
Chad Coburn — 401 (Brunswick, New Hanover)'
Georgette Scott - Stormwater
Joanne Steenhuis - 401 (NCDOT-Brunswick, New Hanover, Onslow, Pender)
Wildlife Resources:
Natural Heritage Program
LPO:
Maria Dunn (WARO)
Rodney Butler
Fax Distribution: Permittee #: Agent#
(NCDOT) Travis Wilson

DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
69 DARLINGTON AVENUE
WILMINGTON, NORTH CAROLINA 28403-1343
February 19, 2019
Regulatory Division
Action ID No. SAW-2015-00481, General Permit No. 198000291 No• �(B�t'�
Ms. Melanie Case
233 Deep Bay Drive
Newport, North Carolina 28570
Dear Ms. Case:
Through coordination with the North Carolina Division of Coastal Management, we
have learned of your request to renew the work associated with your Department of the
Army (DA) permit issued on May 4, 2015 to construct an extension to an existing
docking facility to include a pier, platform, jet -ski lift, and two boat lifts within Bogue
Sound. The property currently has an existing one -slip docking facility -171 ft from the
edge of coastal wetlands within shallow bottom SAVs. The proposal includes the
placement of a 4.5' x 404' pier, a 16' x 29' platform with an 18' x 20' covered area, a 5' x
8' jet -ski lift (over the platform) and two 13' x 13' boatlifts (one will be relocated from
existing placement). This project is located at 233 Deep Bay Drive, adjacent to Bogue
Sound, in Newport, Carteret County, North Carolina. Coordinates in Decimal Degrees
are: 34.72609 N,-76.88752 W..
Your proposal continues to be consistent with the provisions and objectives of
general permit 198000291 (copy enclosed). The permit is hereby renewed. It is
understood that all conditions of your permit conditions remain applicable and that the
expiration date of your DA permit is December 31, 2021.
Please read the enclosed permit to prevent an unintentional violation of Federal
law. As this Department of the Army regional general permit does not relieve you of the
responsibility to obtain any other required approvals, you should contact appropriate
State and local agencies before beginning work.
RECEIVED
F E B 1 9 2019
MP SECTION MHD

-2-
Thank you for your time and cooperation. If you have questions, please contact
Liz Hair, of the Wilmington Regulatory Field Office, telephone: [phone].
Sincerely,
Liz Hair, Project Manager
Wilmington Regulatory Field Office
Enclosure:
GP 291 conditions
CAMA Permit
Electronic Copy Furnished (without enclosures):
NCDEQ/DCM; Mr. Doug Huggett
NCDEQ/DCM: Mr. Gregg Bodner
NCDEQ/DCM: Mr. Ryan Davenport
NCDEQ/DWR; Mr. Robb Mairs
NCDEQ/DWR; Ms. Karen Higgins
RECEIVED
FEB 1 9 2019
fill' SECTION MHD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRAXTON C.'DAVIS
Director
MEMORANDUM:
TO: Gregg Bodnar
Thru: Roy Brownlow
FROM: Heather Styron
NORTH CAROLINA
Environmental Quality
SUBJECT: Transfer/Renewal Request - CAMA Major Permit, 48-15, Clyde B.
Case III and Melanie Case, 233 Deep Bay Drive, Newport, Carteret
County
DATE: December 19, 2018
Please find attached a request from Mrs. Melanie Case, representing the Clyde B
Case estate, to transfer and renew State Permit #48-15 into the name of Melanie
Case. The permit was issued on 4/14/15 and is set to expire on December 31, 2018.
A. copy. of the 11/1 /18 Power of Attorney is attached showing -ownership _of the -
property by Mrs. Melanie Case.
By virtue of 15A NCAC 07J .0406 and 15A NCAC 07J .0404, the permittee is
allowed a transfer and a two-year extension on this, Permit. This district
recommends the transfer and renewal be authorized as proposed.
A check in the amount of $100.00 has been submitted for the renewal request
(transfer fee was waived).
RECEIVED
DEC 1 9 2018
IMP SECTION RAH®
North Carolina Department of Environmental Quality I Division of Coastal Management
Morehead City Office 1 400 Commerce Avenue I Morehead City, North Carolina 28557
252.8082808

Melanie Case
233 Deep Bay Drive
Newport, North Carolina 28570
December 10, 2018
To Whom It May Concern:
I authorize Kathy Vinson, AICP to represent me and apply for CAMA permits to develop
property located at 233 Deep Bay Drive, Newport, Carteret County, North Carolina. This
authorization extends to all permits and authorizations required by local, state, and
federal agencies that may be required as part of the permitting process.
Please feel free to contact me at [phone] if you have questions or need additional
information.
Sincerely,
Melanie Case
RECEIVED
DEC 13 '119
DCM-MHD CITY

{
NEW
Class -�4 c v I tLsV-V- -�
STATE OF NORTH CAROLINA
Department of Environment and Natural Resources
and
Coastal Resources Commission
Vermit
for
X Major Development in an Area of Environmental Concern
pursuant to NCGS I I3A-118
_ Excavation and/or filling pursuant to NCGS 113-229
Permit Number
48-15
Issued to Clyde B. Case, III, 252 US Hwy 70 West, Havelock, NC 28532
Authorizing development in Carteret County adi. Bogue Sound, at 233 Deep Bay Drive, in
Newport , as requested in the permittee's application dated 1/21 /15, including the
attached workman drawings (2). 1 dated revised 1/19/15 and 1 dated revised 1/13/15
This permit, issued on April 14, 2015 , is subject to compliance with the application (where consistent
with the permit), all applicable regulations, special conditions and notes set forth below. Any violation of these terms may
tie suoJect to lines, imprisonment or crvu action; or may cause me permit to oe nun aria vom.
1) In order to satisfy the requirements of the rules of the Coastal Resources Commission, and in
accordance with the authorized agent's email dated 4/14/15, no portion of the authorized docking
facility shall extend into the waters of Bogue Sound more than 536' feet, as measured from the
waterward edge of the coastal wetlands.
Docking Facility
2) Unless specifically altered herein, this permit authorizes the docks, piers, and other structures and
uses located in or over the water that are expressly and specifically set forth in the permit application.
No other structure, whether floating or stationary, shall become a permanent part of this reconfigured
docking facility without permit modification. No non -water dependent uses of structures shall be
conducted on, in or over public trust waters without permit modification.
(See attached sheets for Additional Conditions)
This permit action may be appealed by the permittee or
other qualified persons within twenty (20) days of the issuing
date.
This permit must be accessible on -site to Department
personnel when the project is inspected for compliance.
Any maintenance work or project modification not covered
hereunder requires further Division approval.
All work must cease when the permit expires on
December 31, 2018
In issuing this permit, the State of North Carolina agrees
that your project is consistent with the North Carolina Coastal
Management Program.
Signed by the authority of the Secretary of DENR and the
Chairman of the Coastal Resources Commission.
s'1M ="f
�5 Braxton C. Davis, Director
J Division of Coastal Management
phECEIV E D
is permit and its conditions are hereby accepted.
DEC 13 2018
DCM-MHD CITY
Signature of Permittee

Clyde B. Case, III Permit 9 48-15
Page 2 of 3
ADDITIONAL CONDITIONS
3) Any portion of the permitted docking facility built over wetlands shall be elevated a minimum of three
feet over the wetland substrate as measured from the bottom of the decking.
4) No attempt shall be made by the pennittee to prevent the full and free use by the public of all navigable
water at or adjacent to authorized work.
5) The permittee shall maintain the authorized work in good condition and in conformance with the terms
and conditions of this permit. The pen- ittee is not relieved of this requirement if he abandons the
permitted activity without having it transferred to a third party.
6) This permit does not authorize the interference with any existing or proposed Federal project, and the
pennittee shall not be entitled to compensation for damage to the authorized structure or work, or injury
which may be caused from existing or future operations undertaken by the United States in the public
interest.
7) The permittee shall install and maintain at his expense any signal lights or signals prescribed by the U.S.
Coast Guard, through regulation or otherwise, on the authorized facilities. At a minimum, permanent
reflectors shall be attached to the structures in order to make them more visible during hours of darkness
or inclement weather.
8) This permit authorizes three formalized boat slips.
General
9) The permittee understands and agrees that, if future operations by the United States requires the
removal, relocation, or other alteration of the structure or work authorized by this permit, or if in the
opinion of the Secretary of the Army or his authorized representative, said structure or work shall cause
unreasonable obstruction to free navigation of the navigable waters, the permittee will be required, upon
due notice from the Corps of Engineers, to remove, relocate or alter the structural work or obstructions
caused thereby, without expense to the United States or the state of North Carolina. No claim shall be
made against the United States or the state of North Carolina on account of any such removal or
alteration.
10) No open water areas or vegetated shall be excavated or filled, outside the area indicated on the attached
workplan drawings.
11) This permit shall not be assigned, transferred, sold, or otherwise disposed of to a third party without the
written approval of the Division of Coastal Management.
12) The permittee and/or contractor shall meet with a representative of the Division of Coastal Management
prior to project initiation in order to discuss the conditions set forth in this permit.
RECEIVED
rEG 13 2018
DCM-MHD CITY

