Delegation By A Parent Of Authority For Minor Child Form
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1DELEGATION BY A PARENT OF AUTHORITY FOR MINOR CHILD
STATE OF COLORADO )
)
ss.
POWER OF ATTORNEY
COUNTY OF
)
(Delegation)
Pursuant to Section 15-14-105 C.R.S. 2005, I hereby delegate to
_______________________________________________________________________
(Name)
_______________________________________________________________________
(Address)
whom I designate my attorney in fact for this purpose, all of my power regarding
custody, well being, and property of my minor child ____________________________
which are delegable under the Colorado Probate Code, including the power to consent to
surgical operations and medical and dental treatment and to receive delivery or payment
of money and property due the said minor child. In accordance with the said section, this
delegation does not include power to consent to marriage or adoption. This delegation is
made for a period not exceeding twelve months and shall terminate on _____________.
This power of attorney shall remain in effect, to the extent permitted by section 15-14-
105 of the said Code, not withstanding later disability or incapacity of the principal at
law, or later uncertainty as to whether the principal is dead or alive.
Dated: ______________
____________________________________
Father
____________________________________
Mother
Address:
____________________________________
____________________________________
Subscribed and sworn to before me this _____ day of ______________________,
20____.
____________________________________
Notary Public
{SEAL}
My commission expires: ___________________
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