Section 17-204 - Statutory form-Agent's certification of validity and authority. - Maryland Statutes

§ 17-204. Statutory form - Agent's certification of validity and authority.
 

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 Maryland

   
(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 on 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 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: 

   

_________________________________________________________________________ ."
 

[2010, chs. 689, 690.]