Clyde B. Case, III Permit # 48-15
Page 3 of 3
ADDITIONAL CONDITIONS
NOTE: This permit does not eliminate the need to obtain any additional state, federal or local permits,
approvals or authorizations that may be required.
NOTE: Future development of the permittee's property may require a modification of this permit.
Contact a representative of the Division at [phone] prior to the commencement of any
such activity for this determination. The permittee is further advised that many non -water
dependent activities are not authorized within 30 feet of the normal high water level.
NOTE: The U.S. Army Corps of Engineers authorized the proposed project under COE Action Id. No.
SAW-2015-00481.
NOTE: An application processing fee of $250 was received by DCM for this project.
RECEIVED
DEC 13 2018
DCM-MHD CITY

J
('oN'1' OF`Irll tF, Box fxw
NE{1T'oR'P. NORTH CARD LINA 28570_({)08
WUMV AnjwwB ;
26711011ARb 11017LEPARI)
TELEPROSE [phone]
FA!•.ynnLE [phone]
N.C.G.S. §47-43.1 Execution and acknowledgment of instruments by
attorneys or attorney -in -fact.
When an instrument purports to be executed by parties
acting through another by virtue of a power of attorney, it shall
be sufficient if the attorney or attorney -in -fact signs such
instrument either in the name of the principal by the attorney or
attorney -in -fact or signs as attorney or attorney -in -fact for the
principal; and if such instrument purports to be under seal, the seal
of the attorney -in -fact shall be sufficient. For such instrument
to be executed under seal, the power of attorney must have been
executed under seal.
EXAMPLE: John Doe by his attorney -in -fact Jane Doe; or
Jane Doe, attorney -in -fact for John Doe.
RECEIVED
DEC 13 2M
DCM-MHD CITY

STATE OF NORTH CAROLINAPOR OF STATUTORYFOR CLYDE BROWEg ASE III ATTORNEY
COUNTY OF CARTERET
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD
AND SWEEPING. THEY ARE DEFINED IN CHAPTER 32C OF THE NORTH CAROLINA
THE GENERAL
E ERENT FORMES POWERWHICHEXPRESSLY
OATTORNEY TDIFDESIRED BY TIIE PARTIEE OF ANY OTHER OR
CONCERNED. ,
IMPORTANT W ORMATION:
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 health care
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.
� 44'
Initials
RECEIVED
D-G. w.-,yt,�< CITY

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 coagent, successor coagent, or second successor coagent in the
Additional Provisions and Exclusions. Coagents, successor coagents, or second successor
coagents 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 this Power of Attorney or the authority you
are granting to your agent, you should seek legal advice before signing this form.
DESIGNATION OF_AGCENTS:
I, CLYDE BROWER CASE III, name the following persons as my agents to act
together or independently:
Name and Address of Agents:
MELANIE YOUNG CASE and JANICE BOX YOUNG
233 Deep Bay Drive 404 Grenville Avenue
Newport, North Carolina 28570 New Bern, North Carolina 28560
If either MELANIE YOUNG CASE or JANICE BOX YOUNG should die,
resign, or become incapacitated, in that event and thereafter, the remaining one of them shall
have full power to act as my agent:
INITIAL below if you want to give an agent the power to name a successor agent.
(C 6<"� I give to my acting agent the full power to appoint another to act as my agent, and
full power to revoke such appointment, if no agent named by me above is willing or able to act.
Cam_
Initials
Date
RECEIVED
DEC 13 2018
DCM-ev HD CITY
CANT OF GENERAL AUTHORITY:

QRAN_TQF 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. If
you wish to grant general authority over all of the subjects, you may initial "All Preceding
Subjects" instead of initialing each subject.)
(_
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
&+ All Preceding Subjects
GRANT OF SPECIFIC AUZ fORITY
(OPTIONAL)
My agent MAY NOT do any of the following specific acts for me UNLESS I
have INITIALED the specific authority listed below:
CAUTION: Granting any of the following will give your agent the authority to
take actions that could significantly reduce your property or change how your property is
distributed at your death. INITIAL ONLY the specific authority you WANT to give your agent.
44 af,,-t-
Initials
RECEIVED
DEC 13 2018
DCM-MHD CITY

CQF Make a gift, subject to the limitations provided in G.S. 32C-2-217
( or Create or change rights of survivorship
( C&- Create or change a beneficiary designation
a Authorize another person to exercise the authority granted under this power of
attorney
( Car'}, f l Waive my right to be a beneficiary of a joint and survivor annuity, including a
survivor benefit under a retirement plan
C Exercise fiduciary powers that I have authority to delegate
�2 I y Disclaim or refuse an interest in property, including a power of appointment
( 11;,Access the content of electronic communications
EXERCISE OF SPECIFIC AUTHORITY IN FAVOR OF AGENT
(OPTIONAL)
( % 7l �) 1; UNLESS INITIALED, an agent MAY NOT exercise any of the grants of specific
authority initialed above in favor of the agent or an individual to whom the agent owes a legal
obligation of support.
ADDITIONAL PROVISIONS AND EXCLUSIONS
(OPTIONAL)
EFFECTIVE DATE
This power of attorney is effective immediately.
NOMINATION OF GUARDIAN
(OPTIONAL)
INITIAL below ONLY if you WANT your acting agent to be your Guardian.
( IC i 4 fir} If it becomes necessary for a court to appoint a guardian of my estate or a general
guardian, I nominate my agent acting under this power of attorney to be the guardian to serve
without bond or other security.
Initials
i Date
RECEIVED
V"M-OMHD CITY
RELIANCE ON THIS POWER OF ATTORNEY

RELIANCE ON THIS POWER OF ATTORNEY
Any person, including my agent, may rely upon the validity of this power of
attorney or a copy of it unless that person knows it has terminated or is invalid.
MEANING AND EFFECT
The meaning and effect of this power of attorney shall for all purposes be
determined by the law of the State of North Carolina.
The attachment to this Power of Attorney of a physician's
's � or business affairs a
that 1 am
either physically or mentally incapable of managing y personal
condition precedent to the exercise of any powers granted hereunder.
SIGNATURE AND ACKNO�GMENT
Came - r40t,3-9 (��g
CLYDE BROWER CASE LU
STATE OF NORTH CAROLINA
COUNTY OF CARTERET
/ a Z /-7 �,..
Date
On this the 15' day of, 2018, personally appeared before me
the said named CLYDE BROWER CASE to me known and known to me to be the person
described in and who executed the foregoing instrument, and he acknowledged that he executed
the same and being duly sworn by me, made oath that the statements in the foregoing instrument
are true. _ r
My Commission expires:
5
1.
Notary Public
%1610TARV
~G Jj c
PU BL%
r��f �11��001,�

