A document substantially in the following format 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:
_________________________________________
__________________________________________
__________________________________________
(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:
___________________________________________]
Ala. Code § 26-1A-302 (1975)