STATE OF GEORGIA
COUNTY OF DOUGLAS
This Affidavit is given to ensure that the undersigned, ___________________________ , is aware of, and meets, all of the qualifications for directors of GreyStone Power Corporation ("the Cooperative"), as set forth in Section 4.02 of the Cooperative's Bylaws. The undersigned understands that the Cooperative's Members, its Board of Directors, Nominating Committee and its Credentials and Elections Committee will, in part, rely upon the accuracy of the statements made herein in determining whether the undersigned is qualified to be a candidate for, or serve on the Cooperative's Board of Directors. The undersigned, being duly sworn, hereby deposes, states and agrees as follows:
(a) The undersigned is eighteen (18) years of age or older.
(b) The undersigned is a Member of the Cooperative (the Member of record on the account).
(c) The undersigned's primary place of residence is located within Cooperative District No. ____,
which is described as follows:
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(d) The undersigned is the Member of record receiving electric service from the Cooperative
and his/her bona fide primary residential abode.
(e) The undersigned is not in any way employed by or financially interested in an enterprise or organization that competes with the Cooperative or a business selling electric energy or supplies to the Cooperative.
If the undersigned IS employed by or financially interested in such a business, the following explains any facts which make this interest so inconsiderable or incidental so as not to pose a reasonable prospect of a conflict of interest if the undersigned were to become a director of the Cooperative:
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(f) The undersigned is not now, and has not been within the previous twelve (12) months, an employee of the Cooperative.
(g) The undersigned is not now, and has not been within the previous twelve (12) months, an employee or a director of a competing utility.
(h) The undersigned is not now, and has not been within the previous twelve (12) months, a Close Relative of:
a. An employee of the Cooperative, or
b. An employee or director of a competing utility.
"Close relative" is any person who, by blood or in law, including half, foster, step and adoptive kin, is either a spouse, child, grandchild, parent, grandparent, brother, sister, uncle, nephew, aunt, or niece.
(i) The undersigned is not currently a Close Relative of an incumbent director of the Cooperative.
(j) The undersigned has not been convicted of a felony.
(k) The Cooperative's Credentials and Election Committee has never determined that the undersigned has an irreconcilable conflict of interest with respect to the fiduciary duty a director owes the Cooperative.
(l) The undersigned has not been, during the five (5) years immediately preceding the date of this Affidavit, suspended from membership in the Cooperative pursuant to Section 2.01 of the Cooperative's Bylaws.
(m) The undersigned has not been, during the twenty-four (24) months immediately preceding the date of this Affidavit, late in the payment of amounts due the Cooperative for electric service on more than three (3) occasions.
(n) The undersigned has, as of the date of this Affidavit, a credit score of "average" or better, or which is in the top one-half of consumer scores, as determined by a national consumer credit reporting agency.
IN WITNESS WHEREOF, the undersigned has duly executed this Affidavit this _____ day of
____________________, 20______.
Applicant's Signature:_______________________________________
Applicant's Residential Address:
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Sworn to and subscribed before me this ______ day of ______________, _________.
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Notary Public
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