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Pennsylvania Guardian of Minor Power of Attorney Form

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Pennsylvania Guardian of Minor Power of Attorney Form provides a legal method by which you can appoint another person to care for your children on a temporary basis. This type of appointment should only be made to a relative or a family friend who both the parents and their children are comfortable with trusting. The parental powers delivered here will allow the agent or caretaker to handle the responsibilities that only a parent or legal adult guardian of the child(ren) can tend to on behalf of the parent/legal guardian. It should be mentioned this is only a temporary delegation of powers that will go in effect when the parent/guardian is unable to care for the concerned child(ren). Some examples of when this may come into play are when both parents are taking a trip, a military deployed to another nation during a time of war, detained or incarcerated, or suffers a medical event requiring extended stays in a health care facility.

Laws – No Statute

Standby Guardianship – If the parent would like to designate someone else to take custody of their child(ren) in the event of incapacitation they may do so in accordance with § 5611.

Orphans’ Court Forms – For any other type of guardianship claims.

How to Write

1 – Download The Document On This Page To Appoint A Minor’s Guardian In Pennsylvania

The document one will require to delegate Guardian Authority to an Attorney-in-Fact over a Minor or Child. Only the Minor’s Parent or Current Guardian may perform this action and each one in charge of the Minor’s welfare will need to sign these papers. Download this form using one of the buttons on this page. You may obtain this appointment template as a PDF, ODT, or MS Word file.

2 – The Minor And Both Parents (Or Current Guardian) Should Be Introduced In Section I

Once this document is opened and ready to be filled out, we will need to solidify the concerned Minor’s Identity before proceeding to the Principal and Attorney-in-Fact’s information. Locate Section I, then fill in the Minor’s Full Name on the first blank line. The next three blank spaces in this section are reserved for the presentation of the Minor’s Date of Birth. This will need to be entered as a Two-Digit Calendar Date, the Name of the Month, and the Two-Digit year when he or she was born. This must be the same date as that on the Minor’s Birth Certificate. If more Minors are involved, and there is not enough room, you may manufacture a list of the remaining concerned Minors that includes each one’s Full Name and Date of Birth. In addition to the Minor’s Identity, Section I will require that of each Parent or Current Guardian. This will be handled by producing the Full Name of the Minor on the blank line just after the word “I.” Immediately following this will be two check boxes: “Parent” and “Court Appointed Guardian.” Only the checkbox that defines the role of the individual just named can be checked. In addition to the Parent or Current Guardian’s Name and Status, his or her Residential Address must be properly documented. Use the blank line after the phrase “…A Street Address” to enter the Parent or Guardian’s Building Number, Street, and Unit Number. Follow through with this Address by presenting the City and State where the Principal’s Street Address is located. If another Parent is involved or there is a second Current Guardian responsible for the welfare of the concerned Minor, then his or her information must be presented in a similar fashion using the statement below the words “If Co-Guardian/Parent Exists.” If there is no additional Parent or Current Guardian, this may be left blank, crossed out, or deleted.

3 – State The Determined Guardian’s Identity

Section II will focus on defining the intended recipient of Guardian Powers over the Child/Minor’s welfare. Here, we will use the format as the previously named parties to accomplish this in a declaration statement. Use the first blank space after the term “I/We Hereby Appoint” to fill in the name of the Attorney-in-Fact who is the intended Guardian. Once this template is filled in and signed by the concerned Parents/Guardian, this is the person who will act as the Minor’s Guardian when called to. The second blank space in Section II requires a clear definition of the role the intended Guardian plays in the Child/Minor’s life (i.e. Grandparent, Aunt). The remaining three blank spaces have been provided so the Attorney-in-Fact’s Residential Address may be documented. This should be produced as the Street Address on the line after the words “…Street Address Of,” the City on the line after the words “…City Of,” and the State on the line after “…State Of”

4 – The Powers Delivered To The Agent Must Be Defined And Dated

In Section III, we will address the nature of the Guardian Powers appointed to the Attorney-in-Fact. Two choices have been supplied beneath the statement “I/We Delegate To The Attorney-in-Fact The Powers Of.” The Parent/Guardian delegating such Power must initial the blank line and mark the check box corresponding to the statement that defines what Principal Powers will be delivered here. If the Parent/Guardian wishes to delegate the full scope of Guardian Powers to the Attorney-in-Fact, he or she should initial and check the first statement. If the Parent/Guardian wishes to specifically define what the intended Guardian Attorney-in-Fact can wield Principal Power for, then he or she should initial and check the second statement and provide such instructions on the blank lines in this choice. Now, we address Section IV and its requested definitions. Here, a time-frame must be attached to the Guardian Powers being delivered. First, enter the Date when the Principal’s Guardian Powers will be available to the Attorney-in-Fact by entering the Calendar Day, Month, and Year on the blank lines in the statement beginning with “This Power Of Attorney Document Shall Commence…”

Next, three choices will be made available to the Principal, so the Termination Date of the Principal Guardian Powers can be defined. The Principal will need to initial and check the choice that best defines the manner in which the Guardian Powers here will terminate. If he or she wishes these Powers to automatically Terminate on a certain Date, the Principal should record the Termination Date in Statement A, then initial the blank line that precedes it and mark its check box. If the Principal wants these Powers to terminate upon his or her disability, then he or she must initial and check Statement B. If the Principal wishes these Powers to be more durable and keep them in place until he or she passes away (dies), the Principal will need to choose Statement C by initialing and checking it.

5 – This Delegation Only Occurs With The Each Parent’s (or Current Guardian) Signature

The Principal will need to sign this paperwork once he or she has reviewed it and determined its accuracy. Locate Section V, The Principal must sign his or her Name on the blank line labeled “Parent/Court Appointed Guardian Signature.” The Principal will need to continue his or her execution of this paperwork by printing his or her Name and recording the Signature Date on the two-blank space furnished beneath the Signature Line.

A second “Parent/Court Appointed Guardian Signature” area will supply enough room for a second Parent or Guardian to supply these required items. If more than two Guardians are involved make sure to include their Signatures, Printed Names, and Signature Dates.

The next paragraph section, labeled “Acceptance By Attorney-in-Fact,” must be signed by the Attorney-in-Fact using the “Attorney-in-Fact’s Signature” line. Below this, he or she should Print his or her Name and record the Signature Date.

Two Witness Testimonials will follow the Attorney-in-Fact’s Signature area. Each Witness must read the statement provided in either “Affirmation By Witness 1” or “Affirmation By Witness 2” then supply his or her Signature, Printed Name, and Signature Date.

Finally, the Notary Public attending this signing should then be given direct access to this document so that he or she may provide the notarization process to substantiate this document’s execution.


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