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 of principal) granted me authority as an agent or successor agent in a power 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 of attorney have not terminated.
If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has 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 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
___________________________________________________________
___________________________________________________________
2014 Acts, ch 1078, §44; 2015 Acts, ch 29, §111
Referred to in §633B.119, 638.9