Power Of Attorney Form printable pdf download

Power Of Attorney Form

POWER OF ATTORNEY FORM

AUTHORIZED BY SECTION 3109.52 OF THE OHIO REVISED CODE

I, the undersigned, residing at _______________________________, in the county

of __________________, state of _____________, hereby appoint the child's

grandparent, _____________________, residing at _________________________,

in the county of __________________, in the state of Ohio, with whom the child of

whom I am the parent, guardian, or custodian is residing, my attorney in fact to

exercise any and all of my rights and responsibilities regarding the care, physical

custody,

and

control

the

child,

_________________________,

born

_______________, having social security number (optional) __________________,

except my authority to consent to marriage or adoption of the child

______________, and to perform all acts necessary in the execution of the rights

and responsibilities hereby granted, as fully as I might do if personally present. The

rights I am transferring under this power of attorney include the ability to enroll the

child in school, to obtain from the school district educational and behavioral

information about the child, to consent to all school-related matters regarding the

child, and to consent to medical, psychological, or dental treatment for the child. This

transfer does not affect my rights in any future proceedings concerning the custody

of the child or the allocation of the parental rights and responsibilities for the care of

the child and does not give the attorney in fact legal custody of the child. This

transfer does not terminate my right to have regular contact with the child.

_____________________________________________________________________________________

Power of Attorney Form

Authorized by Section 3109.52 of the Ohio Revised Code

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Power Of Attorney Form