Affidavit Of Attorney-In-Fact Form printable pdf download

Affidavit Of Attorney-In-Fact Form

AFFIDAVIT OF ATTORNEY-IN-FACT

State of FLORIDA

County of _______________

Before me, the undersigned authority, personally appeared _________________________________

(agent) ("Affiant"), who swore or affirmed that:

Affiant is the agent named in the Power of Attorney executed by

___________________________________________ on _______________________.

("Principle")

(Date)

This Power of Attorney is currently exercisable by Affiant. The principle is domiciled in

____________________________________________________________.

(name of state, territory, or foreign country)

To the best of the Affiant's knowledge after diligent search and inquiry:

The Principal is not deceased;

Affiant’s authority has not been suspended by initiation of proceedings to determine

incapacity or to appoint a guardian or guardian advocate; and

There has been no revocation, partial or complete termination of the Power of Attorney or

of Affiant’s authority.

Affiant is acting within the scope of authority granted in the Power of Attorney.

Affiant agrees not to exercise any powers granted by the Power of Attorney if Affiant attains

knowledge that it has been revoked, partially or completely terminated or suspended, or is no

longer valid because of the death or adjudication of incapacity of the Principal.

___________________________________

Affiant/Attorney-In-Fact Signature

___________________________________

Affiant/Attorney-In-Fact Printed Name

Sworn to (or affirmed) and subscribed before me this _____ day of _____________ 20_____ by

__________________________________ who q is personally known to me or q produced a

_______________________________ as identification.

(SEAL)

___________________________

notary public signature

___________________________

notary public printed name

FL-2075-AFF

Pursuant to Title XL, FL Statute §709.08(4)(c) revised pursuant to FL POA Act effective 10/1/2011 per The Florida Bar

Affidavit Of Attorney-In-Fact Form