Colorado Code
Part 7 - Uniform Power of Attorney Act
§ 15-14-742. 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
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:



______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

(Insert other relevant statements)
SIGNATURE AND ACKNOWLEDGMENT
_______________________ _____________ Agent 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: ___________________________________________
Source: L. 2009: Entire part added, (HB 09-1198), ch. 106, p. 417, § 1, effective April 9.
This section provides an optional form that may be used by an agent to certify facts concerning a power of attorney. Although the form contains statements of fact about which persons commonly request certification, other factual statements may be added to the form for the purpose of providing an agent certification pursuant to Section 15-14-719.

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