[§551E‑52]  Agent's certification.  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:

     _______________________________

 

     [L 2014, c 22, pt of §1]