[§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]