North Carolina General Statutes 32C-3-302. Agent’s certification
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 OF
POWER OF ATTORNEY AND AGENT’S AUTHORITY
(N.C. Gen. Stat. § 32C-3-302)
I, __________________________ (Name of Agent), do hereby state and affirm the following under penalty of perjury:
(1) _____________________________ (Name of Principal) granted me authority as an agent or successor agent in a power of attorney dated __________.
(2) The powers and authority granted to me in the power of attorney are currently exercisable by me.
(3) I have no actual knowledge of any of the following:
(a) The principal is deceased.
Terms Used In North Carolina General Statutes 32C-3-302
- Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
- following: when used by way of reference to any section of a statute, shall be construed to mean the section next preceding or next following that in which such reference is made; unless when some other section is expressly designated in such reference. See North Carolina General Statutes 12-3
- Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories, so called; and the words "United States" shall be construed to include the said district and territories and all dependencies. See North Carolina General Statutes 12-3
(b) The power of attorney or my authority as agent under the power of attorney has been revoked or terminated, partially or otherwise.
(c) The principal lacked the understanding and capacity to make and communicate decisions regarding his estate and person at the time the power of attorney was executed.
(d) The power of attorney was not properly executed and is not a legal, valid power of attorney.
(e) (Insert other relevant statements) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
(4) I agree not to exercise any powers granted under the power of attorney if I become aware that the principal is deceased, that the power of attorney has been revoked or terminated, or that my authority as agent under the power of attorney has been revoked or terminated.
SIGNATURE AND ACKNOWLEDGMENT
___________________________________ __________________________________
Agent’s Signature Date
___________________________________
Agent’s Name Printed
___________________________________
Agent’s Address
___________________________________
Agent’s Telephone Number
COUNTY OF ________________________, STATE OF ____________________________.
Sworn to or affirmed and subscribed before me this day by:
Date: ________________________________ _________________________________
Signature of Notary Public
(Official Seal)
________________________, Notary Public
Printed or typed name
My commission expires: ________________”