Michigan Power of Attorney for a Child
This Power of Attorney for a Child document grants temporary authority to an appointed person to make decisions regarding the child's welfare, education, and health, conforming to the Michigan Compiled Laws Section 700.5103. This document does not provide custodial rights but allows the appointed guardian to act on the child’s behalf under specified conditions.
Please fill in the relevant information in the spaces provided:
Principal Information:
- Full Name of Parent/Guardian (Principal): ____________________________
- Principal's Address: ________________________________________________
- City: ________________________, State: Michigan, Zip Code: ____________
- Contact Number: ________________________
Child’s Information:
- Full Name of Child: ____________________________
- Date of Birth: ________________________
- Address (if different from Principal): ________________________________________________
- City: ________________________, State: Michigan, Zip Code: ____________
Attorney-in-Fact Information:
- Full Name of Attorney-in-Fact: ____________________________
- Relationship to Child: ________________________
- Address: ________________________________________________
- City: ________________________, State: Michigan, Zip Code: ____________
- Contact Number: ________________________
Effective Dates:
- Start Date: ________________________
- End Date: ________________________ (not to exceed 6 months from the start date as per Michigan law)
Special Instructions:
If there are any specific instructions, limitations, or conditions that apply to this Power of Attorney, list them here: ________________________________________________
Signatures:
This document must be signed in the presence of a notary public or two adult witnesses.
Principal's Signature: ________________________ Date: ________________________
Attorney-in-Fact's Signature: ________________________ Date: ________________________
Witnesses (if applicable):
- Name: ________________________ Signature: ________________________ Date: ________________________
- Name: ________________________ Signature: ________________________ Date: ________________________
Notary Public Acknowledgment (if applicable):
State of Michigan
County of ________________________
On this day, ________________________, before me, ________________________ (name of notary public), personally appeared, ________________________ (name of principal), known to me (or proved to me on the oath of ________________________) to be the person whose name is subscribed to the within instrument and acknowledged that he/she executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal.
Notary Public's Signature: ________________________
Seal: