New Mexico Agent'S Certification Form
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1New Mexico Agent’s Certification Form
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 _____________________________ (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 instrument was acknowledged before me on
_____________________ (Date) by ______________________________________ (Name
of Agent). Signature of notarial officer: _________________________________________
(Seal, if any) My commission expires: ________________________.
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