LAST WILL AND TESTAMENT
I, CLYDE BROWER CASE III, domiciled in Carteret County, North Carolina,
declare this to be my Last Will hereby revoking all Wills and Codicils previously made by me.
IMPRIMIS
At the present time, my immediate family consists of my spouse, MELANIE
YOUNG CASE, my spouse's son, JOSHUA CRAIG SMITH, born June 17, 1982, my spouse's
daughter, JENNIFER HELEN O'NEIL, born September 25, 1985, and my spouse's daughter,
MADISON GABRIELLE STEPP, born May 3, 2002.
CASE.
All references in this Will to "my spouse" shall refer to MELANIE YOUNG
All references in this Will to "my children" or other similar reference shall refer to
my spouse's children named above. All references in this Will to "my issue" shall refer to such
children and their issue. Except as otherwise provided, the "children" and "issue" of any
individual other than me shall be limited to (i) such individual's natural children and issue and
(ii) any person adopted prior to the time such person reaches the age of eighteen (18) years (and
shall include the issue of such adopted person, whether natural or by adoption prior to the age of
eighteen (18) years).
ARTICLE I
EXECUTOR PROVISIONS
A. Appointment of Executor. I appoint my spouse as Executor of this Will.
If my spouse shall predecease me, or for any reason shall fail to qualify as Executor, or having
qualified, shall die, resign or become incapable of serving for want of mental or physical
condition to act, then I appoint BETH ANN MARTIN as Executor of this Will; and in such
capacity BETH ANN MARTIN shall possess and exercise all powers and authority herein
conferred upon my Executor.
I direct that no bond or other surety be required of any Executor serving
hereunder.
COPY
THE ORIGINAL OF THIS DOCUMENT
IS ON FILE IN THE OFFICES OF
WARD AND SMITH, PA
RECEIVED
DEC 13 2018
DCM-MHD CITY

B. Expenses. Any individual Executor shall be entitled to reimbursement for
out-of-pocket expenses incurred.
C. Compensation of Individual Executor. My spouse shall serve as Executor
without compensation. Any other individual Executor shall be entitled to reasonable
compensation for services as Executor.
ARTICLE II
TRUSTEE PROVISIONS
A. AjTQmtment of Trustee. I appoint my spouse as Trustee of all trusts
created under this Will. If my spouse shall predecease me, or for any reason shall fail to qualify
as Trustee, or having qualified, shall die, resign or become incapable of serving for want of
mental or physical condition to act, then I appoint BETH ANN MARTIN as Trustee and in such
capacity, BETH ANN MARTIN shall possess and exercise all powers and authority herein
conferred upon my Trustee.
B. Expenses. Any individual Trustee shall be entitled to reimbursement for
out-of-pocket expenses incurred.
C. Compensation_of Individual Trustee. My spouse shall serve as Trustee
without compensation. Any other individual Trustee appointed hereunder shall be entitled to
reasonable compensation commensurate with the duties and responsibilities assumed. Any
individual Trustee appointed by a person having the authority hereunder to make such
appointment shall be entitled to receive such compensation, if any, as shall be directed in the
instrument appointing such individual as Trustee.
D. Compensation of Corporate Trustee. Except as otherwise established in
accordance with a written agreement between the Trustee and the person having the authority to
appoint a successor Trustee, as compensation for its services as Trustee, any corporate Trustee, if
such be the case, shall receive the commissions stipulated in its regularly adopted schedule of
compensation in effect and applicable at the time of the performance of such services.
E. Resi nation. Remov_al,_and Appointment of Trustee. Each Trustee
hereunder (whether originally designated herein or appointed as successor) shall have the right to
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beneficiary under a durable power of attorney who has authority to act and bind the beneficiary,
or if none, (ii) the general guardian or guardian of the beneficiary's estate, or if none, (iii) the
guardian of the beneficiary's person, or if none, (iv) the beneficiary's parent who is a lineal
descendant of my spouse.
No one dealing with my Trustee is required to see to the application by my
Trustee of the funds or other properties it receives. My Trustee shall not be liable for
depreciation in the value of properties held in trust or for reasonable errors of judgment, or for
any act, or failure to act, not amounting to negligence, bad faith or positive wrongdoing.
No judicial proceeding or approval shall be required with respect to any
resignation of a Trustee or the appointment of a successor Trustee; and no approval shall be
required by any Court of the accounting or other records of any Trustee hereunder, specifically
including the final accounting of the original or other previous Trustee.
A successor Trustee may indicate acceptance of the trusteeship by signing an
instrument to that effect and delivering it to the then acting Trustee, if any, or by any other
method allowed by law. Any successor Trustee hereunder shall possess and exercise all powers
and authority herein conferred on the original Trustee.
ARTICLE III
DISPOSITION OF PERSONAL EFFECTS
AND OTHER TANGIBLE PERSONAL PROPERTY
I give to my spouse, if my spouse survives me, all of my personal effects and all
tangible personal property not otherwise specifically gifted, including automobiles (owned by me
and held for personal use at the time of my death), coins, stamps and any collectibles, but
excluding all cash (other than collectible bills and coins), intangibles and any tangible personal
property customarily used in connection with any business in which I shall be engaged or
interested at the time of my death.
If my spouse does not survive me, I give the above -described property, subject to
the exceptions, to my Executor to be divided into two (2) parts. The first part shall contain such
property as my Executor determines I would wish to have preserved for my children and issue.
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The second part shall contain the balance of such property, if any. I direct my Executor to store
or deliver the first such part in substantially equal shares to my surviving children and the
surviving issue of deceased children as my Executor, in its sole discretion, may determine. I
direct my Executor to dispose of the second part by sale (with the proceeds to be distributed as
part of my residuary estate) or otherwise as my Executor, in its sole discretion, shall determine to
be appropriate under the circumstances then existing. Any determination or division of property
made or other action taken by my Executor pursuant to the provisions of this Article shall be
conclusive and binding upon all persons interested in my estate.
In any distribution under this Article, if any beneficiary shall be a minor or under
any other legal disability, my Executor may deliver such beneficiary's share to the person with
whom such beneficiary is residing, to such beneficiary's legal guardian, to itself or any other
person my Executor shall select as custodian under the North Carolina Uniform Transfers to
Minors Act, to the trustee of any trust of which such person is a current beneficiary or directly to
such beneficiary. The receipt of the guardian, the person with whom such beneficiary resides,
the custodian, the trustee or such beneficiary shall constitute a full acquittance of my Executor
with respect to the legacy so delivered. I direct that any expenses incurred in safeguarding or
delivering such property be paid from my estate as an administration expense thereof.
I request that any written instructions or directions which I may leave as to further
distributions of tangible personal property be honored.
ARTICLE IV
DISPOSITION OE RESIDUARY ESTATE
I give all of the remainder of my property which I may own at the time of my
death, real or personal, tangible or intangible, of whatsoever nature and wheresoever situated,
including all property which I may acquire or become entitled to after the execution of this Will,
and including all lapsed gifts or other gifts made by this Will which fail for any reason (but
excluding any property over or concerning which I may have any power of appointment),
hereinafter referred to as my residuary estate, to my Executor to be distributed as follows:
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A. If Spouse Survives. If my spouse survives me, then my residuary estate
shall be administered and disposed of as follows:
I. Estate Tax Exists. If the federal estate tax law is in effect at
the time of my death, then my residuary estate shall be administered and
disposed of as follows:
a. Credit Shelter Bequest. The Credit Shelter
Bequest, as defined in this Will, shall be distributed to my
Trustee, in trust, called the Family Trust, and administered
and disposed of in accordance with ARTICLE V.
b. Marital Bequest. The Marital Bequest, as
defined in this Will, shall be distributed to my Trustee, in
trust, called the Marital Trust, and administered and
disposed of in accordance with ARTICLE VI.
2. Estate Taal Does Not Exist. If the federal estate tax law is
not in effect at the time of my death, then my residuary estate shall be
distributed to my Trustee, in trust, called the Marital Trust, and
administered and disposed of in accordance with ARTICLE VI.
3. Disc aimer. My spouse shall have the right to disclaim all
or any portion of the property allocated to the Marital Trust or the Credit
Shelter Bequest. Any disclaimed property which would otherwise pass to
the Marital Trust shall be added to and become a part of the Family Trust
to be administered and disposed of in accordance with ARTICLE V. Any
disclaimed property which would otherwise pass as part of the Credit
Shelter Bequest shall be administered and disposed of in accordance with
paragraph B, as if my spouse did not survive me.
B. If Spouse Does Not Survive. If my spouse does not survive me, then my
residuary estate shall be administered and disposed of in accordance with ARTICLE VII.
C. General Provision Rertardinp. Tax Laws. For purposes of this Article, a
tax law is "in effect" at the time of my death if the law applies to my estate, regardless of whether
such law is enacted and made effective before my death or is enacted after my death but is made
effective retroactively to a date on or before my death.
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ARTICLE V
FAMILY TRUST
The Family Trust shall be administered and disposed of as follows:
A. Income. All or any part of the net income derived from this trust may be
paid to or applied for the benefit of my spouse and my father, not necessarily in equal shares or
amounts, as my Trustee shall from time to time determine for the health, education, support or
maintenance of my spouse and father. Any income not so used may be accumulated as income
or may be transferred to principal and reinvested; and any funds so accumulated may
subsequently be used in any manner as provided herein.
B. Princi al. If my Trustee determines that the income available to my
spouse and my father from all sources shall not be sufficient to meet the reasonable needs of my
spouse and my father, then in that event, I authorize my Trustee to pay to or apply for the benefit
of my spouse and my father, not necessarily in equal shares or amounts, so much of the principal
of this trust as my Trustee shall from time to time deem requisite or desirable for the health,
education, support or maintenance of my spouse and my father.
C. Distribution on Death. On the death of the second to die of my spouse and
father, the assets then constituting this trust shall be disposed of in accordance with
ARTICLE VII.
ARTICLE VI
MARITAL TRUST
The Marital Trust shall be administered and disposed of as follows:
A. Income. During the lifetime of my spouse, all of the net income derived
from this trust shall be paid to or applied for the benefit of my spouse in monthly or quarterly
installments.
B. Principal. If the income payable to my spouse in accordance with
paragraph A above, supplemented by income, other than capital gains, available from other
sources to my spouse, shall not be sufficient to meet the reasonable needs of my spouse in my
spouse's station in life, I authorize my Trustee to pay to or apply for the benefit of my spouse so
7

