Montana Statutory Form Power of Attorney IMPORTANT INFORMATION FOR AGENT Agent?s Duties When you accept the authority granted under this power of attorney, a special legal relationship is created between you PrintForm Montana Statutory Form Power of Attorney AGENT?S CERTIFICATION AS TO THE VALIDITY OF POWER OF ATTORNEY AND AGENT'S AUTHORITY State of Montana County of: I (Name of Agent) certify under penalty of perjury that (Name of Principal) granted my authority as an agent or successor agent in a power of attorney dated I 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 ACKNOWLEDGEMENT Agent?s Signature Date Agent?s Name Printed Agent?s Address Agent?s Telephone Number State of Montana County of Signed and sworn to (or affirmed) before me on by . Print name(s) of person(s) making statement Notary Signature [Montana notaries must complete the following, if not part of stamp.] Printed Name Notary Public for the State of Montana Residing at My Commission expires: , 20 DISCLAIMER: This document has been prepared from the Montana Uniform Power of Attorney Act that was passed by the 2011 Legislature. It is for general information purposes only. The information provided is not legal advice. Legal advice is dependent upon the specific circumstances of each situation. Future changes in the Uniform Power of Attorney Act cannot be predicted. The form is based-solely upon those laws in force on October 2011.