20200135 Ver 1_Attachment_B_AgentAuthorization_20200123

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. Multiple PLAN NO, Multiple PARCEL ID. _Multiple
STREET ADDRESS:. Multiple Piedmont Natural Gas (PNG)-owned pipeline easements
east of Morganton, NC.
Please print:
Property Owner: PNG - Multiple PNG-owned pipeline easements.
Property owner: c/o Arshad Khan, PhD -Project Manager, Duke Energy
The undersigned, registered property owners of the above noted property, do hereby authorize
Will Pruitt of
(Contractor / Agent)
Pond & Company
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, Issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
4720 Piedmont Row Dr. Charlotte, NC 28210
Telephone: [phone]
We hereby certify the above Information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: 12-1 3 o
Authorized Signature
Date: