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Here is the text we could read:

AGENT’S CERTIFICATION 
 
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___________________________ 

, _____________________________________________ (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 ________________.  

 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 Certification 
Utah Code 75-9-101 et seq. 

May 2016 
Revised May 9, 2017 

 

Page 1 of 2 

  I

  I

 

  _

  _

 

 

     

 

   

Agent's Address: ________________________________________________________ 

Agent's Telephone Number:  ______________________________________________ 

On this date, I certify that _________________________________________________________ (name) 
who is known to me or who presented satisfactory identification, in the form of 
______________________________________________________ (form of identification), has, while in my 
presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. 

Typed or Printed Name of Principal 

Sign here ► 

 

 

Typed or printed name (Notary Public) 

Sign here ► 

Notary Seal 

 

 

 

 This document prepared by: _____________________________________________ ] 

Agent’s Certification 
Utah Code 75-9-101 et seq. 

May 2016 
Revised May 9, 2017 

 

Page 2 of 2 

Date 

 
Date 

   

              [

AGENT’S CERTIFICATION

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 2
Fields(s): 92
Average fields per page: 46
Reading Level: Grade 11
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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name_agent_certify was name_of_agent_certify_under (0.37 conf)
page_field__9 was page_0_field_11 (0.31 conf)
principal_granted_authority was principal__granted_me_authority_as_an_agent_or_successor_agent_in_a_power_of_attorney (0.38 conf)
penalty_perjury was penalty_of_perjury_that (0.46 conf)
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i was i (0.38 conf)
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dated was dated (0.45 conf)
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agent_telephone_number was agent_s_telephone_number (0.40 conf)
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agent_address was agent_s_address (0.33 conf)
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page_field__41 was page_1_field_10 (0.36 conf)
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users1_signature was sign_here (1.00 conf)
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users1_name was name (1.00 conf)
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page_field__56 was page_1_field_31 (0.36 conf)
oath_declared_true was presence_and_while_under_oath_or_affirmation__voluntarily_signed_this_document_and_declared_that_it_is_true (0.41 conf)
page_field__57 was page_1_field_33 (0.36 conf)
notary_seal was notary_seal (0.37 conf)
af_f was AFF081 (0.51 conf)
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page_field__65 was page_1_field_43 (0.32 conf)
document_prepared was this_document_prepared_by (0.38 conf)
page_field__66 was page_1_field_45 (0.36 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

AGENT’S CERTIFICATION

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02