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Durable Power Of Attorney: Affidavit Of Attesting Witnesses



STATE OF ___________________     )

COUNTY OF _________________     )   ss.

Each of the undersigned, individually and severally, being duly sworn, deposes and says:

The attached Durable Power of Attorney was executed in our presence and sight by ___________________________ , the person named in the document on the ____ day of ____________, 20__.  Said individual, at the time he/she executed such document, declared the instrument so executed to be a Durable Power Of Attorney.

Each of the undersigned then signed as a witness at the end of such document at his/her request and in his/her presence and in the presence and sight of each other. Said person was, at the time of executing said Durable Power Of Attorney, over the age of 18 years, and, jn the respective opinions of the undersigned, of sound memory and understanding and not under any restraint or in any respect incompetent to execute a Durable Power Of Attorney. The said person, in the respective opinions of the undersigned, could read, write and converse in the English language, and was suffering from no defect of sight, hearing or speech, or from any other physical or mental impairment which would affect his/her capacity to execute a valid Durable Power Of Attorney.

Each of the undersigned was acquainted with the said person at such time and makes this affidavit at his/her request.

The subject Durable Power Of Attorney was executed by said person and witnessed by each of the undersigned affiants, under the supervision of _______________________________, an attorney at law.

Witness No. 1:

________________________________________ (Signature)

Name: (Please print)_______________________________________________   Address: _________________________________________      


Witness No. 2:

________________________________________ (Signature)

Name: (Please print)_______________________________________________   Address: _________________________________________      


The foregoing affidavit was executed before me, a Notary Public in and of the State of __________________,  this ____ day of ____________, 20___ by ________________________ and _________________________________, both of whom are known to me.

______________________________ (Signature) Name (Print): _____________________________________________________

Commission No. _____________________________                 My commission expires: __________________________________


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