Fill and Sign the Affidavit as to Principals Competence at Time of Granting Power of Attorney Form

AFFIDAVIT AS TO PRINCIPAL'S COMPETENCE AT TIME OF GRANTING POWER OF ATTORNEY State: ___________________ County: ___________________ Affiant: ___________________ (Name and Address) Affiant, on oath, swears that the following statements are true: 1. I am personally aware of the execution of the Power of Attorney dated ___________________ , signed by ___________________ (Name of Principal) in favor of ___________________ (Name of Attorney-in-Fact) (if recorded, provide recording information). 2. Based on my personal observations of ___________________ (Name of Principal) , I can state with certainty that on (Date of Power of Attorney) , (Name of Principal) was alive, under no disability, and of sound mind. This Affidavit is signed by me on the date of acknowledgment of my signature. ___________________________ Affiant (The following acknowledgement is not geared toward the law of any particular state and is subject to modification) ACKNOWLEDGMENT State of _____________________________ County of _____________________________ On _____________________________ , _____________________________ personally appeared before me and proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of _____________________________ that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature of Notary (Seal) My Commission Expires _____________________