The certificate of acknowledgment by an attorney in fact must be substantially in the following form:
Territory of ____ or State of ____
County of ____ ss
On this ____ day of ____, in the year ____, before me personally appeared ____, known to me (or proved to me on the oath of ____) to be the person who is described in and whose name is subscribed to the within instrument as the attorney in fact of ____, and acknowledged to me that he subscribed the name of ____ thereto as principal and his own name as attorney in fact.