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 Ohio
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 drafte
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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 Ohio
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;
(4)_______________________________________________________________________________________________________________________________________________________________________________________
(Insert other relevant statements).
SIGNATURE AND ACKNOWLEDGMENT
___________________________________
Agent's Signature
___________________________________
Date
________________________________________________________________
Agent's Name Printed
________________________________________________________________
Agent's Address
________________________________________________________________
Agent's Telephone Number
State of Ohio
County of __________________________
This document was acknowledged before me on______________________,(Date) by _______________________
(Name of Agent).
________________________________
Signature of Notary
My commission expires:
_________________________________
This document prepared by:
_________________________________
_________________________________