Connecticut General Statutes 1-352a – 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
Terms Used In Connecticut General Statutes 1-352a
- 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
State of ______________________________
County of ____________________________
I, _____________________ (Name of Agent), certify under penalty of false statement 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 Commissioner of Superior Court/Notary)
My commission expires: _________________________