633B.302 Agent’s certification — optional form. The following optional form may be used by an agent to certify facts concerning a power of attorney: IOWA STATUTORY POWER OF ATTORNEY AGENT’S CERTIFICATION FORM AGENT’S CERTIFICATION OF VALIDITY OF POWER OF ATTORNEY AND AGENT’S AUTHORITY State of _________________________County of ______________________ I, ______________________________ (name of agent), certify under penalty of perjury that ______________________________ (name ofprincipal) granted me authority as an agent or successor agent in apower of attorney dated _____________________. I further certify all of the following to my knowledge:The principal is alive and has not revoked the power of attorney or the power of attorney and my authority to act under the power ofattorney have not terminated. If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or contingencyhas occurred. If I was named as a successor agent, the prior agent is no longer able or willing to serve. ed to become effective upon the happening of an event or contingency, the event or contingencyhas occurred. If I was named as a successor agent, the prior agent is no longer able or willing to serve. ______________________________________________________________________________________________________________________________________________________________________________. (Insert other relevant statements) SIGNATURE AND ACKNOWLEDGMENT _____________________________ _________________________ Agent’s Signature Date _____________________________Agent’s Name Printed__________________________________________________________Agent’s Address_____________________________Agent’s Telephone NumberThis document was acknowledged before me on _______________(date), by __________________________ (name of agent)_____________________________ (Seal, if any) Signature of NotaryMy commission expires ________________This document prepared by______________________________________________________________________________________________________________________ 2014 Acts, ch 1078, §44; 2015 Acts, ch 29, §111Referred to in §633B.119, 638.9 Sat Dec 23 12:15:37 2023 Iowa Code 2024, Section 633B.302 (14, 0)
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