Sec. 9. Whenever this chapter requires or permits a custodian or other person to make an affidavit of regularity with respect to an electronic power of attorney or a complete converted copy, the custodian or other person responsible for the creation of the affidavit of regularity may use the following format for the affidavit:
"Affidavit of Regularity of Electronic Power of Attorney
(1) Beginning on (insert date of first possession of the electronic power of attorney by the signer of this affidavit) and continuing to the date and time of this affidavit, the undersigned person has had possession of (circle all of the following that apply):
(A) The electronic record for the electronic power of attorney.
(B) A complete converted copy of the electronic power of attorney of (insert name of principal), which was electronically executed on (insert date of electronic signing or insert reference to time stamp).
(2) (Insert client number, customer number, document number, or other unique identifier as applicable) is the unique identifier that the undersigned person assigned to this electronic power of attorney in the undersigned person's records.
(3) The undersigned person believes that the principal (circle one (1) of the following options):
(A) Is alive.
(B) Died on or about (insert date of death) and the undersigned person believes that the power of attorney is currently (circle one (1) of the following options):
(i) In effect.
(ii) Not in effect.
(4) The undersigned person is (circle all of the following that apply):
(A) Transferring custody of the electronic record for the electronic power of attorney to the living principal of the electronic power of attorney.
(B) Transferring custody of the electronic record for the electronic power of attorney to (insert name and address of successor custodian).
(C) Transferring a complete converted copy of the electronic power of attorney to (insert name and address of authorized recipient).
(5) The undersigned person is transferring or submitting the electronic record in the following format: (specify format).
(6) If the undersigned person is transferring or submitting the electronic record for the electronic power of attorney, the undersigned person affirms, under penalty of perjury, that the electronic record has been in the undersigned person's possession or control for the period stated in paragraph (1) and that during this period, the electronic record showed no indication of unauthorized alteration or tampering.
(7) The undersigned person affirms, under penalty of perjury, that (circle one (1) of the following options):
(A) The undersigned person has no knowledge of the principal's later execution of any document that amends, revokes, or supersedes the electronic power of attorney described in paragraph (1).
(B) The undersigned believes that the principal purportedly amended or revoked the electronic power of attorney described in paragraph (1) on (insert date if known or approximate time frame if date is not known), by (insert known details concerning the principal's amendment or revocation).
(8) The undersigned person is (circle all of the following that apply):
(A) The living principal who executed the electronic power of attorney.
(B) An attorney admitted to practice law in the state of Indiana.
(C) A currently serving attorney in fact appointed under or named in the explicit terms of the electronic power of attorney.
(D) A successor attorney in fact nominated by the electronic power of attorney.
(E) A custodian currently in compliance with all applicable requirements.
(9) (Insert date and time of the custodian's or other person's signature).
(10) (Insert name and signature of custodian or other person signing. Insert job title or position of signatory if signatory is not an individual (natural person)).".
As added by P.L.40-2018, SEC.4. Amended by P.L.10-2019, SEC.123.