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Utah Power of Attorney over Protected Person or Minor Child Form

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Utah Power of Attorney over Protected Person or Minor Child Form
Utah Power of Attorney over Protected Person or Minor Child Form
Power of Attorney over Protected person or
Minor Child
Approved Board of District Court Judges January 16, 2009
Page 1 o f 2
Power of Attorney over Protected Person or Minor Child
I swear that the following is true:
(1) I am the parent court-appointed guardian of
_______________________________ (name), who was born on
_______________________________ (date).
(2) I appoint the following person as my attorney-in-fact for the person named in
Paragraph (1).
Name
Address
City, State, Zip
Phone
E-mail
(Check (3) OR (4), not both. If you check (4), describe the authority being delegated.)
(3) I delegate to my attorney-in-fact all power and authority that I have as a
parent or guardian, except the power to consent to marriage or adoption.
(4) I delegate to my attorney-in-fact only the specific authority to:
(5) This power of attorney lasts until ____________________________ (date). (This
date must be within the next 6 months.)
(6) This power of attorney lasts even in the event of my disability.
Utah Power of Attorney over Protected Person or Minor Child Form
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