much of the principal of this trust as my Trustee shall from time to time deem requisite or
desirable for the health, education, support or maintenance of my spouse —even to the full extent
of the entire principal of this trust.
C. Distribution on Death of Spouse. On the death of my spouse, the assets
then constituting this trust shall be administered and disposed of in accordance with
ARTICLE VII.
D. Authority to Withhold for Taxes. On the death of my spouse, the Trustee
shall be authorized to withhold distribution of an amount of property sufficient, in its judgment,
to cover any liability that may imposed on the Trustee for estate or other taxes until such
liability is finally determined, and the Trustee shall be authorized to pay such funds or properties
to my spouse's estate or directly to the appropriate taxing authorities. Any such payment may be.
made on or before the due date of such taxes in order to avoid forcing my spouse's estate to pay
such taxes and seek reimbursement from this trust or the beneficiaries hereunder.
follows:
ARTICLE VII
DISTRIBUTION TO BENEFICIARIES
Any property passing under this Article shall be administered and disposed of as
A. Share for Issue of JOSHUA CASE and JESSICA CASE. Fifty percent
(50%) thereof shall be distributed as provided below. For purposes of this paragraph A, the
"issue" of JOSHUA CASE and JESSICA CASE shall be limited to such individual's natural
children and issue and shall not include any adopted person.
1. Share for Issue of JOSHUA CASE. One-half (1/2) thereof
(or all thereof if no issue of JESSICA CASE shall then be living) shall be
divided into equal shares so that there is one equal share for each then
living child of JOSHUA CASE and one equal share for each then
deceased child of JOSHUA CASE who leaves then surviving issue. Each
share set aside for a living child of JOSHUA CASE shall be distributed to
such child, and each share set aside for the issue of a deceased child of
JOSHUA CASE shall be distributed to such issue, per stirnes -- all subject
to paragraph A of ARTICLE XI. If no issue of JOSHUA CASE shall then

be living, such share shall be distributed in accordance with
subparagraph 2 below.
2. Share for Issue of JESSICA CASE. One-half (1 /2) thereof
(or all thereof if no issue of JOSHUA CASE shall then be living) shall be
divided into equal shares so that there is one equal share for each then
living child of JESSICA CASE and one equal share for each•then
deceased child of JESSICA CASE who leaves then surviving issue. Each
share set aside fora living child of JESSICA CASE shall be distributed to
such child, and each share set aside for the issue of a deceased child of
JESSICA CASE shall be distributed to such issue, per stimes -- all subject
to paragraph A of ARTICLE XI. If no issue of JESSICA CASE shall then
be living, such share shall be distributed in accordance with
subparagraph 1 above.
B. Remainder. The remainder thereof (or all thereof if no issue of JOSHUA
CASE and JESSICA CASE shall then be living) shall be administered and disposed of in
accordance with ARTICLE VIII.
ARTICLE VIII
DISTRIBUTION TO CHILDREN
Any property passing under this Article shall be distributed to my Trustee, in
trust, for the benefit of my children and administered and disposed of as follows:
A. Trust for Children and Issue. All or any part of the net income and
principal of this trust may be paid to or applied for the benefit of my living children and the issue
of any deceased child of mine as my Trustee shall from time to time determine for the health,
education, support or maintenance of such children and issue. Any income not so used may be
accumulated as income or may be transferred to principal and reinvested; and any funds so
accumulated may subsequently be used in any manner as provided herein.
When my youngest living child reaches the age of twenty-three (23) years or at
the death of my last living child, whichever first shall occur, this trust shall be divided into equal
shares so that there is one equal share for each then living child of mine and one equal share. for
each then deceased child of mine who leaves then surviving issue. I direct that such equal shares
shall be administered and disposed of as provided below.

B. Distribution to Children. Each share set aside for a living child of mine
who has reached the age of thirty-five (35) years shall be distributed to such child. Each share
set aside for a living child of mine who has not reached the age of thirty-five (35) years shall be
distributed to my Trustee, in trust, for the benefit of such child to be administered and disposed
of as provided in paragraph D below.
C. Distribution to Issue of Deceased Children. Each share set aside for the
issue of a deceased child of mine shall be distributed to such issue, per gjmgs, subject to
paragraph A of ARTICLE XI.
D. Separate Trusts for Children. All or any part of the net income or
principal of a child's trust shall be paid to or applied for the benefit of such child in such manner
and at such intervals and in such amounts as my Trustee from time to time shall deem requisite
or desirable for the health, education, support or maintenance of such child. Any income not so
used may be accumulated as income or may be transferred to principal and reinvested; and any
funds so accumulated may subsequently be used in any manner as provided herein.
At any time after such child reaches the age of twenty-five (25) years, such child
may withdraw principal and income from such child's trust, at such times as such child may
elect, in aggregate amount not to exceed one-half (1/2) of the "distribution amount." At any time
after such child reaches the age of thirty-five (35) years, such child may withdraw principal and
income from such child's trust in such amounts and at such times as such child may elect, even to
the exhaustion of the trust assets. The "distribution amount" shall be the sum of (i) the value of
such child's trust as of December 31 of the prior calendar year (or as of the date of initial funding
of the trust if a withdrawal is made during the first year), and (ii) the value of all previous
withdrawals (if any) from such trust by such child prior to the end of such preceding calendar
year valued as of the date or dates of such withdrawals. Such right of withdrawal shall he
exercised, if at all, by such child's notifying my Trustee in writing to such effect.
A child shall have the right to appoint part or all of the principal of such child's
trust as such child may determine to and among one or more or all of the creditors of such child's
estate; provided, however, that such child shall not have the right to appoint anyPppal'tCbRAQ
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that is wholly exempt from generation -skipping transfer tax under the generation -skipping
provisions of the Internal Revenue Code of 1986, as amended, or the corresponding provisions of
any tax law (the "GST Exempt Trust"), or the "Limited Share" of a trust that is not wholly
exempt (the "GST Non -Exempt Trust"). Such right shall be exercised, if at all, by such child by
an effective Will or Codicil specifically referring to this power of appointment. My Trustee may
rely upon an instrument admitted to probate in any jurisdiction as the Last Will of such child, but
if it has no written notice of the existence of such a Will within a period of three months after the
death of such child, it may be presumed that such child died intestate, and my Trustee shall be
protected in acting in accordance with such presumption. If this power of appointment shall not
be effectively exercised as to all or any portion of such trust, then, on the death of such child, so
much of such child's trust as shall not have been disposed of by the effective exercise of such
power of appointment shall be distributed to such child's then living issue, per stirpes, subject to
paragraph A of ARTICLE XI; or if such child has no issue then living, to my then living issue,
per stirpes, and their respective shares or proportions shall be administered and disposed of in
accordance with the terms and provisions of the trusts created under this Article for the benefit of
my children, or under paragraph A of ARTICLE XI for the benefit of my more remote issue, as
the case may be.
For purposes of the power of appointment granted hereunder, the "Limited Share"
of the GST Non -Exempt Trust is that portion of the child's GST Non -Exempt Trust at the child's
death which, if excluded from the child's gross estate for federal estate tax purposes and in
default of the exercise of the power of appointment granted under this Article, would pass only
to one or more persons assigned to the child's generation or a higher generation for federal
generation -skipping transfer tax purposes.
ARTICLE IX
GUIDELINES IN MAKING DISTRIBUTIONS
The following provisions apply to all trusts created under ARTICLE VIII and
paragraph A of ARTICLE XI of this Will:
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Prior to making any distribution otherwise permitted to be made to a beneficiary,
my Trustee shall consider whether such beneficiary is suffering from a chemical dependency to
alcohol or drugs and whether such distribution would be in the best interests of such beneficiary.
In the event that my Trustee determines, in its sole discretion, that such beneficiary is suffering
from a chemical dependency and that a distribution would not be in the best interests of such
beneficiary, my Trustee shall have the right to withhold such distribution.
To assist my Trustee in determining whether such beneficiary is suffering from a
chemical dependency to alcohol or drugs, my Trustee shall have complete discretion to require
tests for drug or alcohol use and to pay the costs of tests and analysis from the trust assets. Tests
may be announced or unannounced. My Trustee shall have absolute discretion to interpret any test
results as it deems proper. If such beneficiary refuses to submit to a test, my Trustee shall be
entitled to conclude that such beneficiary is suffering from a chemical dependency.
In the event my Trustee deems that such beneficiary is suffering from a chemical
dependency, then my Trustee may (but shall not be required to) pay costs of treatment from
income or principal directly to any hospital or rehabilitation center at which such beneficiary is
seeking medical services or treatment, whether as an in -patient or an out -patient.
ARTICLE X
GENERAL PROVISIONS REGARDING THE
CREDIT SHELTER BEQUEST AND THE MARITAL BEQUEST
A. "Credit Shelter Bequest" Defined. The "Credit Shelter Bequest" shall be
that fraction of my residuary estate, the numerator of which shall be equal to the largest amount,
if any, that can pass free of federal estate tax by reason of the applicable credit amount, any tax
referred to in Section 2001(b)(2) of the Code, any state death tax credit, and any other allowable
credits, exclusions, or exemptions (but only to the extent that the use of any credit for state death
taxes does not increase the death tax payable to any state), and the denominator of which shall be
equal to the value of my residuary estate. The numerator of this fraction will be reduced by
(i) the value of my adjusted taxable gifts, (ii) the value of all other dispositions of property
(whether passing pursuant to this Will or outside of this Will) which is includable in my gross
12

