New Hampshire Revised Statutes 564-E:302 – Agent’s Certification
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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
STATE OF NEW HAMPSHIRE
COUNTY OF _______________
I, _______________ , certify under penalty of perjury that _______________ granted me authority as an agent in a power of attorney dated _______________ .
I further certify that to my knowledge:
(1) the principal is alive and has not revoked the Power of Attorney or my authority to act under the Power of Attorney and the Power of Attorney and my authority to act under the Power of Attorney have not terminated;
(2) if the Power of Attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred;
(3) if I was named as a successor agent, the prior agent is no longer able or willing to serve; and
(4) (Insert Other Relevant Statement(s)).
SIGNATURE AND ACKNOWLEDGMENT
Agent’s Signature: ________________________________________
Date: __________________________________________________
Agent’s Name Printed ___________________________________
Agent’s Address ________________________________________
Agent’s Telephone Number ______________________________
Signed and sworn to (or affirmed) before me on _______________ , by _______________ , known to me or satisfactorily proven to be the person named herein
Signature of Notarial Officer:
Title (and Rank):
My commission expires:
AGENT’S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT’S AUTHORITY
Terms Used In New Hampshire Revised Statutes 564-E:302
- following: when used by way of reference to any section of these laws, shall mean the section next preceding or following that in which such reference is made, unless some other is expressly designated. See New Hampshire Revised Statutes 21:13
- person: may extend and be applied to bodies corporate and politic as well as to individuals. See New Hampshire Revised Statutes 21:9
- 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
- sworn: when applied to public officers required by the constitution to take oaths therein prescribed, shall refer to those oaths; when applied to other officers it shall mean sworn to the faithful discharge of the duties of their offices before a justice of the peace, or other person authorized to administer official oaths in such cases. See New Hampshire Revised Statutes 21:25
STATE OF NEW HAMPSHIRE
COUNTY OF _______________
I, _______________ , certify under penalty of perjury that _______________ granted me authority as an agent in a power of attorney dated _______________ .
I further certify that to my knowledge:
(1) the principal is alive and has not revoked the Power of Attorney or my authority to act under the Power of Attorney and the Power of Attorney and my authority to act under the Power of Attorney have not terminated;
(2) if the Power of Attorney was drafted to become effective upon the happening of an event or contingency, the event or contingency has occurred;
(3) if I was named as a successor agent, the prior agent is no longer able or willing to serve; and
(4) (Insert Other Relevant Statement(s)).
SIGNATURE AND ACKNOWLEDGMENT
Agent’s Signature: ________________________________________
Date: __________________________________________________
Agent’s Name Printed ___________________________________
Agent’s Address ________________________________________
Agent’s Telephone Number ______________________________
Signed and sworn to (or affirmed) before me on _______________ , by _______________ , known to me or satisfactorily proven to be the person named herein
Signature of Notarial Officer:
Title (and Rank):
My commission expires: