Complete Home & Office Legal Guide/Complete Home and Office Legal Guide (Chestnut) (1993).ISO/forms/pe/14400.bld

Text File | 1993-08-01 | 2KB | 70 lines

#14400
@001 State the name of the principal (person giving power):
@440 Enter the place of residence of the principal:
@441 State the name of the children's guardian:
@442 Enter the place of residence of the guardian:
@443 Enter the names of the children:
@449 Enter the beginning date of the power of attorney:
@450 Enter the ending date of the power of attorney:
@003 Enter the state where signed:
@004 Enter the county where signed:
#end control section
#14400
/* 14400.arm--- Simple power of attorney- Custody of kids*/


POWER OF ATTORNEY


@001, the "parent"" of @440, herewith appoints @441
of @442, as their attorney in fact, to act in the place and
stead and with the same authority as Principal would have to
do the following acts:


To act as the guardian of the person of my minor children:


@443


including the right to act entirely in loco parentis; including the
authority to approve or to decline medical treatment of any kind for
the child and including the right to review medical records or
school records of the child.



This power of attorney shall be in effect from @449 to @450.




_____________________________________________________

@001, As Principal



STATE OF @003


COUNTY OF @004


@001 personally appeared before me and acknowledged the execution
of this power of attorney for the purposes set forth therein.



Dated: _______________________________






__________________________________________

Notary Public