estate and does not qualify for the marital or charitable deduction, and (iii) charges to principal
that are not allowed as deductions in computing my federal estate tax (including death taxes
imposed upon my estate). The values as finally determined for federal estate tax purposes shall
be used in ascertaining this fraction.
I recognize that (i) it is possible that no property may be distributed under the
Credit Shelter Bequest; and (ii) the Credit Shelter Bequest may be affected by the exercise of
certain tax elections.
B. "Marital Bequest" Defined. The "Marital Bequest" shall be the remainder
of my residuary estate after the Credit Shelter Bequest has been funded.
My Executor is authorized to determine whether or not an election shall be made
to qualify all or any part of any terminable interest property for the marital deduction, but the
computation of the Marital Bequest and the Credit Shelter Bequest shall be made on the
assumption that my Executor has made the election to qualify all of the Marital Bequest for the
estate tax marital deduction as qualified terminable interest property, regardless of whether or not
such election is made.
If any portion of the Marital Bequest shall not qualify for the estate tax marital
deduction, that portion not so qualified may, in the discretion of my Trustee, be set apart as a
separate trust to be administered under the same terms and provisions as provided herein for the
qualified terminable interest property trust. The pro rata share of the federal estate tax payable
by reason of my death which is attributable to that portion of the Marital Bequest not qualified
for the marital deduction shall be charged against and paid from the assets comprising the
non -qualified portion thereof.
C. Payment of Income During Administration.. Prior to the satisfaction in full
of the Marital Bequest, my spouse shall be entitled to a portion of the income of my residuary
estate commensurate with the portion of my residuary estate designated as the Marital Bequest.
Such income shall be paid to or applied for the benefit of my spouse at such time or times as may
be determined by my Executor during the settlement of my estate, but no later than the
satisfaction in full of the Marital Bequest.
13

I further direct that any income taxes paid by my Executor in respect of income
attributable to the Marital Bequest shall be charged to and deducted from the net income payable
under this paragraph in such equitable manner as my Executor shall determine. The
determination of my Executor as to the amount of income to which my spouse is entitled under
this paragraph shall be final and conclusive as to all persons interested or clainvng to be
interested in my estate.
D. General Provisions Rep arding-Marital Bequest. To the extent possible, I
direct that the Marital Bequest shall be satisfied only out of assets that qualify for the marital
deduction under the provisions of the Internal Revenue Code applicable to my estate or out of the
proceeds of such assets, and that the Marital Bequest shall not be reduced by any estate,
inheritance, generation -skipping transfer taxes, or similar taxes paid out of property passing
under this Will. To the extent, also, that other assets qualifying for the marital deduction are
available, the Marital Bequest shall not be satisfied by the distribution of: assets with respect to
which a credit for foreign taxes paid is allowable under the federal Internal Revenue Code; or
policies of insurance on the life of my spouse or any other person.
Except as otherwise expressly provided herein, the decision of my Executor as to
which assets shall be distributed in satisfaction of the Marital Bequest; as to whether or not my
estate shall be valued under the optional valuation provisions of the federal estate tax law; as to
whether or not an election shall be made to qualify all or any part of any terminable interest
property for the marital deduction; as to what tax elections shall be exercised; and as to what
proceedings are necessary to complete the ascertainment of the federal estate tax, shall be
conclusive and binding on all persons, and no compensating adjustments between income and
principal or between the Marital Bequest and other bequests shall be required to be made as a
result of such tax elections exercised by my Executor.
It is my intention that the Marital Bequest shall qualify for the marital deduction.
My Executor shall be vested with all of the discretionary powers herein conferred, but neither my
Executor nor Trustee (if any) shall have any power or authority to exercise any of such
discretionary powers in any manner which would disqualify the Marital Bequest for the marital
14

deduction (except that this provision shall not prohibit an election not to qualify all or any part of
any terminable interest property for the marital deduction); and accordingly, all other provisions
of this Will shall be subordinate to this requirement.
E. Definitions. As used in this Will, the term "federal estate tax" means the
tax imposed on the transfer of a decedent's estate pursuant to Chapter 11 of the Internal Revenue
Code of 1986, as amended (the "Code"), or any similar tax imposed under any subsequent tax
law, whether or not specifically denominated as an "estate tax." Whenever used in this Article,
the words "marital deduction," "pass," "gross estate," "applicable credit amount," and
"terminable interest property" shall have the same meaning as such words have under the
provisions of the Code applicable to my estate.
F. Qualified Retirement Plan and Individual Retirement Account. If I am a
participant in a qualified retirement or deferred compensation plan (plan) (described in
Section 401(a), 403(a), 403(b) or 457 of the Internal Revenue Code) or am the owner of an
individual retirement account (IRA) (described in Section 408(a) or 408A of the Internal
Revenue Code) (hereinafter referred to as "the account"), and if my Trustee shall allocate all or
any portion of the account to a Marital Trust hereunder, then the following provisions shall
apply:
1. Distribution of Income and Principal. My Trustee shall
direct that the balance of such Marital Trust's share of the account as of
the date of my death be paid to such Marital Trust at least annually in
amounts which are equal to the greater of (i) all of the income of such
share of the account, or (ii) the minimum distribution amount required to
be distributed in accordance with Section 401(a)(9) or Section 408(a)(6) of
the Internal Revenue Code and the regulations thereunder.
My Trustee, in its discretion, may direct that additional amounts of
principal of such share of the account be paid to such Marital Trust.
Upon the death of my spouse, if the entire balance of such share of
the account is not otherwise payable to my Trustee, my Trustee shall
direct that all the undistributed income of such share of the account,
including income accrued to the date of my spouse's death, be paid to such
Marital Trust.
15

