POWER OF ATTORNEY
For use of this form, see AR 600-20; the proponent agency is DCS, G-1.
PRIVACY ACT STATEMENT
AUTHORITY:10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.
PRINCIPAL PURPOSE: To designate a guardian to care for your child (ren) in your absence.
DISCLOSURE:Mandatory; failure to maintain a Family Care Plan could subject you to separation, administrative action, or. disciplinary action under the UCMJ.
KNOW ALL PERSONS BY THESE PRESENTS:
That I, |
, Social Security Number |
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, of the state of |
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, a |
member of the United States Armed Forces, currently residing in
, pursuant to Military Orders, do hereby appoint , presently residing at
, my true and lawful attorney-in-fact to do the
following acts or things in my name and in my behalf: To assume and maintain guardianship of my child (ren),
;
to do all acts necessary or desirable for maintaining health, education, and welfare; and to maintain customary living standards, including, but not limited to, provision of living quarters, food, clothing, medical, surgical and dental care, entertainment and other customary matters; and, specifically, to approve and authorize any and all medical treatment deemed necessary by a duly licensed physician and to execute any consent, release or waiver of liability required by medical or dental authorities incident to the provision of medical, surgical or dental care to any of them by qualified medical or dental personnel.
I hereby give and grant individually unto my said attorney full power and authority to do and perform all and any act, deed, matter and thing whatsoever in and about any of the aforementioned specified particulars as fully and effectually to all intents and purposes as I might and could do in my own person if personally present; and in addition thereto. I do hereby ratify and confirm each of the acts of my aforesaid attorneys lawfully done pursuant to the authority herein above conferred.
I HEREBY AUTHORIZED MY ATTORNEY TO INDEMNIFY AND HOLD HARMLESS ANY THIRD PARTY WHO ACCEPTS AND ACTS UNDER OR IN ACCORDANCE WITH THIS POWER OF ATTORNEY.
I intend for this to be a DURABLE Power of Attorney. This Power of Attorney will continue to be effective if I become disabled, incapacitated, or incompetent.
I authorize by attorney-in-fact to hire legal counsel in order to carry out the provisions of this document or determine the existence of legal requirements, such as required filing or placement of notices, which may affect the validity of this document.