§ 15-14-742 — Certification

Colorado § 15-14-742

• Jurisdiction: Colorado
• Title 15: Probate,
• Art.: Persons Under Disability - Protection

Text

The following optional form may be used by an
agent to certify facts concerning a power of attorney.

AGENT'S CERTIFICATION AS TO THE VALIDITY OF

POWER OF ATTORNEY AND AGENT'S AUTHORITY

State of __________________________________ County of
__________________________________

I, __________________________________ (Name of agent), certify under penalty of
perjury that __________________________________ (Name of principal) granted me
authority as an agent or successor agent in a power of attorney dated
__________________________________.

I further certify that to my knowledge:

(1) The principal is alive and has not revoked the power of attorney or my
authority to act under the power of attorney and the power of attorney and my
authority to act under the power of attorney have not terminated;

(2) If the power of attorney was drafted to become effective upon the
happening of an event or contingency, the event or contingency has occurred;

(3) If I was named as a successor agent, the prior agent is no longer able or
willing to serve; and

(4) ______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

(Insert other relevant statements)

SIGNATURE AND ACKNOWLEDGMENT

_______________________ _____________

Agent signature Date

_______________________

Agent's name printed

_______________________

_______________________

Agent's address

_______________________

Agent's telephone number

This document was acknowledged before me on ________________________,

(Date)

by ________________________.

(Name of agent)

__________________________ (Seal, if any)

Signature of notary

My commission expires:________________________

This document prepared by:

___________________________________________

Legislative History

Source: L. 2009: Entire part added, (HB 09-1198), ch. 106, p. 417, � 1, effective April 9.