Maryland Statutes
Subtitle 2 - Statutory Forms
Section 17-204 - Statutory Form -- Agent's Certification of Validity and Authority

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 Maryland
(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 on 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:
______________________________________________________________________________.

Structure Maryland Statutes