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 Ohio
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
State of Ohio
County of __________________________
This document was acknowledged before me on______________________,(Date) by _______________________
(Name of Agent).
________________________________
Signature of Notary
My commission expires:
_________________________________
This document prepared by:
_________________________________
_________________________________
R.C. § 1337.61