WI0100138_GEO THERMAL_20110118

A . A
MEW ,
North Carolina Department of Environment and h
Division of Water Quality
Beverly Eaves Perdue Coieen H. Sullins
Governor Director
1 /18/2011
3oha I`.reamers
Alexanne kreamers
2 Lake Hill'I?rive
Arderi. NC 24704
Subject: Acknowledgement of Intent to Construct Type 5QW injection Well System
Permit No. WIOi t-',j : J..
'Y Lake Hill Drivt, Arden, NC: 2o70w
Dear Mr. & Mrs. Dreamers:
On 1/5/2011, the Aquifer Protection Section (APS) received notification of your intent to construct a closed -loop water-onlN
geothermal injection well system for the operation of a ground -source heat pump located at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system As long as the
following conditions are met:
I. The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
3. The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these conditions constitutes a violation of the North Carolina Well Construction Act and North .Carolina
Administrative Code Title 15A Section 2C Subchapter .0211(u)(2). Additionally, you should contact the Buncombe County Health
Department as they may have additional requirements -for this type -of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Roaers(u),ncdenr. ,ov if you have any questions.
Sincerely,
for Deirra ,Mutts
Supervisor
cc: Asheville Regional Office - APS
APS Central Files - Permit No. W 101001.3B
Buncombe County Health Dept.
Clearwater Weil Drilling (Von Plemmons -- PO Box 71. Hot Springs, NC 283743 #
Cond'ott Central (kevin Schuniarrn — 253 Tianberlane. Drive, Pisgah Foresi, NC 2,9765)
AQUIFER PROTECTION SECT01
1636 Mail Service Center, Raleigh, North Carolina 2769E-1636
Location: 2728 Capital Boulevard, Raleigh. North Carolina 27604
Phone. [phone] FAX 1: M-715-05W FAX 2: 919-715.6048 ! Cus'.omer Service: 1-877-62M748
Internet: www.nmatergualily.oM
M Equal Dopa: iurity Affirnaova Action. Fmplwe,
One
Nol-thCaroi.ina
Naturally

Central Files: APS SWP
01/18/11
Permit Number W10100138 Permit Tracking Slip
Program Category
Ground Water
Permit Type
Injection Water Only GSHP Well System (50W )
Primary Reviewer
michael.rogers
Coastal SW Rule
Permitted Flow
Facility Name
John 8 Alexanne Kreamer SFR
Location Address
2 Lake Hill Dr
0 Dr,dt
Arden NC 28704
Owner
Status Project Type
In review New Project
Version Permit Classification
Individual
Permit Contact Affiliation
Von Plemmons
PO Box 71
Hot Springs NC 28743
MajorIMinor Region
Minor Asheville
County
Buncombe
Facility Contact Affiliation
Owner Name Owner Type
Individual
John G R Kreamer Owner Affiliation
John G 6 Kreamer
L� ., 1; 11
2 Lake -Hill Dr
Arden NC 28704
DateslEvents
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
01/05/11
Regulated Activities
❑utfall I•:. v-
Waterbody Name Stream Index Number Current Class Subbasin

HCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beveriy Eaves Perdue Coleen H. Sullins
Governor Director
111 F12011
John Kfeamers
Alexannt! Kreamers
Lake Hill Drive
Arden, NC 29704
Subject: Acknowledgement of Intent to Construct Type 5QW injection Well System
Permit No. W10100139
2 Lak-e li-Al Drive, Arden, NC 29704
Wk Hrl11
Dear Mr. & Mrs. Kreatners:
Dee Freeman
5ecretanj
On 11512011, the Aquifer Protection Section (APS) received notification of your intent to construct a ciosed-loop water -cm
geothermal injection well system for the operation of a ground -source heat pump located. at the address referenced above. An
individual permit is not required for the construction and operation of this type of geothermal injection well system as long as the
following conditions are met -
The injection well system contains only potable water,
2. The injection well system is constructed in accordance with well construction standards specified in North
Carolina Administrative Code Title 15A Section 2C Subchapter .0213, and
The required notification form and associated maps have been completely and accurately submitted.
Failure to comply with all of these condirions constitutes a violation of the North Carolina Well Construction Act and North Carolina
Administrative Code Title 15A Section 2C Subchapter .0211(u)(2). Additionally, you should contact the Buncombe County Health
Department as they may have additional requirements for this type of system. Noncompliance with applicable state, county, or
municipal rules and regulations may result in the assessment of civil penalties.
