File No.
STATE OF NORTH CAROLINA

                                                                                                                                                                                     In The General Court Of Justice
                                                                                                                      County                                                         Superior Court Division
                                                                                                                                                                                                Before The Clerk

                                                                                                                  IN THE MATTER OF THE ESTATE OF:
Name Of Decedent/Incompetent                                                                                                                                         APPOINTMENT OF
                                                                                                                                                      RESIDENT PROCESS AGENT

                                                                                                                                                                                                  G.S. 28A-4-2(4); 35A-1213(b)

I, the qualified personal representative or guardian of the above named estate, submit to the jurisdiction of the North                                                                                          
Carolina Courts in the above captioned matter, and appoint the resident process agent named below on whom may be                             
served citations, notices and processes in all actions or proceedings with respect to this estate.                                                
Name, Street Address, PO Box, City, State And Zip Code Of Resident Process Agent                                                                  Date

                                                                                                                                                  Name Of Personal Representative Or Guardian (Type Or Print)

Telephone                                                                                                         County Of Residence             Signature Of Personal Representative Or Guardian

                                                                                                                                            ACCEPTANCE OF APPOINTMENT

I accept this appointment as resident process agent for the above named personal representative or guardian, and 
agree to notify the personal representative or guardian of all citations, notices and processes served on me as his 
resident process agent.

                                                                                                                                                  Date
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date                                                                                                                                              Name Of Resident Process Agent (Type Or Print)

Signature Of Person Authorized To Administer Oaths                                                                                                Signature Of Resident Process Agent

     Deputy CSC               Assistant CSC                   Clerk Of Superior Court
                                                                                                                  Date My Commission Expires
     Notary
                                                                                                                  County Where Notarized
     SEAL

AOC-E-500, Rev. 1/14
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