Section 302 – Agent’s certification.

Effective 5/10/2016
75-9-302. 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:
  _________________________________________________________________

Enacted by Chapter 256, 2016 General Session