FL Power of Attorney Affidavit

This form applies to:
  • Florida
Forms by State
Organization Forms

FL Power of Attorney Affidavit

Form Document
V 5


STATE OF ___________________

COUNTY OF _________________

Before me, the undersigned authority, personally appeared _____________________________________ (“Affiant”), who swore or (Attorney in Fact) affirmed that:

  1. Affiant is the attorney in fact named in the Durable Power of Attorney executed by _________________________________      (“Principal”) on ___________________.
    (Principal)                                                                                Date
  2. This Durable Power of Attorney is currently exercisable by Affiant.  The principal is domiciled in ____________________________.
                         State, Territory or Foreign Country
  3.  To the best of the Affiant’s knowledge after diligent search and inquiry:
    1. The Principal is not deceased; and
    2. There has been no revocation, partial or complete termination by adjudication of incapacity or by the occurrence of an event referenced in the durable power of attorney, or suspension by initiation of proceedings to determine incapacity or to appoint a guardian.
  4. Affiant agrees not to exercise any powers granted by the Durable Power of Attorney if Affiant attains knowledge that it has been revoked, partially or completely terminated, suspended, or is no longer valid because of the death or adjudication of incapacity of the Principal.

                                                                        _________________________________________.                                                                                        (Person Making Statement)




Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online notarization, this ___ day of ________, 20____, by ___________________ (name of person making statement).

Personally Known ☐ OR Produced Identification ☐  

Type of Identification Produced: ____________________ 

(Signature of Notary Public)  

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

Affix Notary SEAL

Online Notary: ☐ (Check Box if acknowledgment done by Online Notarization)

For issuing guidelines on this form, see Guidelines.