Conn. Gen. Stat. § 1-350h
(c) If a power of attorney becomes effective upon the principal's incapacity and the principal has not authorized a person to determine whether the principal is incapacitated, or the person authorized is unable or unwilling to make the determination, the power of attorney becomes effective upon a determination in a writing or other record by:
(e) If the principal, in the power of attorney, authorizes one or more persons to determine in a written affidavit that the event or contingency has occurred, as provided in subsection (b) of this section, then the written affidavit may be in substantially the following form:
AFFIDAVIT THAT POWER OF ATTORNEY
IS IN FULL FORCE AND EFFECT
| STATE OF | } | ss: |
| COUNTY OF | ||
| I, .... of ...., being duly sworn, depose and say: |
THAT ...., of ...., as principal, did on ...., 20.., appoint me in a power of attorney dated ...., 20.., to execute an affidavit that a specified contingency had occurred;
THAT specified contingency was: ....
THAT specified contingency has occurred.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
.... L.S.
....
Witness
....
Witness
Subscribed and sworn to before me this .... day of ...., 20...
....
Commissioner of the Superior Court
Notary Public
My commission expires: ....
(P.A. 15-240, S. 9; P.A. 16-40, S. 9.)
History: P.A. 15-240 effective July 1, 2016; P.A. 16-40 changed effective date of P.A. 15-240, S. 9, from July 1, 2016, to October 1, 2016, effective May 27, 2016.