Ark. Code Ann. § 28-68-302: 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 OFATTORNEY 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 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 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: __________________ Acts 1965, No. 61, § 10; A.S.A. 1947, § 58-510; Acts 2011, No. 805, § 1.

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 OFATTORNEY 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 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 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: __________________

__________________

(Insert other relevant statements)

SIGNATURE AND ACKNOWLEDGMENT

__________________ __________________ Agent's Signature Date

__________________

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: __________________