The following optional form may be used by an agent to certify facts concerning a power of attorney.

power of attorney

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Terms Used In Ohio Code 1337.61

  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC

AGENT’S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT’S AUTHORITY

State of Ohio

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;

(4)_______________________________________________________________________________________________________________________________________________________________________________________

(Insert other relevant statements).

SIGNATURE AND ACKNOWLEDGMENT

___________________________________

Agent’s Signature

___________________________________

Date

________________________________________________________________

Agent’s Name Printed

________________________________________________________________

Agent’s Address

________________________________________________________________

Agent’s Telephone Number

State of Ohio

County of __________________________

This document was acknowledged before me on______________________,(Date) by _______________________

(Name of Agent).

________________________________

Signature of Notary

My commission expires:

_________________________________

This document prepared by:

_________________________________

_________________________________

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