2016 Hawaii Revised Statutes
TITLE 30. GUARDIANS AND TRUSTEES
551E. Uniform Power of Attorney Act
551E-52 Agent's certification.

[§551E-52] 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 OF ATTORNEY 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: ________

This document prepared by:

_______________________________

[L 2014, c 22, pt of §1]