20211746 Ver 1_Agent Authorization_20211205

AGENT AUTHORIZATION FORM
PROPERTY LErAL DESCRIPTTON,
LQT I*O. 3JL _ PLAN INFa _ PARCIELIb: 4Q7163561
STREET ADDRESS, a 35 Holt L rr Moore v 1 le NC 2 7
Please print;
A PertY (X-- —fAhri and All€la C3 bw.
The ur6migned, registered ProPerry otv`ers Of tl►e aCave noted property, do hereby aurhariu
Seth Wtostel6kr _ : Uf _ bale & Betli's Lake lJse Pelmik Service
(COFFtFadw I Agent) Name aF corlstlltfng fmm) —
to adt on my behalf and takR all Wtibns neo -AW Far die pra ngr +ssuaDCB and aaotparrow of
ft pesmlt or oertificadon anp any and all standard arxf spedal cor ditns atnxhed.
PrDP N" Ovrrwes Address (IF dlffe *nt than propwty abDve):
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Teleptum: 4o60
We h"t?y cuuN the abYm hnfwmadon submlt#ed m this appficattah FS true arid a 71, to to the
Best Of bUr kJiowle kr—
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�gnatune Authariz€d Signature
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