Nebraska Statutes 30-4042. Agent’s certification
The following optional form may be used by an agent to certify facts concerning a power of attorney.
Terms Used In Nebraska Statutes 30-4042
- Attorney: shall mean attorney at law. See Nebraska Statutes 49-801
- 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: when applied to different states of the United States shall be construed to extend to and include the District of Columbia and the several territories organized by Congress. See Nebraska Statutes 49-801
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: | |
| …………………………………… |