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'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:
..............................................................
§ 72-31-354, MCA