Please contact Mike Rogers at [phone] or Michael.Rovers a�nedenr. ,ov if you have any questions.
Sincerely,
jot Deb; a ja
Supervisor
cc: Ashe�,Uc Regional Office - APS
AP Central Files - Permit No. W101001 3R
Buncnmhe County Health Dept,
Clearwater Well Drilling (bon Plemmons —PO El x 7 i _ Hot Sprml s. NC 25 743 )
Comfnn Central (Ke�Ldn Schumann — 253 Timberlane Drive, Pisgah Ftzrest, NC 29769)
P.QUFER PROTECTION SECTION
1636 Mail Service Center Raleiati, North Carolina 2769 ,-1636
Loealion_ 2728 Caoltal 6oalevarl. Raleigh. North Carolina 276LA
Phone: [phone] I FAY 1 i 915-715-0588: FAY. 2- 919.715-430481 Customer Service: 1-877•623-6748
Internet rwwAr.nmaterauaimy.ora
kr equal Qpwrtun•!, Affirm azwe. Aitnn --mp,gve
One
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F•�'atUral4lf

,lan 02 11 04:11 p Larry Gossett
82M54-8530
CAROLINA
NORTH
DEPARTMENT OF ENVIRONIvIENI' RAND NATURAL RESOURCES
-NUTIFICA'TION OF INTMT TO CON,S'MUCI' A CypSED_LDUP G
WATER -ONLY INJECTION WELL SYSTEM
TYPE 5 W WELL 5
fn Accordance With the Prnvisims of NCAC Title i SA 02 C,0200
Print or type the required information and mail to address on IA& buck page-
DATE: 1 � - 241SZ c� t CD (D 13�
Well TYPe Confirmation: Does the propr)sed systern circuiate potable Aates cn3_� (nn ddditiVeS) in
centinuOus piping rbat ccnnpleteiy isoiates the fluid frorn the envi1ronment (i_s.
closed -loop)"
Yes � tinue completing this farm -
No _, Ua Not complete this fo;7n. Complete other UIC application forrnis for installing
eitlier n 5A7 well well iq eCiin_Z potable water into the aquifer} or a 50M wctl (Closed -
loop welt containing natives such as R-22, ethanol, nr other witifree= or wrrosian infabitors'_
A. PROPERTY OWNER(S)IAPPLICAI+Ti'(s)
List e 1 Property Owner listed on property deed (if owned by 1a-b``,usiness or governmestt agency. stone name of
entity and a roprMentative wlauthority for signature) ,j i Orm tcJ �
LAf ZL N i l � D {'I
_ (!) Mail ing Address: 2
City. �, State: ��ip Code: � �Caursty:' �'�Q-1 Vl r�O
HomelOfficc Tele No.: U No. -
Email Address.• Websate:
+2) Physical Address of Well Sim (if different than above):
City: s we: Zip Code: _-Cowity:
HometMce Tale No.: Celt �Io.:
B. AUTHORIZED AGENT OF OWNER, IF ANY (if the Permit Applicant doers nat own the subjW property,
attach a letter from the property comer authorizing Agent to install and operate UIC well)
Company waxne:
Contact Person: _ _ EMAIAddtrss:
Address:
City: State.• Zip Code: —County:
Office Tete No.: Call No.:
Website Address of CornpaM, if anY-
opul . x 3QW Notit;catinnti of intent Foam (Revised 812008) Pap t

Jan 02 11 04:11 p Larry Gossatt
82M54-8530 p.2
C. WELL DRILLER IISFORNIATION
Company Name: _ 'J/.:�I..,-
1
Well Driller Contractor's Name:
NC Contractor Certification No.:
Cort1w Perso�: ���1 1 C� ��i ■.' EMAIL Addre
-7, J
address: J� f .
City: �'� !� G Zip Code: 7 �3 County:--
Ofiice T'ele No.: Ceti No.:
HEAT PUMP CONTRACTOR W RMATIN (if d0went than drilktr)
Company Name� e :_ ��r, . t i -P I
EMAIL Address a, ,•_ r;�san zp - Gl4�+iizai , [:t3'►'�
Address: r' r ^
City: rr� _ w+ Zip Code- 282 hts County: C
1
Office Tele No.: y - qC 'j Q Cell No.: (2EZ )
E. STATUS OF AM .IC A14T
Private: Federal: (ommercW.
