Affidavit of Validity of Power of Attorney : Please fill out the following form. Please print your completed form if you would to have a copy for your records.




Above Space Reserved For Recording


The recording official is directed to return this instrument or a copy to the above person.


RE : POWER OF ATTORNEY FROM________________(PRINCIPAL) DATED ____________________________
RECORDED WITH PUBLIC RECORDS OF_________________
COUNTY AT DOCKET/PAGE ___________


1. I hereby depose and say I am an adult and otherwise competent to execute an Affidavitand further, I am the above-named Attorney-in-Fact.


2. The Affidavit is executed pursuant to the Uniform Probate Code. This provides anAffidavit executed by the Attorney-in-Fact stating that he/she did not have, at the time of the actpursuant to the Power of Attorney, actual knowledge of the revocation or termination of the powerby death, disability or incompetence. The Affidavit, in the absence of fraud, is conclusive proofof the non-revocation or non-termination of the power at that time. If the power requires theexecution of an instrument which is recordable, the Affidavit, when authenticated for record, issimilarly recordable.


3. Pursuant to the above, I affirm that on the date below I have had no actual knowledgeof any revocation or termination of the Power of Attorney by death, disability, incompetence orotherwise and I have good reason to believe the Power of Attorney is in full force and effect.


4. I have read the foregoing and of my own knowledge affirm that the facts stated aboveare true and correct.


Attorney-in-Fact :


STATE OF


COUNTY OF


Then personally appeared the above-named Attorney-in-Fact, who acknowledged the foregoing, before me.


Notary Public :


My Commission Expires :


This product does not constitute the rendering of legal advice or services. This product is intended for informational use only and is not a substitute for legal advice. State laws vary, so consult an attorney on all legal matters. This product was not prepared by a person licensed to practice law in this state.





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