North Carolina General Statutes
Article 3 - Forms of Acknowledgment, Probate and Order of Registration.
§ 47-43 - Form of certificate of acknowledgment of instrument executed by agent.

47-43. Form of certificate of acknowledgment of instrument executed by agent.
When an instrument purports to be signed by parties acting through another by virtue of the execution of a power of attorney, the following form of certificate is sufficient, but does not exclude other forms:
I (here give name of the official and the official's title), do hereby certify that (here give name of agent) (the "Agent"), agent for (here give names of parties who executed the instrument through the Agent) (the "Principal"), personally appeared before me this day, and being by me duly sworn, says that the Agent executed the foregoing and annexed instrument for and on behalf of the Principal, and that the Agent's authority to execute and acknowledge the instrument is contained in an instrument duly executed, acknowledged, and recorded in the office of (here insert name of official in whose office power of attorney is recorded, and the county and state of recordation), on the (day of month, month, and year of recordation), and that this instrument was executed under and by virtue of the authority given by the instrument granting the Agent power of attorney; that the Agent acknowledged the due execution of the foregoing and annexed instrument for the purposes therein expressed for and in behalf of the Principal.
WITNESS my hand and official seal, this ____ day of ______, (year) ____.
(1941, c. 238; 2018-142, s. 34.)

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