AFFIDAVIT AS TO POWER OF ATTORNEY BEING IN FULL FORCE
THAT , as principal, who resides at , did in writing under date of , 20 , appoint me [his/her] true and lawful attorney, and that annexed hereto, and hereby made part hereof, is a copy of said power of attorney.
THAT at the time of executing the above-described instrument(s), I had no actual knowledge or actual notice of revocation or termination of the aforesaid power of attorney by death of said principal or otherwise, or notice of any facts indicating the same.
THAT I hereby represent that the said principal is now alive; has not, at any time revoked or repudiated the said power of attorney; and the said power of attorney still is in full force and effect.
THAT I make this affidavit for the purpose of inducing acting through to accept delivery of the above-described instrument(s), as executed by me in my capacity of attorney in fact of the said principal, with the full knowledge that the above-names parties in accepting the execution and delivery of the aforesaid instrument and in paying a good and valuable consideration therefore, will rely upon this affidavit.
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