2. Determination and Allocation of Account Income. All
expenses of such Marital Trust allocable to principal, including but not
limited to income taxes payable on distributions from the account, shall be
charged to principal of such Marital Trust and not to the portion of such
share of any account distributions representing account income.
My Trustee shall allocate to the income of such Marital Trust (i) at
least annually during my spouse's lifetime, an amount equal to the income
of such share of the account, and (ii) upon my spouse's death, an amount
equal to the income of such share of the account accrued to the date of my
spouse's death but not previously allocated to income so that the income of
such share of the account so allocated shall constitute income of such
Marital Trust to be disposed of in accordance with,paragraph A of such
Marital Trust above.
3. Right to Convert Unnroductive Property. My Trustee shall
require that any unproductive property in such Marital Trust's share of the
account payable or allocated to such Marital Trust be converted into
productive property within a reasonable time upon receipt of signed
instructions from my spouse to this effect.
ARTICLE XI
GENERAL TRUST PROVISIONS
A. Trust to Specified Age. Except as otherwise provided in this Will, if any
of the funds and properties constituting a part of my estate shall vest in any person who shall be
under thirty-five (35) years of age at the time of vesting thereof in accordance with the foregoing
provisions of this Will, such funds and properties so vesting nevertheless shall pass to and be
held by my Trustee and be administered as a separate trust. All or any portion of the net income
therefrom or the principal thereof shall be applied, in such manner and at such intervals and in
such amounts as my Trustee shall deem requisite or desirable for the health, education, support
or maintenance of such person. Any income not so used may be accumulated as income or may
be transferred to principal and reinvested; and any funds so accumulated may subsequently be
used in any manner as provided herein.
At any time after such person reaches the age of twenty-five (25) years, such
person may withdraw principal and income from such person's trust, at such times as such person
16

may elect, in an aggregate amount not to exceed one-half (1 /2) of the "distribution amount." At
any time after such person reaches the age of thirty-five (35) years, such person may withdraw
principal and income from such person's trust in such amounts and at such times as such person
may elect, even to the exhaustion of the trust assets. The "distribution amount" shall be the sum
of (i) the value of such person's trust as of December'31 of the prior calendar year (or as of the
date of initial funding of the trust if a withdrawal is made during the first year), and (ii) the value
of all previous withdrawals (if any) from such trust by such person prior to the end of such
preceding calendar year valued as of the date or dates of such withdrawals. Such right of
withdrawal shall be exercised, if at all, by such person's notifying my Trustee in writing to such
effect.
If such person shall die prior to the termination of his or her trust, the assets
constituting such person's trust at the time of his or her death shall be distributed to the executors
or administrators of such person's estate.
B. Trustee to Consider Other Income. Whenever authorized to make a
discretionary disbursement of income or principal from any trust created under this Will to any
beneficiary thereof, my Trustee may take into consideration any other income (other than capital
gains) or property which such beneficiary or other person may have from any other source. For
all such sums so disbursed, my Trustee shall have full acquittance. All such disbursements shall
be charged against the trust fund from which they are made, and shall not be charged against any
individual share subsequently divided and distributed to any beneficiary.
C. Maximum Duration for Trusts. The maximum duration for trusts created
hereunder is the longest period that property may be held in trust under the applicable rules
governing perpetuities, vesting, accumulations, the suspension of alienation and the like. Upon
the expiration of the applicable period, a trust shall terminate. In the event of such termination,
in the absence of other specific vesting provisions contained in this instrument, the assets thereof
shall be distributed outright to such persons as are then entitled to the income therefrom and in
the same proportions; but if no person is then entitled to a specific portion of income, then to the
living income beneficiaries, per §times. This paragraph shall also apply to a trust created by the
17

exercise of a power of appointment conferred by this instrument (unless the exercise of the
power of appointment expressly commences a new rule against perpetuities or similar rule that
limits the time that property may remain in trust).
D. Direct Distributions. In the event that the contingencies provided in this
Will for the disposition of my trust estate to my beneficiaries shall occur prior to the delivery of
my residuary estate to my Trustee as herein provided, I direct that such residuary estate not be
delivered to my Trustee and that my Executor shall make the division and distribution of such
residuary estate directly to my beneficiaries pursuant to the terms of this Will.
E. Advancements to Beneficiaries. During the existence of any trust created
hereunder, my Trustee is authorized from time to time to transfer and deliver to any beneficiary
of such trust after the attainment of twenty-one (21) years of age by such beneficiary, discharged
of the trust, all or any part of the funds and properties then constituting such beneficiary's
proportionate share of the trust for the purpose of such beneficiary buying a home, entering a
business or profession or for any other purpose my Trustee shall deem proper, provided that my
Trustee determines that such beneficiary has demonstrated to my Trustee his or her need and
further has manifested such habits of industry and thrift together with sufficient financial acumen
and business ability to qualify such beneficiary prudently to use and manage such funds and
properties. Provided, further, that if my Trustee is a beneficiary of such trust, any such
distributions to my Trustee shall be limited to those requisite for his or her health, education,
support, or maintenance. There shall be no interest charged on any advancements made pursuant
to this paragraph and any such advancements made to a beneficiary shall be deducted from his or
her share or the share of his or her successors in interest upon distribution of the trust estate.
F. No Assignment or Alienation. All trusts created hereunder shall be
"spendthrift" trusts. No interest of a beneficiary in a trust created hereunder shall be voluntarily
or involuntarily alienated or encumbered by such beneficiary except as may be otherwise
expressly provided herein.
G. Governing Law and Principal Place of Administration. All trusts crested
hereunder (except as herein otherwise expressly provided) shall be governed by and construed in
III

accordance with, and the administration of properties held in any trust created hereunder shall be
determined by, the laws of the State of North Carolina without regard to my domicile or
residence or the situs of any property held in any trust created hereunder. The principal place of
administration for a trust shall be the State of North Carolina. Provided, however, my Trustee
may change the governing law or principal place of administration without notice to of consent
of the beneficiaries if it deems such change to be in the best interests of the beneficiaries.
H. Termination of Uneconomic Trusts. Except as otherwise provided in this
Will, if during the administration of any trust or trusts hereunder, the Trustee determines that the
value of any such trust is such that the continuation thereof is uneconomic or the Trustee
determines that the continuation of such trust is not in the best interests of the beneficiaries, then
the Trustee (excluding any Disqualified Trustee, as defined below) may terminate any such trust
or trusts and deliver the assets, discharged of all trusts, to the surviving beneficiaries who are
then or would have been entitled to the income therefrom and in the same proportions; but if no
beneficiary is then entitled to a specific portion of such income, then to the living income
beneficiaries, Mr sthM. If any beneficiary shall be under the maximum age permitted under
North Carolina law for assets held in custodianship for minors, the assets otherwise passing to
such beneficiary may be delivered to any person the Trustee shall select as Custodian under the
North Carolina Uniform Transfers to Minors Act.
I. Trustee Mav Confer Power. The Trustee (excluding any Disqualified
Trustee, as defined below), at any time prior to the death of any person for whom a trust shall
have been established herein ('Beneficiary"), by an instrument in writing may: (1) confer upon
the Beneficiary a power exercisable only by a Last Will and Testament to appoint all or part of
the assets of such trust to the creditors of the Beneficiary's estate (other than any taxing
authority), and the instrument conferring such power may require consent of the Trustee (other
than a Disqualified Trustee); (2) revoke any such instrument previously executed, with or
without executing a replacement instrument; and/or (3) irrevocably relinquish the powers
conferred under (1) and (2). Without limiting the Trustee's discretion, the Trustee may use the
authority conferred by this paragraph to subject the trust property to estate tax instead of the
19