State: Municipal: Native American Lands:
V. INJECTION PROCEDURE (briefly describe ow 'a in •'don1'ell(s) will be US4
Q WELL CONS RUCTIOIN DATA
(1) Proposed date to he wru urded: 1 1 plumber of berings:
Approximate depth ofeacb boring (fbzt):
() Type of tubing to be used (copper, PVC, etc):
(3) Well casing. Is the wcil(s) easrd? (check either (a.) Yes or (b.) No below)
(a) Yes . if yes, then provide casing information below
Type: galvanized steel Mack steel plastic other (specify)
Casing depth: From to feet (reference to lased surface)
Casing extends to above ground __inches
(b) No L1___
(4) Grout Into (material surrounding well casing end/or piping): +
(a) Groin tppe: Neat Cement Re�ntonibe t�Dd W (gp�fy)
(b) Grout placement_ Pumpiag_L____ Pressure Other
(c) Grout depth of tubing (reference to 1-and surFace). from � 0 to (feet)
f r well has casin& indicate grout depth: Pram 'to (£bet)
GPU)LGC 5OW Nctifieatian of Intern Form 0xvised 8;20081
Page 2

02 11 04,11P
Larry Gossett
628-654-8530 P.''
r

82e-66"&30 pA
Jan 02 11 04:12p Larry Gossett
u. SIN JECTION-RELATED EQUIPMENT
Attach a diagram showing the er4 inecring layout or proposed modification of the injection equipment and exterior
pipiagftubing associated with the injection operation. The manufacturer's brochure may provide supplemenuuy
int'orra tiom
I. LQCATION Oft WELit,(S)
Attach two copies of maps showing the following information:
(1) Include a Site Map (can be drawn) showing: buildings, property Lines, swface water bodies, potential
sources of groundwater contamination and the orientation of and distances between the proposed well(s) and
any existing we]1(s) or waste disposal facilities such as septic tanks or drain fields ioc:ated within 200 feet of
the geothermal heat pump well system. Label all fmtuns clearly and inciude artgrth arrxaw.
(2) The Site Map must show the subject property in relation to the stir mending area by using at least two fixed
reference points such as roads, streams, and/or highway intersections.
J. CERTMCAT ION
Note: This Permit AppBeation must be signed by eaeb person appearing an the
recorded legal property deed,
"r hereby certify, under penally of law, that I have penonally examined end am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and complete.
f am aware that there am siguficartt pet+alties, including the possibility of fides and imprisonment, for submitting
f9se information_ I agree to com uc� operate, maintairp, repair, and If applicable, abandon tune injection well and
all related uppurmnances in accordance with th f,approvv j j3 r icajio�s snd condiva,,s of the Permit."
d use o Pra rtv Owner/Applicant
hr1 *- ;r-<Xrner
i-ry T POE.
or Type Full blame and title
Signature of I'Merty OwneApplicam
Print or Type Full-Nartte and title
Sifg wWre of Authorized Agent, if any
Print or Type Full Narne and title
Please return two copies of the completed Application package to:
Forth Carolina DENR-DWQ
Aquifer Protection Section-UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telepaone [phone]
GrvrurC sQw Notification of LnLent Form (Revised WON) i Pop 3

Jan 02 11 04:12p Larry Gossatl 828-864-8530
p.6
Iegi on$ 011111111111913
DOM g; a7 41221a4GI Tvae: ORP
RRcar�3od: 1 0e/2009 at 11:4ts48 AM
Fee Amt: 614.00 Pape 1 of I
workflow# o000017aes-boat
sunoomhe Geunt . NC
Ot.tjo�� w. moftuhy lAeataator, of needs
isK
POWER OF AlMrORN]EY
r /►A C4" �GJ �
"NOTTCE: THE PDWE" GRA 4TED BY THIS DOCTjtAEN-r ARE
BROAD AND St�EEPFNG. TKEY ARE DEFDTED IN CaAPTER 32A OF THE
NORTY-T CAROLINA GENERAL STATUTES WMC14 EXPRESSLY PERM TS THE
USE OF A-N-Y OTHER OR DIFFERENT FOiLM OF POWER OF ATTOR1iEY
DESnRFED 13Y THE PARTIES CONCERNED -
State ofNORITI CAROLINA
county of BUNCOMBE
T, TOF1N G.R. K USAM[EP, appoint ALEXANNE S. KREA1AER to be my
attorney-in=Fact to act in my name in any way which I could act for myself; with respect
to the following matter as each of them is defined in Chapter 32A of the North Carolina
General Stalutes.
