Affidavit Of Agent Form printable pdf download

Affidavit Of Agent Form

AFFIDAVIT OF AGENT FORM

STATE OF _______________

COUNTY OF ______________

Before me, the undersigned authority, personally appeared _________________ (agent)

(“Affiant”), who swore or affirmed that:

1. Affiant is the agent named in the Power of Attorney executed by _________________

(“Principal”) on _______________ (date).

2. This Power of Attorney is currently exercisable by Affiant. The principal is

domiciled in ________________ (insert state, territory, or foreign country).

3. To the best of the Affiant’s knowledge after diligent search and inquiry:

The Principal is not deceased;

Affiant’s authority has not been suspended by initiation of proceedings to determine

incapacity or to appoint a guardian or guardian advocate; and

There has been no revocation, partial or complete termination of the Power of

Attorney or of Affiant’s authority.

4. Affiant is acting within the scope of authority granted in the Power of Attorney.

5. Affiant agrees not to exercise any powers granted by the Power of Attorney if

Affiant attains knowledge that it has been revoked, partially or completely

terminated or suspended, or is no longer valid because of the death or adjudication

of incapacity of the Principal.

_________________________

(Affiant)

Sworn to (or affirmed) and subscribed before me this the ____ day of ___________

(month), ________ (year), by _________________ (Affiant)

____________________________________

(Signature of Notary Public- State of Florida)

(Print, Type, or Stamp Commissioned Name of Notary Public)

Personally Known OR Produced Identification ______________________________

(Type of Identification Produced)

Affidavit Of Agent Form