Affidavit Of Attorney-In-Fact - Nuvision Federal Credit Union printable pdf download

Affidavit of Attorney-in-Fact

To:

NuVision Federal Credit Union

Regarding Member: ___________________________

Account(s):

___________________________

I certify under penalty of perjury that:

I have been appointed and am currently serving as the Attorney in Fact for the above referenced individual

pursuant to the validly executed power of attorney attached hereto.

The power of attorney authorizes me to (withdraw from, make deposits to, draw checks and other debits upon,

make payments on) the above referenced account until such time as I provide written notice to the Credit Union to

the contrary. I represent that I have no knowledge of the revocation or termination of the power of attorney,

including but not limited to, by reason of revocation, incapacity (if not a durable power of attorney) or death

of the above referenced individual. I agree to notify the Credit Union in writing immediately if I obtain

actual knowledge of the termination or revocation of the power of attorney.

I hereby agree to indemnify and hold the Credit Union harmless from any and all claims, suits, actions, damages,

judgments, costs, charges, and expenses, including court costs and attorneys’ fees, against any and all liability,

loss and damage of any nature whatsoever that the Credit Union shall or may sustain resulting from its reliance

upon the attached power of attorney and the transaction of any business related to the above referenced account(s)

pursuant thereto.

I also agree to pay any necessary expenses, attorneys’ fees or costs incurred in the

enforcement of this paragraph.

______________________________________________

Typed Name (Attorney in Fact)

Social Security Number (Attorney in Fact)

______________________________________________

State Issued DL/ID and Expiration (Attorney in Fact)

Date of Birth (Attorney in Fact)

______________________________________________

Street Address (Attorney in Fact)

Daytime Phone (Attorney in Fact)

______________________________________________

City

State

Zip

Email Address (Attorney in Fact)

______________________________________________

Signature of Attorney in Fact

Attorney in Fact (Member Name)

______________________________________________

Signature of Credit Union Witness

Date

If form not witnessed and signed by Credit Union Employee, form must be notarized below.

A notary public of other officer completing this certificate verifies only the identity of the individual who signed the document to which this

certificate is attached, and not the truthfulness, accuracy, or validity of that document.

State of California

County of _________________________

Subscribed and sworn to (or affirmed) before me on this _______ day of ___________________________, 20_______

by _______________________________________________ proved to me on this basis of satisfactory evidence to be

the person(s) who appeared before me.

(Seal)

Signature ____________________________________

Revised 04/15

Affidavit Of Attorney-In-Fact - Nuvision Federal Credit Union

Related Articles

Related forms

Related Categories