(DIREC'i'IONS. Initial the line opposite anyone or more of the subdivisions as to which
the principal desires to eve the attorney -in -fact autbority.)
(1) Real property trs.asacoons ............................................... .... .
(2) Personal property transactions ................ ......................................
(3) Band, share, s lock, securities and commodity transactions .....................
(4) Blacking transactions. .....................•.-............................._..._.....
(5) Sa£e Deposits .........................................................................
(6) Business operating tractions .... . ...... . . . . . ................ . . . ...............
(7) Insurance Uan actions............................ -- ... . ................... . ......
(8) Estate tmnsactlons............................ _................................... -..
(9) Personal reLndonab pa and afFsirs............ . ....................................
(10) Social security and unemploymr..at.................. .............................. —
(11) Benefits from military service. ......... ------ ........................ .......--
(12) Tax matters.........................•---...--......----.....--..... __._...._------ -�-
(13) Employment of agents............ _ .. _ .. _ . _ .............. - - .................. ..................
(14) Gigs to charitios, And to individuals other than the attorney -in -fact..... _ _-_
(15) Oifis to the named attorney -in -fact ...................... . .................. __.- .�
I also give to such person fish power to appoint another to act as my attorney -in -
Fact and fuII power to revoke. suclx appoinrmerm This power of attorney. sbail not be.
affected by my subsequent incapacity or mental ia4_4,rnpet$nc0.
Dai:ed: I7ecetnbar 4, 2009.
f ► OHN G-R. ICR EAMLR
ti
STATE OF NORTH CAROL NA, COUNTY OF BUNCOMBE:
On this 4"' day of Decernberr, 2009 personally appeared before me, the said named
JOHN Cx.% ICREAMER to me knovm and known to me to he the person described in and
who executed the foregoing instrument and he acknowledged that he executed the swine
and being dvdy swom by me, made oath that the statements in the foregoing insttuniont
are true. ...--
My Commission Exp ires. May 6, 2Q 14 - OU BX>
�-�lt.:: ..........

01/04/2011 09:32 FAX
Clearwater Well Drilling, Inc.
P.O. Sox 71
Hot Springs, N.C. 28743
828-622-7421 828-776 5525
Retw-rc Fax: [phone]
Fax: 919- J 15-0588
To: NCDENR-DWQ
From: Jeff Moore, Clearwater Well Drilling, Inc.
Subject: Permit for John Rreamer
Pages: 5 Including Cover
Note: Original is in today's marl.
Any further questions, piease give me a call.
r
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oi10412011 o9:32 FAX iy us�et��e
..,,... v- , 1 ',IT. L IF
828.65"WO
NORTH CAROLINA
DEPARTMENT OF Fj4Vf 0 NMFN'1' AND NATURAL RESOURCES �
C NOTIVICATION OF VMNT To CONSTRUCT A S&D L00P GROTHERhfAG
WATIlLR- NLY [11TjF,CTION W.L SYSTEM
TjrL 5 lY WILL •S
1n Accordaneo With tlta Pmvistow of NCAC Tito i 5A 0dC.0200
Print or type the required ►V�rrxatlsrw a7d i afl to aYl vm an the bagcklxagm
Well Type Co -nib a adoig: D"s the propcmed sys"n) circulate potabia water gpjy (n4 Wditiw g) in
cont►nuoua piping that Completely isolates the Raid from dw environment (i.e,
Yea �CuD drlUe completing thin farm.
A '
No Do Not cordplete Ibis form. Co=empiate other UiC appliciujon forms fcr ktasOng
J
#"
eirher• a SA7 waii (QM -coop well jailpting potable water into the aquifer) or 5QM wo,I (civnad-
loop welt conWMing &JdjfB= such as R-22, ethamn1, or other full ilti = Of Gurrosion inhibitora).
A. IPROPR'lY0WNRR(SYAFnJC-AN1'(s)
rr�u raperty Owner listed On property deed (i f owned by a business cr govemmont agency, stare nettle of •,.,W-f "44..
L�P
vtlt'rry end a represerttativc wlauthotity fur sigrra�rej- _ t r r 1��It iI �.I � � `� * :
�
h9►u`1 litg Addrew. AL.
