Special Power Of Attorney Template printable pdf download

SPECIAL POWER OF ATTORNEY

PREAMBLE: This is a military Power of Attorney prepared pursuant to Title 10, United States Code, Section 1044b, and executed by

a person authorized to receive legal assistance from the military service. Federal law exempts this power of attorney from any

requirement of form, substance, formality, or recording that is prescribed for powers of attorney by the laws of a state, the District of

Columbia, or a territory, commonwealth, or possession of the United States. Federal law specifies that this power of attorney shall be

given the same legal effect as a power of attorney prepared and executed in accordance with the laws of the jurisdiction where it is

presented.

KNOW ALL PERSONS BY THESE PRESENTS:

That I, ____________________, of the State of ___________________, a member of the United States

Armed Forces, do hereby appoint my wife, _________________ of ___________________________________

my true and lawful attorney-in-fact to do the following in my name and in my behalf:

To continue IVF treatments in my absence, including but not limited to: Deployment, Temporary Duties,

Emergency Leave, Regular Leave or Pass, or am unable to make it to the appointment.

Further, I wish my spouse to have complete access to all medical records and information pertaining to our

medical process, to include information produced by providers affiliated with Walter Reed National Military

Medical Center at Bethesda and its outside laboratories and providers. I wish my wife to have exclusive decision

rights regarding assisted reproductive technology process to include oocyte (egg) retrieval, sperm thawing, sperm

preparation, fertilization, embryo thawing, and embryo transfer. Also, I wish my wife to have exclusive decision

rights as to disposition to include freezing, destruction, or transfer as it pertains to leftover product (oocytes, sperm,

embryos).

Giving and granting individually unto said attorney full power and authority to do and perform all and any

act, deed, matter and thing whatsoever in and about any of the specified particulars mentioned in the paragraph

immediately above, as fully and effectually to all intents and purposes as I might and could do in my own person if

personally present; and in addition thereto, I do hereby ratify and confirm each of the acts of my aforesaid attorney

lawfully done pursuant to the authority herein above conferred.

TO INDUCE ANY THIRD PARTY TO ACT HEREUNDER, I HEREBY AGREE THAT ANY THIRD

PARTY RECEIVING A DULY EXECUTED COPY OR FACSIMILE OF THIS POWER OF ATTORNEY

MAY ACT HEREUNDER, AND THAT REVOCATION OR TERMINATION HEREOF SHALL BE

INEFFECTIVE AS TO SUCH THIRD PARTY UNLESS AND UNTIL ACTUAL NOTICE OR

KNOWLEDGE OF SUCH REVOCATION OR TERMINATION SHALL HAVE BEEN RECEIVED BY

SUCH THIRD PARTY. I, FOR MYSELF AND MY HEIRS, EXECUTORS, LEGAL REPRESENTATIVES

AND ASSIGNS, HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS ANY SUCH THIRD

PARTY FROM AND AGAINST ANY AND ALL CLAIMS THAT MAY ARISE AGAINST SUCH THIRD

PARTY BY REASON OF SUCH THIRD PARTY HAVING RELIED UPON THE PROVISIONS OF THIS

POWER OF ATTORNEY.

This Power of Attorney shall become effective when I sign and execute it below. Further, unless sooner revoked or

terminated by me, this Power of Attorney shall become NULL and VOID on _____________________________.

I intend for this to be a DURABLE Power of Attorney. This Power of Attorney will continue to be effective if I

come disabled, incapacitated, or incompetent; or when the United States Government determines that I am in a

military status of “missing,” “missing in action,” or “prisoner of war.” All acts done by my Attorney hereunder

shall have the same effect and inure to the benefit of and bind myself and my heirs as if I were competent, and not

disabled, incapacitated, or incompetent.

I shall be considered disabled or incapacitated for purposes of this power of attorney if a physician, based on that

physician's examination, certifies in writing at a date subsequent to the date which this power of attorney is

executed, that I am disabled from or incapable of exercising control over my person, property, personal affairs, or

financial affairs. I authorize the physician who so certifies, to disclose my physical or mental condition to another

person for purposes of this power of attorney. A third party who accepts this power of attorney, endorsed by proper

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Special Power Of Attorney Template

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