I, [YOUR NAME], of legal aging age and sound mind, residing at [YOUR COMPANY ADDRESS], do hereby make, constitute, and appoint [AGENT'S NAME] residing at [AGENT'S ADDRESS], to act as my Attorney-In-Fact (Hereinafter referred to as "the Agent").

I. Powers of the Agent

I hereby delegate to the Agent the power and authority to make decisions concerning the care, custody, and property of my minor child(ren), [CHILDREN’S NAME(s)] if I’m unable to do so due to illness, absence from the country or other circumstances.

II. Limitations of Power

This Power of Attorney shall not be affected by my disability, or by the lapse of time. This Power of Attorney will remain in effect unless I revoke it or it is terminated by my death. The rights, powers, and authorities of the Agent herein shall be limited, and shall not in any way whatsoever be construed as a grant of general authority.

III. EFFECTIVE DATE AND TERMINATION

This Power of Attorney is effective on the date of execution and will remain in effect until [DATE] or until it is revoked by me in writing and that revocation is delivered to the Agent.

[YOUR NAME][Principal]

[DATE]

[AGENT'S NAME]

[DATE]

Witness Acknowledgement

We, the undersigned witnesses, hereby acknowledge that the above-named Principal has signed this Power of Attorney in our presence on the date stated above.

[WITNESS NAME][WITNESS 1]

[DATE]

[WITNESS NAME][WITNESS 2]

[DATE]

Notary Acknowledgement

On this            day of               in the year               , before me, a Notary Public in and for said County and State, personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.

Witness my hand and official seal.

[NOTARY PUBLIC NAME]

[DATE]

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