Agent'S Certification Of Authority Of Power Of Attorney printable pdf download

Agent'S Certification Of Authority Of Power Of Attorney

Agent’s Certification of Authority of Power of Attorney

State of _______________

County of _______________

I, (name of Agent) _____________________________, certify under penalty of perjury, that I

am authorized to act as an agent or successor agent, under a power of attorney granted by

(name of Principal) ______________________________, dated ____________________.

I accept the appointment as Agent.

A true copy of the power of attorney is attached.

I further certify, to the best of my knowledge:

1. The Principal had the capacity to execute the power of attorney, is alive, and has not

revoked the power of attorney, or my authority to act under the power of attorney, and

my powers to act under the power of attorney have not been altered or terminated, and

remain in full force and effect;

2. If the power of attorney was written to become effective upon the occurrence of a

specific 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 any other relevant statements)

AFFIRMATION

______________________________

Agent’s signature

______________________________

Print agent’s name

______________________________

Agent’s address

______________________________

Agent’s phone

Subscribed and sworn to, or affirmed, before me on this date ____________________, by

_______________________________ (name of Agent).

______________________________ [Notary seal]

Notary signature

____________________

My commission expires:

Agent'S Certification Of Authority Of Power Of Attorney