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New York Minor Child Power of Attorney Form | Guardianship

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New York Minor Child Power of Attorney Form (Guardianship) can be used to appoint another to have decision making power over your minor child’s education, health, and finances. Such documentation must be set in place when the parent(s) or legal guardian(s) of the minor or child anticipates being unavailable (i.e. military deployment) or incapacitated (i.e. long-term hospitalization). Even if no such anticipation exists, this paperwork can be utilized as a precautionary tool to safeguard a child or minor’s interests in case one or both parents/legal guardians become unable to care for the child or minor. Naturally, the parent(s) or legal guardian(s) will want to make sure the agent named here will be someone that can be trusted to always act in the child’s best interests, such as a relative or friend of the family. Once this template has been filled out and executed, the resulting document will allow the agent it names with guardian powers to handle the day-to-day issues that arise when you cannot be reached.

Laws – § 661

Guardianship Forms – Use to arrange legal guardianship (for incapacitation or permanent) for a minor. Use the Instructions on how to file with the county of your jurisdiction (sample instructions are for Nassau County).

How to Write

1 – Documentation To Delegate Guardianship Has Been Provided On This Page

Download the paperwork on this page using the buttons on this page. Make sure you have your reference information handy then, open and fill out this template.

2 – Article I Requires The Minor And Parent/Current Guardian Information

The first statement, Article I, will supply a framework so that a (new) Guardian can be appointed. To begin, we will positively identify the Minor (child). Use the first blank space to record the Minor’s Full Legal Name (as it appears on his or her Birth Certificate) then, utilize the three spaces after the words “…Born On The” to record the Calendar Day (1-31), Month, and Year reported as the Birth Date on the Minor’s Birth Certificate.

This statement will continue and require the Name of the Parent or Current Guardian being delegated with Principal Powers filled onto the next blank space.

Indicate if the issuing Principal is a Parent or a current Court Appointed Guardian by marking the appropriate check box in this statement. The first one will indicate the issuing Principal is a Parent while the second will name the issuing Principal as a Court Appointed Guardian.

Utilize the last three empty spaces to document the issuing Principal’s Building Number/Street Name/Apt Number, City, and State of Residence. Use the blank lines after the terms “A Street Address Of,” “City Of,” and “State Of” to supply this information.

The next statement applies and requires the same information if a second Parent or Court Appointed Guardian is involved. This will require the Name, Role, and Home Address for the second Parent/Court Appointed Guardian supplied in this order. If there is no second Parent or Court Appointed Guardian involved this statement may be left blank, crossed out, or edited out (deleted). Note: At Least One Parent Or Court Appointed Guardian of the above-named Minor must issue this document.

3 – Article II Will Identify The Determined Guardian Appointment

The language in Article II enables the issuing Principal to name a specific Guardian to receive Guardian Powers. This language will require some appropriate information to be supplied. First, after the words “I/We Hereby Appoint,” present the determined Guardian’s Legal Name.

Identify the Role the determined Guardian plays in the Minor’s life (i.e. Aunt, Cousin, etc.) in the space labeled “(Relation)”

Next, use the three spaces following the words “…With A Street Address Of” to record the determined Guardian’s Home Address. The first space is reserved for the Building Number, Street Name, and Apartment Number. The second space is provided for the determined Guardian’s City of Residence to be supplied. The last line will call for the determined Guardian’s State of Residence.

4 – Article III Must Be Used To Define What Guardianship Powers Are Being Granted Here

We will need to now state what Guardian Powers will be conferred to the determined Guardian by the issuing Principal (Parent/Court Appointed Guardian). Article III will present two choices, each with a check box, the issuing Principal can choose from. If the determined Guardian should be able to make all the decisions and take all the actions the Parent/Court Guardian can with the Minor’s welfare, then mark the first check box.

If the issuing Principal wishes the determined Guardian to have the Principal Power to make only certain decisions and take only specific actions, the second check box should be marked. This choice will provide several blank lines which must be used to report the Powers being granted.

5 – Article IV Should Specifically Name The Start And End To These Powers

We will need to name a Start Date for the Effective Period of the Guardian Powers here. The first three blank spaces in the first statement of Article IV will accept this Starting Date. This will be the Date when the determined Guardian may use the Principal Guardian Powers in this document. It may be any Date the issuing Principal believes appropriate including the Signature Date. Report this a Two-Digit Calendar Day, the name of the Month written out, and a Two-Digit Calendar Year across these three spaces.

This statement will lead into three choices of which the issuing Principal must choose one. The Principal will now define how the Guardian Powers will terminate. If he or she would like these Powers to terminate automatically on a certain day, the issuing Principal will need to initial Choice A and mark the first check box, then enter the Calendar Date when the determined Guardian will no longer be able to use Guardian Powers across the three check boxes provided.

If the determined Guardian Powers should terminate automatically upon the issuing Principal’s incapacitation or disability then, he or she should initial the blank space for Choice B and mark the check box.

If the Principal wishes the Powers here to terminate only upon his or her death, then he or she should mark initial and mark the third statement.

6 – Article V Calls For Direct Attention From The Principal, Attorney-in-Fact, Witnesses, And Notary Public

The last article on this page has been provided so the issuing Principal may execute this document, placing its terms in effect. This can only be done through the Principal Act of signing this document. There will be enough room for two Parent/Court Appointed Guardian Signatures to be provided.

Each issuing Principal should find the “Parent/Court Appointed Guardian Signature” line then sign his or her Name. Making sure to tend to a unique section. Below this, the issuing Principal should present his or her Printed Name and Signature Date on the lines labeled “Print Name” and “Date.”

The next entity to satisfy the requirements of this execution will be the determined Guardian. He or she should read the statement labeled “Acceptance By Attorney-in-Fact, then provide his or her Name as a Signature and in Print. The determined Guardian must enter the current Date on the line labeled “Date” as his or her Signature Date.

The two Witnesses who have viewed this signing will also need to tend to a statement. This statement will testify to the authenticity of the issuing Principal’s Signature. Two such statements have been provided: Affirmation By Witness I and Affirmation By Witness 2. Each Witness should pick one of these statements, supply his or her Name on the blank space in the paragraph then Sign his or her Name, Print his or her Name, and enter his or her Date of Signature in the appropriate area.

Only the Notary Public physically notarizing this document may supply the items in the “Notary Acknowledgement” statement.


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