POWER OF ATTORNEY:

POWER OF ATTORNEY:

CARE AND CUSTODY OF CHILD OR CHILDREN

KNOW ALL MEN BY THESE PRESENTS: That the undersigned JEROME D. ROBERSON, parent of the child identified below, residing at 3701 Brady Street, Greensboro, NC 27401 hereby make, constitute and appoint ALLISON SMITH and JON E. SMITH as the true and lawful Attorneys-in-Fact of the undersigned, to act in name, place and stead of the undersigned, to do and execute all or any of the following acts, deeds and things with respect to the care and custody of the following child:

JANIECE RENEE BROWN-ROBERSON born on June 7th, 2005.

  1. To grant permission to consent to the child participating in any activity sponsored by any group, association or organization which activity the Attorneys-in-Fact may deem appropriate.
  2. To grant permission to consent to the child participating in any form of lawful employment, which employment the Attorneys-in-Fact may deem appropriate.
  3. To make health care decisions on behalf of the child, including making decisions regarding the child’s medical or dental care, whether routine or emergency in nature, including admissions to hospitals or other institutions; to consent, to refuse to consent to, or to withdraw consent to the provision of any care, tests, treatment, surgery, service or procedure to maintain, diagnose or treat a physical or mental condition, as well as the right to sign such medical forms as may be necessary to carry out such decisions; to talk with health care personnel who may be treating the child and to examine the child’s medical records and to consent to the disclosure of such records in circumstances the Attorneys-in-Fact may deem appropriate; to file claims for medical insurance and to obtain information for any insurance company with respect to any policy of health or medical insurance under which the child may be insure; provided however, that the Attorneys-in-Fact shall not be required to execute any documents which would involve incurring any personal liability for any such treatment and acre, and the undersigned affirms that the undersigned will be responsible for payment of any such care or treatment consented to by the Attorneys-in-Fact of the undersigned which is not covered by insurance.
  4. To generally do and perform all matters and things, to execute all other instruments of every kind which may be necessary or proper to effectuate all powers hereinabove specifically granted, or any other matter or thing appertaining to the child of the undersigned, with the same full powers, and all intents and purposes, with the same validity as the undersigned could, if personally present; and hereby ratifying and confirming whatsoever said Attorneys-in-Fact of the undersigned shall and may do, by virtue hereto.
  5. SPECIFICALLY EXCLUDED FROM THE AUTHORITY AND POWERS GRANTED HEREIN AS THE AUTHORITY OR POWER TO CONSENT TO THE MARRIAGE OR ADOPTION OF THE CHILD NAMED HEREIN.

The powers herein granted to said Attorneys-in-Fact of the undersigned shall be exercisable by any of them or all of them at any time and from time to time from [start date] until [termination date].

This power of attorney shall remain in full force and effect until the date stated above, and any party dealing with the Attorneys-in-Fact during such time shall be fully protected and is hereby discharged, released and indemnified from so doing in respect of any matter relating hereto unless such particular party shall have received prior notice in writing of the revocation of this Power of Attorney.

IN WITNESS WHEREOF, I hereunto set my hand and seal, this the  day of  2021.

JEROME D. ROBERSON

3701 Brady Street,

Greensboro, NC. 27401

STATE OF NORTH CAROLINA

COUNTY OF GUILFORD

On this  day of , 20 , personally appeared before me the named JEROME D. ROBERSON, to me known and known to me to be the person describe in and who executed the foregoing instrument and he acknowledges that he executed the same and being duly sworn by me, made oath that the statements in the foregoing instrument are true.

Notary Public

My Commission Expires:

(OFFICIAL SEAL)

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