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 P
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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's
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:
..........................................