2020 Colorado Revised Statutes
Title 15 - Probate, Trusts, And Fiduciaries
Article 14. Persons Under Disability - Protection
Section 15-14-742. 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 OF ATTORNEY AND AGENT'S AUTHORITY

S t a t e o f _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C o u n t y o f

__________________________________

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 toact 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 anevent 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 toserve; and

4. ______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

(Insert other relevant statements)

SIGNATURE AND ACKNOWLEDGMENT

_______________________ _____________ Agent 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:

___________________________________________

Source: L. 2009: Entire part added, (HB 09-1198), ch. 106, p. 417, § 1, effective April 9.

SUBPART 4

MISCELLANEOUS PROVISIONS