generation -skipping transfer tax when it appears that it may reduce overall taxes to do so. The
Beneficiary's power conferred by this paragraph shall not be exercisable in any manner so as to
postpone the vesting of any estate or interest in the appointed property or to suspend the absolute
ownership or power of alienation of the appointed property for a period ascertainable without
regard to the date of my death, and the validity of any exercise shall be measured with respect to
that date.
J. Restrictions on Exercise of Powers. Notwithstanding any provisions
herein to the contrary, the powers granted in paragraphs H and I above shall not be exercised by
any Disqualified Trustee, as defined below. As used in this Article, "Disqualified Trustee"
means a Trustee who is: (i) a transferor of property to the trust, including a person whose
qualified disclaimer resulted in property passing to the trust; or (ii) a person who is or in the
future may be eligible to receive income or principal pursuant to the terms of the trust. A
Trustee described in (i) is a Disqualified Trustee only with respect to the transferred property
(including income and gain on, and reinvestment of, such property). A person is described in
(ii) even if he or she has a remote contingent remainder interest, but is not described in (ii) if the
person's only interest is as a potential appointee under a power of appointment held by another
person in his or her individual capacity, the exercise of which will take effect only in the future,
such as a testamentary power held by a living person. Such powers may be exercised only by the
Trustee or Trustees who are not Disqualified Trustees. If there is no Trustee who is not a
Disqualified Trustee, such powers may be exercised by a special fiduciary appointed by the court
pursuant to the provisions of North Carolina General Statutes, Section 36C-8-814. Any
corporate fiduciary so named or otherwise appointed shall be entitled to reasonable
compensation commensurate with the duties and responsibilities assumed.
K. Release from Liabilitv. The Trustee shall not be held liable to the trust or
to any beneficiary or third -party for any loss, damages, or other consequences resulting from its
action or failure to act with respect to the powers granted in paragraphs H and I above, and the
trust shall indemnify the Trustee against any and all claims, liabilities, penalties, and cost,
including attorney's fees, rising from any error of judgment, mistake of law, or any action or
PIC

failure to act by the Trustee, unless such liability or loss shall be proven by clear and convincing
evidence to have resulted directly from the Trustee's gross negligence or willful misconduct.
ARTICLE XII
PAYMENT OF DEBTS AND EXPENSES
I direct that all of my just debts, including unpaid charitable pledges whether or
not the same are enforceable obligations of my estate, my last illness expenses, my funeral
expenses including the cost of a suitable monument at my grave (whether or not such
expenditures exceed the limitations otherwise imposed by law) and the cost of administration of
my estate be paid out of the assets of my estate as soon as practicable after my death.
In the event that any property passing by reason of my death shall be encumbered
by any lien, the indebtedness secured by the lien shall not be charged to or paid from my estate;
and the beneficiary shall take such property subject to all encumbrances existing at the time of
my death.
Provided, however, that my Executor shall have the discretionary authority to pay
any such indebtedness if such payment does not increase the share of the beneficiary entitled to
any such encumbered asset.
ARTICLE XIII
PAYMENT OF TAXES
I direct that all estate, inheritance and generation -skipping transfer taxes and other
taxes in the general nature thereof (but specifically excluding any generation -skipping transfer
taxes which are not imposed as a result of a generation -skipping transfer made by me either
during my lifetime or at my death, and also specifically excluding any taxes payable by .reason of
the inclusion in my gross estate of any property in which I had a qualifying income interest for
life) together with any interest or penalty thereon, which shall become payable by reason of my
death, whether or not the property taxed passes under this Will, shall be equitably allocated
among the beneficiaries interested in my estate to whom such property is or may be transferred
or to whom any benefit accrues. For purposes of the federal estate tax or any tax in the general
nature thereof, such allocation shall be made in the proportion that the *b fl boperty,
OF" f3Z018
21
D�', ,o-MHD CITY

interest or benefit of each such beneficiary bears to the total value of the property, interests and
benefits received by all of such beneficiaries interested in my estate, except that in making such
allocation allowances shall be made for any exemptions granted by the law imposing the tax and
for any deductions, specifically including the marital deduction and the charitable deduction,
allowed by such law for the purpose of arriving at the amount of the tax. For purposes of any
state inheritance tax, or any tax in general nature thereof, such allocation shall be made on the
basis of the tax computed on the shares of the respective beneficiaries. Provided, however, that
no interest in income and no estate for years or for life or other temporary interest in any
property or fund (including, but not limited to, interests in trust) shall be subject to
apportionment as between the temporary interest and the remainder; and both the tax on the
temporary interest and the tax on the remainder shall be paid from the corpus of the property or
funds subject to the temporary interest and the remainder. As far as practicable my Executor
shall deduct the amount of such taxes allocable to each beneficiary from the amount distributable
to such beneficiary and shall recover from all others for the benefit of my estate their allocable
parts of such taxes.
Notwithstanding the foregoing, if any of the above -described taxes shall become
payable with respect to any property passing under ARTICLE III, such taxes shall be paid by my
Executor out of that portion of the principal of my residuary estate not qualifying for the marital
or charitable deduction, and I direct that no part of any such taxes be charged against or collected
from the organization or person receiving or in possession of the property taxed, or receiving the
benefit thereof.
If my spouse does not survive me, then under the Will of my spouse dated the
&�A ay of 2Vj�ir,-G A , 2016, there is created a qualified terminable interest property
trust. The assets in such trust or any other qualified terminable interest property trust at my death
or some portion thereof will be included in my gross estate, and such inclusion may increase the
taxes assessed upon my estate. Therefore, my Executor shall direct the Trustee under the Will of
my spouse, or the Trustee or other person in possession of any qualified terminable interest
property included in my estate, to pay to the appropriate tax authorities, when due, so much of
22

the death taxes due by reason of my death (together with any interest and penalties thereon) as
my Executor determines to represent the increase in such taxes, interest and penalties fairly
attributable to such trust property --to the end that the death taxes (together with any interest and
penalties thereon) which shall be paid from my estate shall not exceed such taxes, interest and
penalties computed as if this trust property were not taxable in my estate. In the absence of such
payment by such Trustee directly to the appropriate tax authorities, I direct my Executor to seek
reimbursement from such trust or the beneficiaries thereof for the taxes, interest and penalties as
determined above. If any other qualified terminable hiterest property is included in my gross
estate, nothing herein shall be interpreted as limiting the right of my Executor to recover from
the beneficiary receiving such property the death taxes (together with any interest and penalties
thereon) attributable to such property.
ARTICLE XIV
POWERS OF EXECUTOR AND TRUSTEE
A. General Powers. I hereby grant to my Executor and also to the Trustee of
each trust established hereunder, including any substitute or successor personal representative or
Trustee, the continuing absolute, discretionary power to deal with any property, real or personal,
held in my estate or in any trust, as freely as I might in the handling of my own affairs, including
the power to make any tax elections available to my estate or any trust created hereunder. Such
power may be exercised independently and without prior or subsequent approval of any court or
judicial authority, and no person dealing with the Executor or Trustee shall be required to inquire
into the propriety of any of their actions. Without in any way limiting the generality of the
foregoing and subject to North Carolina General Statutes, Section 32-26,1 hereby grant to my
Executor and also to my Trustee hereunder all the powers set forth in North Carolina General
Statutes, Sections 32-27 and 36C-8-815(a)(2) (which includes all of the powers set forth in
Section 36C-8-816), and these powers hereby are incorporated by reference and made a part of
this instrument and such powers are intended to be in addition to and not in substitution of the
powers conferred by law.
23

B. Liability for Actions of Predecessor. Any successor Executor, any
successor Trustee, or any Trustee that did not serve as Executor is authorized and directed to
accept from any prior Executor or Trustee the assets delivered by such prior Executor or Trustee
on the basis of the accounting therefor as submitted by such prior Executor or Trustee, without
requiring an audit or other independent accounting of the acts of such prior Executor or Trustee,
and any successor Executor or Trustee shall not have any duty, responsibility, obligation or
liability whatsoever for the acts or omissions of any prior Executor or Trustee.
C. Power to Select Assets. Notwithstanding any provision herein to the
contrary, I specifically grant to my Executor and Trustee the power to make distributions.
(including the satisfaction of any pecuniary bequests) in cash or in specific property, real or
personal, or an undivided interest therein, or partly in cash and partly in such property, and in
installments or all at one time. Assets distributed in kind shall be valued at their date or dates of
distribution values.
D. Power to Retain Assets. My Executor and Trustee are authorized to retain
as an asset of my estate or any trust created under this Will any property owned by me at the time
of my death. Such authority shall not impair the power of sale or exchange or other powers or
discretion given the Executor or Trustee, but if such assets or any of them are retained by my
Executor or Trustee for the duration of the administration of my estate or any trust, or for any
shorter period of time, my Executor or Trustee shall not be responsible or liable for any loss or
decrease in the value of such assets or any of them, or the estate or trust, by reason of such
retention.
Notwithstanding any other provisions of this Will, however, my spouse shall have
the right at any time and from time to time to compel my Trustee to convert any non -income
producing property held in the Marital Trust established under this Will for the benefit of my
spouse into income producing property by delivering to my Executor or Trustee a written notice
to that effect.
E. Loans. My Trustee is authorized to lend money for such periods of time
and upon such terms and conditions as to rates, maturities, renewals and securities as my Trustee
24

