FL Power of Attorney Affidavit

STATE OF ____________________________

COUNTY OF __________________________

Before me, the undersigned authority, personally appeared _____________________(attorney in fact) _____________________ (“Affiant”), who swore or affirmed that:

1. Affiant is the attorney in fact named in the Durable Power of Attorney executed by ______________________________ (principal) _______________ (“Principal”) on _________________________ (date).

2. This Power of Attorney is currently exercisable by Affiant. The principal is domiciled in _________________________________ (insert name of state, territory, or foreign county).

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

a. The Principal is not deceased;

b. Affiant’s authority has not been suspended by initiation of proceedings to determine incapacity or to appoint a guardian or a guardian advocate; and

c. There has been no revocation, or 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 is the successor to ________________________ (insert name of predecessor agent), who has resigned, died, become incapacitated, is no longer qualified to serve, has declined to serve as agent, or is otherwise unable to act, if applicable.

6. Affiant agrees not to exercise any powers granted by the Durable Power of Attorney if Affiant attains knowledge that it has been revoked, has been partially or completely terminated or suspended, or is no longer valid because of the death or adjudication of incapacity of the Principal.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 _____ day of ____________ (month), 20__, by ________________________ (name of person making statement).

___________________________________________________

(Signature of Notary Public‐State of Florida)

___________________________________________________

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

Personally Known OR Produce Identification ________________________________________ (Type of Identification Produced).

For issuing guidelines on this form, see Guidelines