Utah Power of Attorney over Protected Person or Minor Child Form
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Power of Attorney over Protected personor
Approved Board of District Court Judges January 16, 2009
Page 1 o f2
Power of Attorneyover Protected Personor Minor Child
I swear that the following is true:
(1)I am the parent court-appointed guardian of
_______________________________ (name), who was born on
(2)I appoint the following person as my attorney-in-fact for the person named in
City, State, Zip
(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
parentor 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.
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