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:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
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(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: _________________________________________
Okla. Stat. tit. 58, § 3042