Conn. Gen. Stat. § 1-352a
This is the official text of Conn. Gen. Stat. § 1-352a, part of Connecticut’s Gen. Stat — part of the compiled statutory law of Connecticut, published by the state as "Gen. Stat." Browse the sections below, each linked to its official government source.
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Sec. 1-352a. Agent's certification.
Official statutory text
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 false statement 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 Commissioner of Superior Court/Notary) My commission expires: _________________________
State of ______________________________
County of ____________________________
I, _____________________ (Name of Agent), certify under penalty of false statement 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 Commissioner of Superior Court/Notary) My commission expires: _________________________
Status: in_force · Read it on the official government site
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