POWER OF ATTORNEY AGENT’S CERTIFICATION AND AFFIDAVIT AS TO THE VALIDITY OF POWER OF
ATTORNEY FOR FINANCES AND PROPERTY AND AGENT’S AUTHORITY
Commitment No.: _______________
STATE OF WISCONSIN
COUNTY OF ___________
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The undersigned, ________________ (name of agent), being first duly sworn, deposes, states, warrants and certifies under
penalty of perjury, that:
1.
______________ (name of principal) (“Principal”) granted me authority as an agent or successor agent in a power of
attorney dated _____________.
2.
I am authorized to deal with any real estate owned by Principal, as I deem proper, including the real estate located at
______________________________________________and legally described on the above-referenced commitment
(the “Property”).
3.
Pursuant to the power of attorney, today I will execute a conveyance for the Property (the conveyance being either a
deed or mortgage, as identified and required in the above-referenced commitment).
4.
The conveyance is made solely for the benefit of Principal and is pursuant to the power of attorney.
5.
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.
6.
If the power of attorney is not a durable power of attorney under applicable state law, the Principal is not
incapacitated (as defined under state law).
7.
If the power of attorney was drafted to become effective upon the happening of an event or contingency, the event or
contingency has occurred.
8.
If I was named as a successor agent, the prior agent is no longer able or willing to serve.
9.
I understand that the title company shown on the Commitment (“Agent”), as agent for the title insurance underwriter
named in the Commitment (“Underwriter”) (Agent and Underwriter are collectively, referred to as “Companies”),
shall rely upon these statements and representations to issue its title insurance policies, including endorsements, on
the above-referenced commitment. I agree to indemnify and hold the Companies harmless from and against any and
all loss or damage caused by my misrepresentations, inaccuracies and/or omissions in the above information, plus
any cost, expense or liability, including attorney fees, arising from the enforcement of this indemnification
Dated: ___________________
____________________________________
Print Name: __________________________
This document was acknowledged before me on
_________________, 2010, by _______________ (name
of agent).
___________________________________
Notary Public,
County, Wisconsin.
My commission (expires) (is permanent).
___________________________________
THIS DOCUMENT WAS PREPARED BY:
___________________________