2024 CODE OF GEORGIA
Title 10 - COMMERCE AND TRADE (§§ 10-1-1 — 10-15-7)
Chapter 6B - GEORGIA POWER OF ATTORNEY ACT (§§ 10-6B-1 — 10-6B-81)
Article 3 - FORMS (§§ 10-6B-70 — 10-6B-71)
Section 10-6B-71 - Optional form for agent certification of facts
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 Georgia
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 were 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
__________________
Agent's email address
This document was signed in my presence on (Date)____, by
__________________
(Name of agent)
__________________
(Seal)
Signature of notary
My commission expires: __________________
This document prepared by: __________________.
Amended by 2024 Ga. Laws 701,§ 2, eff. 7/1/2024.
Amended by 2018 Ga. Laws 412,§ 20, eff. 7/1/2018.
Added by 2017 Ga. Laws 186,§ 2-1, eff. 7/1/2017.