City. S tote: Lip Code: L�5 —, a County: `� L
HomeMflioe Tale No.: -
Email Addr+e
Physsiml Addrau of WeH Sto (If diffemnt &An above):
city, . � State: Zip Lode: ,_Cauntyr
"•
IiotneADDff a Tale No.: •
�r
& A1nM0RtUD AGKr4T OF OWNER. IF ANY (if the Pemilt Applimnt ggW own ft sw6Ject pmpijjr, �, V-
attach a lerw from the property owner authorizing Agent to install and operate UIC well)
. -
+ +r'
City; state: Lip Code: county: _ _
rrR 4
"
Wobsker Addra68 of CotrrPNV, if MY:
�►:: � �
-3pUAJIC SQW Nod GLAUrin or%Wm Form (Rewhad 90BUR) paw I

01/04/2011 09 : 92 FAX
09s, , _ :k 4
PY
C.
WELL DRO"R INFORMATION
ComlMY Ntutl :
Well Dnller ContrrlctoC s Name:
NC: Contnictor Cartifseation No.:
Corrt(tct pars ►`I � � �. 6 ' F.MAYiAddress: �>r1 f •.
Addmss: a &
,
L
City: ` Zip Code: T T. County.p�r,
4Pi+ice rats Nci.. 7 ��-- �,,� Cal! too.. �.j��.l" ��
- '� • y� •
.. _� _
-
Q
)F3F•AT 'L3111lP CONTRACTOR RMAT !w (indifferent than driltar)
.
Compmy Name, C en +~
Address: 2S3 T
City. �.x�� �i4 _ _ 'Lip gods 2b8 __ Cow": _7 tc� -
{
❑fice '#`ele Tea.:Q120, e.1u3' • �IG� t Cell No.:?�
$.,
STATUS OF ANi~
.�4k
Ptivale: � Federal! L'ommamial:
�
r
Slaw: Municipal: Dative Aincrim Lands;
}' ,
F
9NJWTRON PROCEDURE (briefly ducribe �►� a inf ctiorf Il(s) will be used)
•�'' , �, r
G.
WlL, CONSTRUCTION DATA
,'`•
r�" r
(l) Proposed dare to be aummcled_ _ L7-01-_I Number of boriW:
Appteaimate depth of each boring (fcek):,�,
(2) Type of tubbig to be used (eopW, PVC, etc): _ -3 4C � _
•� �
(3) Well casing. Is ttve wall(s) cmad ? (chuck chher (a.) Yee 5L (b.) No below)
(a) Yea if yes, then provide casing ir&rmsiioa below
'r
_
Type, galvanized steel lslat,ic steek�iactic ether (specify]
-- y �
Casing depth.: From to feat (rafaa►t.e to land aurfamc)
� '" -I, 1 � •
Casing extends to above ground inolles
(b) No
•
(4) CxsuA Info (mmWiM sum OWWing well coting and/or pipiogy:-
(e) Grout type: West Camant Rentonise .- Oihw (specil~Y)"
`^
(b) Grout. ptrczmcnt: Pusnpingr�L,--� Pressure_ ouw
(e) Grout depth of tubing (reverence to lend surface), from n_ to 10 (!teat)
IF well has casing, indicate groin depth: fim W — (f6K)
GPLVW $QW Woiilira 6m of tnunc Form (hrvized 87008)
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01/04/2011 09:39 FAX
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82&654-8530 PA
01/04/2011 ,08: 33
Atmrh a dlag= ahowing the aa&ee&?S laym or propodad modification of the injection equipment and£extbrit'l ,.
pipingltubu:9 aa+oakWd with the i*cdon operation. The rrmnufacturer's brochure rosy provide supplmnenWZ A
irtfatraation =� ;r. •
X. LOCATION OF WZLJ4S) --
r
Attars two copies of Maps showing the following information:
(1) Include a Sitt Map (can be drnwtt) showing: buildings, propery lines, surface water bodies, potential
sources a groundwater contarnirnationand the orierrtation of and distances between the proposed weli(tjwo .
any ex] s r ng weil(s) of w w disposal thailities such as seTnic mks or drain fields located within 200 Ngt.pf
the-wtherm&I hear prmip weJi system. Label all featurts,:Jewly and inC U�e_�n
(2) The Sift Map must show the subject pn perty in relation to the surrounding area by using at least two fixrd
referme points such as romd9, strftms, amVor i�lgizuniy itiixr:scuriong,
J. CERTMCATION
Note- II& >lferrrrit Appikatteu moat be aigncd by pLd parion xpparieg art tea � 4
Molded kpi pre"rty deed. t. _ 4
"I hereby certify, under penalty of law, that I have getsanaliy examined wul are familiar with the inform. Ion 44r.
