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
District of Columbia ____________________________
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 was prepared by: ________________________________________________
D.C. Code § 21-2603.02