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:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
(Insert other relevant statements)
SIGNATURE AND ACKNOWLEDGMENT
_______________________ | _____________ |
Agent 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:
___________________________________________
C.R.S. § 15-14-742
OFFICIAL COMMENT
This section provides an optional form that may be used by an agent to certify facts concerning a power of attorney. Although the form contains statements of fact about which persons commonly request certification, other factual statements may be added to the form for the purpose of providing an agent certification pursuant to Section 15-14-719.