Power Of Attorney Delegating Parent'S Power Over Minor Child
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3HOW TO FILL OUT A PARENTAL POWER OF ATTORNEY FORM
Section 1: Fill in the county in which the minor child resides.
Section 2: Fill in the full name of the custodial parent or guardian who is giving the Power of
Attorney to another person.
Section 3: Fill in the relationship of the person who is giving Power of Attorney to the minor
child (for example: mother).
Section 4: Fill in the full name of the minor child.
Section 5: Fill in the date of the minor child’s birth date.
Section 6: Fill in the full name of the person who you wish to have a parental power of attorney
over the minor child.
Section 7: Fill in the full name of the minor child.
Section 7a: Fill in the full name of the person who you wish to have a parental power of attorney
over the minor child.
Section 8: Fill in the date that you wish to have the parental power of attorney begin.
STOP
Section 9: The person who is giving the Parental Power of Attorney must sign their name in
Section 9 in front of two (2) witnesses and a notary public. The witnesses will also sign in
Section 9.
NOTARY PUBLIC WILL COMPLETE
Section 10: The notary will complete this section.
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