Statutory Form for Power of Attorney to Delegate Parental or Legal Custodian Powers
_____________________________________ ___________________________(Full name of minor child) (Date of birth)
_____________________________________ ___________________________(Full name of minor child) (Date of birth)
_____________________________________ ___________________________(Full name of minor child) (Date of birth)
(minor child(ren))."
___________________________________________________________________, (Street address, city, state and zip code of Attorney-in-fact)
(Home phone of Attorney-in-fact) (Work phone of Attorney-in-fact)
as the attorney-in-fact of each minor child named above."
____________________________________________________________________
This delegation shall not include the power or authority to consent to marriage or adoption of the child, the performance or inducement of an abortion on or for the child, or the termination of parental rights to the child."
" By:__________________________________ (Parent/Legal Custodian signature)
(Attorney-in-fact signature)
State of ____________
County of ___________
ACKNOWLEDGEMENT
Before me, the undersigned, a Notary Public, in and for said County and State on this _____day of ___________________, 20__, personally appeared _____________________________(Name of Parent/Legal Custodian) and ___________________________(Name of Attorney-in-fact), to me known to be the identical persons who executed this instrument and acknowledged to me that each executed the same as his or her free and voluntary act and deed for the uses and purposes set forth in the instrument.
Witness my hand and official seal the day and year above written.
_______________________________(Signature of notarial officer)
(Seal, if any)
______________________________(Title and Rank)
My commission expires: ___________
Okla. Stat. tit. 10, § 701