Michigan Compiled Laws, Chapter 556. Powers of Appointment § 556.403

CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY

State of _________________________________________

[County] of ______________________________________

I, _________________________ (Name of Certifier), certify under penalty of perjury that _________________________ (Name of Principal) granted _________________________ (Name of Agent) 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 the Agent's authority to act under the Power and the Power and the Agent's authority to act under the Power have not otherwise terminated;

(2) If the Power of Attorney was drafted to become effective upon the happening of a specified event or contingency, the specified event or contingency has occurred;

(3) If the Agent was named as a successor agent, the prior agent is unable or unwilling to serve; and

(4) _______________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

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(Insert other relevant statements. You may attach separate sheets if additional space is needed.)

SIGNATURE AND ACKNOWLEDGMENT

__________________________________

_____________________

Certifier's Signature

Date

__________________________________

Certifier's Name Printed

__________________________________

Certifier's Capacity (as Agent, attorney at law for Agent, or attorney at law for Principal)

__________________________________

Certifier's Address

__________________________________

Certifier's Telephone Number

This document was acknowledged before me on

__________________

,

(Date)

by _____________________________________________________________________________________.

(Name of Certifier)

________________________________________________

(Seal, if any)

Signature of Notary

My commission expires: __________________

This document prepared by:

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