Special Power Of Attorney For Seeking Army Emergency Relief Assistance Form
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1
2SPECIAL POWER OF ATTORNEY
FOR SEEKING ARMY EMERGENCY RELIEF ASSISTANCE
PREAMBLE: This document is a MILITARY POWER OF ATTORNEY prepared pursuant to Title 10 United States Code, Section 1044(b), and
executed by a person authorized to receive legal assistance from the military. 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 in which it is presented.
KNOW ALL MEN BY THESE PRESENTS:
1. That I, _____________________________, of ________________ (the state of residence or state where service
member entered active duty), a member of the United States Armed Forces, currently at ___________________
pursuant to Military Orders, do hereby appoint ________________________________, of ____________________
(current city and state of residence), my true and lawful attorney-in-fact to do the following in my name and in my behalf:
a. To apply for, contract, and receive a loan or loans and / or to borrow any sums of money or to apply for grants from
Army Emergency Relief (AER), whether directly from AER or through the Air Force Aid Society, Navy Marine Corps Relief
Society, Coast Guard Mutual Aid, or the American Red Cross, in my name and upon such terms as my said attorney-in-
fact shall see fit and to execute in the name of the undersigned a DD Form 139 and/or such other indemnities,
applications, or other documents which may be required by law or regulation to effect such loan or grant; to receive,
endorse, and collect checks payable to the order of the undersigned obtained pursuant to such loans or grants; to obligate
the undersigned for repayment, if warranted, of such assistance.
b. The above enumerated powers specifically include the authority to establish, change, or stop allotments from my
military active duty and or retired pay for the purpose of repayment of said assistance loan issued by AER or through the
Air Force Aid Society, Navy Marine Corps Relief Society, Coast Guard Mutual Aid, or the American Red Cross on behalf
of AER.
Furthermore, I hereby give and grant 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.
2. Hold Harmless Clause. I HEREBY AUTHORIZE MY ATTORNEY TO INDEMNIFY AND HOLD HARMLESS ANY
THIRD PARTY WHO ACCEPTS AND ACTS UNDER OR IN ACCORDANCE WITH THIS POWER OF ATTORNEY.
3. Termination Date. 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 the _____ day of
_____________________________, 20____. (Maximum two years from today’s date)
4. Durable Power of Attorney. I intend for this to be a DURABLE Power of Attorney. This Power of Attorney will
continue to be effective if I become 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 physician certification of my
disability or incapacity, is held harmless and fully protected from any action taken under this power of attorney.
Notwithstanding my inclusion of a specific expiration date herein, if on that specified expiration date I should be or have
been properly certified, in writing, by a physician to be disabled from or incapable of exercising control over my person,
property, personal affairs, or financial affairs, then this Power of Attorney shall remain valid and in full effect until sixty (60)
days after I have recovered from such disability UNLESS OTHERWISE REVOKED BY ME. Furthermore, if on the
above-specified expiration date, or during the sixty (60) day period preceding that specified expiration date, I should be or
have been determined by the United States Government to be a military status of “missing,” “missing in action,” or
“prisoner of war,” then this Power of Attorney shall remain valid and in full effect until sixty (60) days after I have returned to
the United States military control following termination of such status UNLESS OTHERWISE REVOKED OR TERMINATED BY ME.
AER Form 53, Version 10/2014
Page 1 of 2
Initials _____
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