Connecticut Minor (Child) Power of Attorney Form

Connecticut minor (child) power of attorney is a form that assigns a representative to provide care for a minor on behalf of a parent or guardian. This type of appointment allows the representative to make decisions and handle parental duties necessary to maintain the child’s well-being, education, and other needs.

Connecticut Minor (Child) Power of Attorney Form

Connecticut minor (child) power of attorney is a form that assigns a representative to provide care for a minor on behalf of a parent or guardian. This type of appointment allows the representative to make decisions and handle parental duties necessary to maintain the child’s well-being, education, and other needs.

Last updated June 7th, 2024

Connecticut minor (child) power of attorney is a form that assigns a representative to provide care for a minor on behalf of a parent or guardian. This type of appointment allows the representative to make decisions and handle parental duties necessary to maintain the child’s well-being, education, and other needs.

  1. Home »
  2. Power of Attorney »
  3. Connecticut »
  4. Minor Child

Signing Requirements

A minor power of attorney must be signed by the parent/guardian before two witnesses, and their signature must be notarized.[1]

Sample

Download: PDFWord (.docx)OpenDocument

CONNECTICUT MINOR (CHILD) POWER OF ATTORNEY

1. For the Minor named [CHILD’S NAME], born on [MM/DD/YYYY] (hereinafter known as the “Minor”), I, [PARENT’S NAME], the Parent or Court Appointed Guardian with a street address of [PARENT’S ADDRESS],And I, [CO-PARENT’S NAME], the Parent or Court Appointed Guardian with a street address of [CO-PARENT’S ADDRESS],

2. Hereby appoint [ATTORNEY-IN-FACT’S NAME] as the Attorney-in-Fact for the Minor who is their [RELATION TO CHILD] with a street address of [ATTORNEY-IN-FACT’S ADDRESS] (hereinafter referred to as the “Attorney-in-Fact”).

3. I/We delegate to the Attorney-in-Fact the authority to [DESCRIBE AUTHORITY].

4. This power of attorney document shall commence on [MM/DD/YYYY] and end on:

A. [INITIAL] [MM/DD/YYYY].
B. [INITIAL] – In the event of my disability (incapacitation).
C. [INITIAL] – In the event of my death.

This document can be terminated at any time by completing a revocation or by creating a new minor power of attorney form.

5. This power of attorney shall be governed under the laws in the State of Connecticut and terminates any prior written form.

Parent/Guardian Signature: _______________ Date: _______
Print Name: _______________

Parent/Guardian Signature: _______________ Date: _______
Print Name: _______________

AFFIRMATION BY WITNESSES

I witnessed the execution of this Power of Attorney by the Parent/Court Appointed Guardian(s), and I affirm that the Parent/Court Appointed Guardian(s) appeared to me to be of sound mind, was not under duress, and the Parent/Court Appointed Guardian(s) affirmed to me that he/she was aware of the nature of this Power of Attorney and signed it freely and voluntarily.

Witness Signature: _______________ Date: _______
Print Name: _______________ Address: _______________

Witness Signature: _______________ Date: _______
Print Name: _______________ Address: _______________

NOTARY ACKNOWLEDGMENT

State of Connecticut
County of _______________, ss.

On _______, before me appeared _______________, as the Parent(s)/Court Appointed Guardian(s) who proved to me through government-issued photo identification to be the above-named person(s), who in my presence executed the foregoing instrument and acknowledged that (s)he executed the same as his/her free act and deed.

Notary Signature: _______________
Print Name: _______________
My Commission Expires: _______ (Notary Seal)

Sources

  1. § 1-350d