Georgia § 10-6B-71 - Optional form for agent certification of facts.

§ 10-6B-71. Optional form for agent certification of facts.

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 Georgia 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: 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; If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred; If I were named as a successor agent, the prior agent is no longer able or willing to serve; and _____________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ________________________ __________________________________________________ Agent's signature Date ________________________ Agent's name printed ________________________ ________________________ Agent's address ________________________ Agent's telephone number ________________________ Agent's e-mail address This document was signed or acknowledged in my presence on ______________, by ________________________. (Date) (Name of agent) ________________________ (Seal) Signature of notary My commission expires: ________________________ This document prepared by: ____________________________________." (Code 1981, § 10-6B-71 , enacted by Ga. L. 2017, p. 435, § 2-1/HB 221; Ga. L. 2018, p. 520, § 20/HB 897.) (Insert other relevant statements) SIGNATURE AND ACKNOWLEDGMENT The 2018 amendment, effective July 1, 2018, in the form under AGENT'S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY, inserted a comma following "under the power of attorney" in paragraph (1); and, in the form under SIGNATURE AND ACKNOWLEDGMENT, inserted "or acknowledged" following "this document was signed".