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 AUTHORITYState of GeorgiaCounty 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 signatureDate__________________Agent's name __________________________________________________(Insert other relevant statements)SIGNATURE AND ACKNOWLEDGMENT____________________________________Agent's signatureDate__________________Agent's name printed____________________________________Agent's address__________________Agent's telephone number__________________Agent's email addressThis document was signed in my presence on (Date)____, by__________________(Name of agent)__________________(Seal)Signature of notaryMy commission expires: __________________This document prepared by: __________________.Amended by 2024 Ga. Laws 701,§ 2, eff. 7/1/2024.Amended by 2018 Ga. Laws 412,§ 20, eff. 7/1/2018.Added by 2017 Ga. Laws 186,§ 2-1, eff. 7/1/2017.
Georgia Legal Code