NEW HAMPSHIRE MINOR (CHILD) POWER OF ATTORNEY

1.	PARTIES.

Child name: _______________________________ (hereinafter the “Child”).
Birthdate: ____________ (mm/dd/yyyy)

Parent / Guardian name: ________________________________ 
Address: _____________________________________________

If another parent or co-guardian exists:

Parent / Guardian name: ________________________________
Address: _____________________________________________

Hereinafter the “Parent(s)/Guardian(s)”.

I/We, the Parent/Guardian, hereby appoint ________________________________ as the Attorney-in-Fact for the Child, with a street address of _____________________________________________, hereinafter the “Attorney-in-Fact”.

2.	POWERS.

I/We delegate the Attorney-in-Fact the following powers: (Initial and Check just ONE option)

☐  _______ (initial if selected) - All authority that I have as the Child’s legal
Parent(s)/Guardian(s) under the State of New Hampshire.

☐  _______ (initial if selected) - Only the authority to _______________________________.

3.	TERM.

This Power of Attorney (the “Agreement”) shall commence on ____________ (mm/dd/yyyy), and shall end on: (Initial and Check all that apply)

☐  _______ (initial if selected) - On the following date: ____________ (mm/dd/yyyy).
☐  _______ (initial if selected) - In the event of my disability (incapacitation).
☐  _______ (initial if selected) - In the event of my death.

This Agreement can be terminated at any time by (A) completing a revocation or by (B) creating and signing a new Agreement.

4.	GOVERNING LAW.

This Agreement shall be governed under the laws in the State of New Hampshire.

5.	PARENT/GUARDIAN SIGNATURES.

Parent/Guardian Signature: ________________________________________
Print Name: ________________________________ Date: ______________

Parent/Guardian Signature: ________________________________________
Print Name: ________________________________ Date: ______________

6.	ACCEPTANCE BY ATTORNEY-IN-FACT.

I, the Attorney-in-Fact, acknowledge and execute this Agreement, and by such execution hereby affirm that I accept the appointment and understand the duties under the Agreement and under New Hampshire law.

Attorney-in-Fact Signature: ________________________________________
Print Name: ________________________________ Date: ______________

7.	WITNESSES.

I/we witnessed the execution of this Agreement by the Parent(s)/Guardian(s), and I/we affirm that the Parent(s)/Guardian(s) appeared to be of sound mind and were not under duress. The Parent(s)/Guardian(s) affirmed to me/us that they were aware of the nature of this Agreement and signed it freely and voluntarily.

Witness 1 Signature: ______________________________________________
Print Name: ________________________________ Date: ______________
Address: ______________________________________________________

Witness 2 Signature: ______________________________________________
Print Name: ________________________________ Date: ______________
Address: ______________________________________________________  
NOTARY ACKNOWLEDGMENT

State: ___________________
County: __________________

On ____________ (mm/dd/yyyy), before me __________________________ (Notary Name) appeared __________________________ (Parent/Guardian Name(s)), as the Parent(s)/Court Appointed Guardian(s) who proved to me through government issued photo identification to be the above-named person(s), in my presence executed foregoing instrument and acknowledged that they executed the same as his/her/their free act and deed.

_________________________________________
Notary Public	

Print Name: __________________________

My Commission Expires: ________________

(Notary Seal)