shall deem advisable, to my estate or to any trust created by me, by my spouse or by any child of
mine. This power is granted to my Trustee whether or not the individual or corporation serving
as Trustee is the personal representative of my estate or the Trustee of the trust to which such
money is loaned.
F. Discharge of Legal Obligation. No Trustee may exercise any power or
authority to distribute trust property (including income) in order to discharge a legal obligation of
such Trustee to any beneficiary. The benefits provided in this Will are in addition to and not in
substitution for, any legal obligation of any person to a beneficiary, and my Trustee may not use
trust property to satisfy the Trustee's legal obligation or the legal obligation of any individual
who has the right to remove and replace my Trustee.
G. Borrow Money. My Trustee is authorized to borrow money for such
periods of time and upon such terms and conditions as to rates, maturities, renewals, and
securities as my Trustee shall deem advisable, including the power of a corporate Trustee, if any,
to borrow from its own banking department, and to deposit the proceeds of such loan into the
trust corpus of any trust created hereunder and to use the proceeds for any valid trust purpose,
including, but not limited to, making investments, operating a business, making income or
principal distributions to beneficiaries, or paying any debts, taxes, or other charges against any
trust created hereunder. In connection with such borrowings, my Trustee shall also have the
power to mortgage, pledge, or otherwise encumber any trust assets to secure such loans. Anyone
dealing with my Trustee is not required to see to the application by my Trustee of any funds it
receives as a result of any such loan.
Without limiting the generality of the foregoing, during the lifetime of my spouse,
my Trustee may, in its sole discretion, mortgage or otherwise encumber any property, real or
personal, of any trust created hereunder for the benefit of my spouse to secure any loan made by
a third party to my spouse individually; provided, however, that if my spouse is serving as
Trustee of such trust, then such power shall not be exercised by my spouse but shall be exercised
by a special Trustee who is appointed by my spouse for the sole purpose of exercising this
?A1

authority and who is not a "related or subordinate party" to my spouse within the meaning of
Section 672(c) of the Internal Revenue Code.
H. Power to Divide Trusts. If any portion of a trust created under this Will
shall be subject to a generation -skipping transfer tax under the generation -skipping provisions of
the Internal Revenue Code of 1986, as amended, or the corresponding provisions of any tax law,
that portion which is subject to such generation -skipping transfer tax may, in the discretion of my
Trustee, be set apart as a separate trust either before or after the establishment, creation or
funding of such trust, to be administered under the same terms and provisions as herein provided
for that portion of the trust which is exempt from such generation -skipping transfer tax under any
applicable exemptions or exclusions. Such generation -skipping transfer tax shall be charged
against and paid from the trust containing the assets which are subject to such generation -
skipping transfer tax.
I. Residence in Trust. My Trustee is authorized to retain in any trust created
hereunder for the benefit of my spouse all of my interest in any primary or vacation residence
which I may own at the time of my death, so long as my spouse shall use and occupy it as a
home or vacation residence. If my spouse shall no longer occupy such property as a home or
vacation residence, my Trustee may, in its discretion, sell and convey the same, at public or
private sale, at such time and price and upon such terms and conditions, including credit, as my
Trustee may determine.
If at any time, there shall be no property in the trust which my spouse desires to
use and occupy as a home or vacation residence, then my Trustee may, in my Trustee's
discretion, purchase and hold in the trust any real property which my spouse desires so to use and
occupy.
During the period that any property is so held for the use and occupancy of my
spouse, my spouse shall be permitted to use and occupy same free of any rent. All taxes,
insurance, assessments, repairs and other charges necessary to maintain such property and
properly chargeable to income shall be paid out of the income of the trust; and all such
expenditures not properly chargeable to income shall be paid out of the principal of the trust.
EO

The foregoing powers to retain, sell and purchase real property suitable for use
and occupancy as a home or vacation residence by my spouse shall be continuing and shall not
be exhausted by the exercise or repeated exercise thereof. Any proceeds of the sale of any such
property, which are not used in the purchase of other similar real property, shall be invested and
reinvested as a part of the trust.
No party dealing with my Trustee shall be required to ascertain whether or not
any of the requirements relating to the sale or purchase of any real property have been complied
with; nor shall any such party be required to look to the application of the proceeds of any sale;
and such parties may deal with my Trustee as having full and complete, independent power and
authority to consummate any purchase or sale hereunder.
J. Special Fiducian% Except as otherwise provided in North Carolina
General Statutes, Section 36C-8-814, a power conferred upon a fiduciary in his or her capacity as
a fiduciary, but not in his or her capacity as beneficiary, which would constitute in whole or in
part, a general power of appointment, may not be exercised by such fiduciary. Such powers shall
be exercised only by the fiduciary or fiduciaries who are not so disqualified. If there is no
fiduciary qualified to exercise the power, it may be exercised by a special fiduciary appointed by
the court pursuant to North Carolina General Statutes, Section 36C-8-814. Any corporate
fiduciary so named or otherwise appointed shall be entitled to reasonable compensation
commensurate with the duties and responsibilities assumed.
ARTICLE XV
MISCELLANEOUS
A. Representation of Minor. Incompetent. or Incapacitated Beneficiaries. If a
minor, incompetent, or incapacitated beneficiary is an Appointer hereunder, then such .
beneficiary's powers as Appointer shall be exercised by (i) the agent of such beneficiary under a
durable power of attorney who has authority to act and bind the beneficiary, or if none, (ii) the
general guardian or guardian of the beneficiary's estate, or if none, (iii) the guardian of the
beneficiary's person, or if none, (iv) the beneficiary's parent who is a lineal descendant of my
spouse.
►xi

B. Inca ci . Except as may otherwise be provided in this Will, any
individual may be treated as being under a legal disability, incompetent, or incapacitated during
any period when such person has been adjudicated as such by a court of competent jurisdiction,
when a guardian, conservator, or other personal representative of such individual's person or
estate has been appointed by a court of competent jurisdiction, or when, in the opinion of two (2)
licensed physicians, such person is unable effectively to manage such persons property or
financial affairs.
C. Presumption of Survival. If any beneficiary and I shall die under such
circumstances that there is not sufficient evidence to determine the order of our deaths or if such
beneficiary shall die within a period of 120 hours after the date of my death, then it shall be
presumed that such beneficiary predeceased me; and my estate shall be administered and
distributed, in all respects, in accordance with such presumption.
TESTIMOMUM
I, CLYDE BROWER CASE I11, the Testator, sign my name to this instrument
this day of -1� not- L , 2016, and being first duly sworn, do hereby declare to the
undersigned authority that I have read and understand the provisions of this instrument, that I
sign and execute this instrument as my Last Will and that I sign it willingly, that I execute it as
my free and voluntary act for the purposes therein expressed, and that I am eighteen (18) years of
age or older, of sound mind, and under no constraint or undue influence.
CLYDWER CASE III
;oeW
We, and /Z-L 7A VtJ-
the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to
the undersigned authority that the Testator signs and executes this instrument as the Testator's
Last Will and signs it willingly, and that each of us, in the presence and hearing of the Testator
and each other, hereby signs this Will as witness to the Testator's signing, aA aIbf our
;) 3 2018
28
,A-mHo CITY

knowledge the Testator is eighteen (18) years of age or older, of sound mind, and under no
constraint or undue influence.
witn�
l t/ la
Witness
29

STATE OF NORTH CAROLINA
COUNTY
Subscribed, sworn to and acknowledged before me by CLYDE BROWER
CASE 11I, the Testator, and subscribed and sworn to before me by
and _� ffi� h l� r t! witnesses, this
b� day of, 2016. CLYDE BROWER CASE III (check one) — is
personally known to Ine, '--A produced a driver's license (issued by a state of the United States
within the last five (5) years) as identification, or —produced other identification, to wit:
My Commission Expires:
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Place Sj.!AL")tbove This Line
111333-00001
ND: 4831-6643-2804, V. 2
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NC Division of :Coastal'Management
Cashier's Official Receipt f c f) ABC D
Date: -i � � 1 . 20�_
%Received From:
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Permit No.: y.
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Applicant's.Name` :County:
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Project Address: _ _ : _ ! J. i k �` t .f-, i ..
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Please retain receipt for your records as, proof of payment for permit issued.
Signature of Agent or Applicant
Signature of Field Representative.
Date '
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