Arkansas Code of 1987 (2024)
Title 28 - WILLS, ESTATES, AND FIDUCIARY RELATIONSHIPS (§§ 28-1-101 — 28)
Subtitle 5 - FIDUCIARY RELATIONSHIPS (§§ 28-65-101 — 28-77-803)
Chapter 68 - UNIFORM POWER OF ATTORNEY ACT (§§ 28-68-101 — 28-68-406)
Subchapter 3 - STATUTORY FORMS (§§ 28-68-301 — 28-68-303)
Section 28-68-302 - Agent's certification

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 OFATTORNEY AND AGENT'S AUTHORITY

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: __________________

Acts 1965, No. 61, § 10; A.S.A. 1947, § 58-510; Acts 2011, No. 805, § 1.