TITLE 15

UNIFORM PROBATE CODE

CHAPTER 12

UNIFORM POWER OF ATTORNEY ACT

PART 3.

STATUTORY FORMS

15-12-302.  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 Idaho                      )

                                             ) ss.

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 that 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, that the prior agent is no longer able or willing to serve; and

     (4)  (Insert other relevant statements): 

.

SIGNATURE AND ACKNOWLEDGMENT

Date: 

Agent’s Name Printed: 

Agent’s Address: 

Agent’s Phone Number: 

This document was acknowledged before me on …..(date)….., by ….(Name of Agent)…..

Notary Public for Idaho: 

Residing at: 

My commission expires on: 

History:

[15-12-302, added 2008, ch. 186, sec. 2, p. 584.]