Delegation Of Powers By Parent
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1DELEGATION OF POWERS BY PARENT M
. S
. § 524.5-211
INN
TAT
STATE OF MINNESOTA
)
) ss.
COUNTY OF
)
KNOW ALL PERSONS BY THESE PRESENTS THAT:
1.
I,
, of the County of
, State of Minnesota, am the parent
of
, born
,
.
2.
I hereby appoint
, of the County of
, State of
Minnesota, to be my true and lawful Attorney in Fact for the exercise of parental authority over my
child,
, for a period of _____________ (up
to one year) following the date of my signature, pursuant to M
. S
. § 524.5-211.
INN
TAT
3.
This Power of Attorney hereby constitutes my delegation to
,
of my parental powers and authority regarding the care, custody, and property of
, including, but not limited to the authority to:
a.
authorize medical treatment;
b.
enroll my child in school; and
c.
provide a home, care, and supervision of my child at the home of
.
This Power of Attorney does not authorize
to consent to
marriage or adoption of
.
I, ____________________________, understand that I am legally obligated, pursuant to M
.
INN
S
.§ 524.5-211(b) to mail or give a copy of this document to any other parent within 30 days of
TAT
its execution unless:
a.
the other parent does not have visitation rights or has supervised visitation rights; or
b.
there is an existing order for protection under chapter 518B or similar law of another state in
effect against the other parent to protect me.
IN TESTIMONY WHEREOF, I have hereunto set my hand this
day of
,
20
.
Signature of Parent or Guardian
Subscribed and sworn to before me
this
day of
, 20
____________________________
Notary Public
I hereby accept the foregoing Delegation of Parental Authority over
.
Signature of Attorney in Fact
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