Fill and Sign the Agents Certification as to the Validity of Power of Form

AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITYState 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: (1) the Principal is alive and has not revoked the Power of Attorney or my authority to act under the Power of Attorney and the Power of Attorney and my authority to act under the Power of Attorney have not terminated; (2) if the Power of Attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred; (3) if I was named as a successor agent, the prior agent is no longer able or willing to serve; and (4) ______________________________ (Insert other relevant statements) SIGNATURE AND ACKNOWLEDGMENT___________________________ ______________________________Agent's Signature Date ______________________________ Agent's Name Printed ______________________________ Agent's Address______________________________ Agent's Telephone NumberThis document was acknowledged before me on ____________________, 20_____ (Date) by ______________________________ (Name of Agent)________________________________ (Seal, if any) Signature of NotaryMy commission expires: ______________________________