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 OFPOWER 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: (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 were 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 Agent’s e-mail address This document was signed in my presence on , by (Date) (Name of agent) (Seal) Signature of notary My commission expires: This document prepared by: .”
Click to view
History. Code 1981, § 10-6B-71 , enacted by Ga. L. 2017, p. 435, § 2-1/HB 221; Ga. L. 2018, p. 520, § 20/HB 897.
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”.