Indiana Power of Attorney for a Child
This Power of Attorney document is created in accordance with the laws of the State of Indiana. It grants authority to a designated individual to make decisions on behalf of a minor child.
Principal Information:
- Name: ___________________________
- Address: _________________________
- City, State, Zip: ________________
- Phone Number: ____________________
Agent Information:
- Name: ___________________________
- Address: _________________________
- City, State, Zip: ________________
- Phone Number: ____________________
Child Information:
- Name: ___________________________
- Date of Birth: ____________________
- Address: _________________________
- City, State, Zip: ________________
Effective Date: This Power of Attorney shall become effective on: ____________________.
Duration: This Power of Attorney shall remain in effect until: ____________________.
Powers Granted: The Agent shall have the authority to make decisions regarding:
- Medical care and treatment.
- Education and schooling.
- Travel and relocation.
- Other matters as specified: ____________________.
Revocation: This Power of Attorney may be revoked by the Principal at any time, provided that written notice is given to the Agent.
Signature:
By signing below, the Principal acknowledges that they understand the powers granted herein.
Principal's Signature: ___________________________
Date: ______________________________________
Witness Information:
Witness Name: ___________________________
Witness Signature: ________________________
Date: ______________________________________
Notary Public:
State of Indiana, County of ____________________.
Subscribed and sworn to before me this ____ day of __________, 20__.
Notary Public Signature: ________________________
My Commission Expires: ______________________