Fillable Power Of Attorney Form Delegating Parental Powers (Page 2 of 2) in pdf

Power Of Attorney Form Delegating Parental Powers Page 2

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MANNER OF REVOCATION: The Principal may revoke this document in writing at any time before the expiration

date, if the specific tasks have been accomplished by the Attorney-in-Fact, for no reason, for cause, or if the

Attorney-in-Fact exceeds or violates the scope and authority granted by this document.

COMPENSATION of Attorney-in-Fact: None.

SIGNATURES:

For Principal:

, the principal, sign my name to this power of attorney this

day of

and, being first duly sworn, do declare to the undersigned authority that I

sign and execute this instrument as my power of attorney and that I sign it willingly, or willingly direct another to sign for

me, that I execute it as my free and voluntary act for the purposes expressed in the power of attorney that

I am eighteen years of age or older, of sound mind, and under no constraint or undue

influence.

Principal Signature

For Witness:

, the witness, sign my name to the foregoing power of attorney

being first duly sworn, and do declare to the undersigned authority the principal signs and executes this instrument as

the principal’s power of attorney and that the principal signs it willingly, or willingly directs another to sign for the

principal, and that I, in the presence and hearing of the principal sign this power of attorney as witness to the principal’s

signing, and to the best of my knowledge the principal is

eighteen years of age or older, of sound mind, and under

no constraint or undue

influence.

Witness Signature

7. NOTARIZATION:

For Notary:

The State of

County of

Subscribed, sworn to and acknowledged before me by

, the principal, and subscribed

and sworn to before me by

, witness, this

day of

(Seal)

(Signed)_

(Notary Public)

Page 2 of 2

Power Of Attorney Form Delegating Parental Powers Page 2

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