ur submitted in this doeem and all atteclhmmt,5 tixreto and that, based on my inquiry of those indivl&als
itrunediately responsibla far obUdning said infurnistion, 3 believe him thu infbnnarlon is trthe, wcurate and complete.. s -
1 horn aware tlxnt there am slgrhlficant perohles, ihichiding the pos.stbii'tty of fines and Imprisonment, for submittlr�
NL,e infon nation. i area to construo , upomw, maint:dn, repair, and tf a{pplloablu, jibandon the lnjection wail ae"d
-all relarad appurte ==% in accordance with th rmover p r_1ia s anti Corditio s 4f the Permit,"
f
�� POA +'
i urc a Pro ChwnerlApplicvmt
�J n rt erne►{ y �.
�inr
tat nt Type Purl Name and title 1
s
Signature of Prop rty Owner/Applicant
l
Print or Type Futl Nam: and title
81grtattuc AuMosized Agent, ifany
of
-
Print or Type Pull Name and tilk
Plewe nstvtn two copies of the completed Application package to. -
North Carolina DENR-DWQ
A,qu fer Frotm6eu Sectkon-'L'IC' Program
'
I636 Maid Service Center
Weigh, NC: 27699-1&1!6
T'etepho>ae t9f.9) T33-3�27
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atloraury-in-fact, to a,ct in ruty name- ixt cuW ,,ray wWAh I could art 114r inyealt, wills mp;peut
to the foil Icewijig maMrs is Lnv--l1 of'thvux iK d6fincd 4rn (,]spur 3 2 A of ti3ie t4pr h Car UruL
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(01REip'no IS! Initial the line opposite soy ono or more oftho subdivisions-aas td Wbich
thco prir�dr ell desirva to givo icho attnrney-iz-Fast authority,)
(I), Real pwpewty t:csixnucsions ......................... ..-,, ....................... ..
(2) PeevonalPrope+rty+ LnMIacTiona......... ......_....___ ...__...................-_._
(3) Druid* ah=v. &Look. sec:uritiem anti *,omrvodity tran,%"Iions...............-... _
(4) i3enking trar ut rx. Iona....... , ...... , ... ... _ ............ _ ........ , ... . ............ . .
(s) Sans Deposits ........ ..... .... T..-........... - ......................... _ _
(6)5uainessoperating irrutsactiona.........................................---•-...
(']) rxS$tYCRIJr.I• r%7tilySact18r3i._r........,.f....._...._............................__.... C -.
(S) Hatate tralmactions.................................._ .......
(9) Personal. reLariariahivt % d sf'Faimn _.........- . , .... _ ............... _ ......... . _
(10) Social soour%ty and unaenployrneat......... .......... ........................
(Yl) ReosEts fioxn military sexvica................. I.. ...... ..,._...................
(12) Tax matterm.............................................................
............,
(13) EUV ployMont of agorAS. t _
! 14) Oifts to =h"ities, and to individuals nowt' Own
(1 :5), t3•sfib to the tuned attmuey-in-Nez..............
.. ........... ,.......... .... �.
t ab a give to Such tsi on MI power to n-pl>nhit another to not as mLy--aiturn*y-in-
fttgY wW full power to reviqi� such Appointment- ThU power of altamahai oy li noL lye
afttw=d by my sxzbaegvoiU �108pesclty or rntnisll in laetcn,ze.
Dated: Decembur4; 2009. j of �Cr
/ t7N1,1 C .R. '1L .Mimi t
S'1'A.TF QF NO 1Z7T1 CAROLIN A. cot]l+ry t]F U� i,Comi3'y-,
OtI this 401 day of Dwinnber, 2Ug4 ri4rsoxrtxlly pppeared beCofe me, lhca said rialued
J014N 03 R. LCRFAWiR t0 fac lcnowsti a3ld known to rpc to 'be the pion de-ecribed in and
who exvcutod the thregrxing• )nstruxnerat and he aciu'tuv 1cl ged 'that Inn ext�cu[ud the IR41no
and heaug aLily sworn byme. made oKtitclint the stateraotibg b3'ho Yufogninb in3fXV4VIdAt
are ttue-
Ask+—.
My Com►r►ierion Lxpli')• May 4r 2014
mob