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_SETUP.1
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14400.BLD
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1997-07-22
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#14400
@001 State the name of the principal (person giving power):
~Enter the name of the person giving the power of attorney.
@440 Enter the place of residence of the principal:
~Enter the city and state where the principal resides.
@441 State the name of the children's guardian:
~Enter the name of the person receiving the power. If the person
~is a relative, you may wish to state this. For example: Sue
~Smith, my sister.
@442 Enter the place of residence of the guardian:
~Enter the city and state where the person receiving the power
~resides.
@443 Enter the names of the children:
~Enter the full names of the children.
@449 Enter the beginning date of the power of attorney:
~Enter the date when the power begins.
@450 Enter the ending date of the power of attorney:
~Enter the date when the power of attorney will end.
@003 Enter the state where signed:
~Enter the name of the state where this power is being signed.
@004 Enter the county where signed:
~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