Fill and Sign the Iowa Power Attorney 497305184 Form

AFFIDAVIT (Iowa Code 633.706) STATE OF       COUNTY OF       Before me, the undersigned authority, personally appeared       (attorney in fact/"Affiant"), who swore or affirmed that: 1. Affiant is the attorney in fact named in the Durable Power of Attorney executed by       ("Principal") on       (date). 2. To the best of Affiant's knowledge after diligent search and inquiry: (a) The Principal is not deceased, has not been adjudicated incapacitated, and has not revoked, partially or completely terminated, or suspended the Durable Power of Attorney; and (b) The Affiant has no actual knowledge of the revocation or termination of the power of attorney, by death, disability or incompetence. 1. Affiant agrees not to exercise any powers granted by the Durable Power of Attorney if Affiant attains knowledge that it has been revoked, partially or completely terminated, suspended, or is no longer valid because of the death or adjudication of incapacity of the Principal. ________________________________________ Affiant On this       day of       20       before me,       (insert title of acknowledging officer) personally appeared       (full name of signer of instrument) to me known (or proved to me on basis of satisfactory evidence) to be the person who is named in and who executed the foregoing instrument and acknowledged that he/she executed same as his/her own voluntary act and deed. _________________________________________________ Notary Public in Sate of Iowa Print Name of Notary:       My Commission Expires: