2015 Maryland Code
ESTATES AND TRUSTS
Title 17 - MARYLAND GENERAL AND LIMITED POWER OF ATTORNEY ACT
Subtitle 2 - STATUTORY FORMS
§ 17-204 - Statutory form--Agent's certification of validity and authority.

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 Maryland

(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 on 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:

."