26-113 - Agent's certification.
§ 26-113. Agent's certification.
The following optional form may be used by an agent to certify factsconcerning a power of attorney.
AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF
ATTORNEY AND AGENT'S AUTHORITY
State of ....................
County/City 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)
....................
....................
Signature of Notary
My commission expires: .................... (Seal, if any)
Notary Registration Number: ....................
This document prepared by:
....................
(2010, cc. 455, 632.)