2019 Arkansas Code
Title 28 - Wills, Estates, and Fiduciary Relationships
Subtitle 5 - Fiduciary Relationships
Chapter 68 - Uniform Power of Attorney Act
Subchapter 3 - Statutory Forms
§ 28-68-302. Agent's Certification

Universal Citation: AR Code § 28-68-302 (2019)
  • The following optional form may be used by an agent to certify facts concerning a power of attorney.
  • 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:
    • (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 Number This document was acknowledged before me on ____, (Date) by____. (Name of Agent) ____ (Seal, if any) Signature of Notary My commission expires: ____
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