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Here is the text we could read:

Power of Attorney over Protected Person or Minor Child 

I am the [  ]  parent  [  ]  court-appointed guardian of 
___________________________________________________ (name), who was 
born on _______________________________ (date). 

(2) 

I appoint the following person as my attorney-in-fact for the person named in 
Paragraph (1). 

 swear that the following is true: 

  I

(1) 

(Check (3) OR (4), not both. If you check (4), describe the authority being delegated.) 

(3) 

[  ]   

I delegate to my attorney-in-fact all power and authority that I have as a 
parent or guardian, except the power to consent to marriage or adoption. 

(4) 

[  ]   

I delegate to my attorney-in-fact only the specific authority to: 

(5) 

This power of attorney lasts until ____________________________ (date). (This 
date must be within the next 6 months.) 

(6) 

[  ]    This power of attorney lasts even in the event of my disability. 

Power of Attorney over Protected Person or 
Minor Child 
 

Approved Board of District Court Judges January 16, 2009 
Revised May 9, 2017 

Page 1 of 2 

Name 

Address 

Phone 

E-mail 

City, State, Zip 

 

 

 

 

 

       

 

 

Sign here ► 

Typed or printed name 

Address 

City, State, Zip 

Phone 

E-mail 

n this date, I certify that _________________________________________________________ (name) 

who is known to me or who presented satisfactory identification, in the form of 
______________________________________________________ (form of identification), has, while in my 
presence and while under oath or affirmation, voluntarily signed this document and declared that it is true. 

Date: 

 

Sign here ► 

Typed or printed name 

 

Notary Seal 

 

 

 

 

 

 

 

 

Date 

 

  O

 

Power of Attorney over Protected Person or 
Minor Child 
 

Approved Board of District Court Judges January 16, 2009 
Revised May 9, 2017 

Page 2 of 2

Power of Attorney over Protected Person or Minor Child

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 2
Fields(s): 57
Average fields per page: 28
Reading Level: Grade 7
LIST Grouping(s): GO-00-00-00-00.

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

signature_date was date (1.00 conf)
page_field__1 was page_0_field_1 (0.31 conf)
page_field__2 was page_0_field_2 (0.31 conf)
page_field__3 was page_0_field_3 (0.31 conf)
swear_following_true was i_swear_that_the_following_is_true (0.38 conf)
page_field__4 was page_0_field_5 (0.31 conf)
page_field__5 was page_0_field_6 (0.31 conf)
born was born_on (0.43 conf)
parent_appointed_guardian was i_am_the_parent_court_appointed_guardian_of (0.46 conf)
page_field__6 was page_0_field_9 (0.31 conf)
page_field__7 was page_0_field_10 (0.31 conf)
page_field__8 was page_0_field_11 (0.31 conf)
page_field__9 was page_0_field_12 (0.31 conf)
paragraph was paragraph__1 (0.45 conf)
page_field__10 was page_0_field_14 (0.31 conf)
city_state_zip was city__state__zip (0.35 conf)
check_describe_authority was check__3__or__4_not_both__if_you_check__4_describe_the_authority_being_delegated (0.42 conf)
af_f was AFF017 (0.51 conf)
page_field__11 was page_0_field_18 (0.31 conf)
page_field__12 was page_0_field_19 (0.31 conf)
lasts_date_must_within was this_power_of_attorney_lasts_until__date_must_be_within_the_next_6_months (0.37 conf)
page_field__13 was page_0_field_21 (0.31 conf)
date was date_this (0.43 conf)
lasts_even_event_disability was this_power_of_attorney_lasts_even_in_the_event_of_my_disability (0.35 conf)
page_field__14 was page_0_field_24 (0.31 conf)
page_field__15 was page_0_field_25 (0.31 conf)
page_field__16 was page_0_field_26 (0.31 conf)
page__1 was page_1_of_2 (0.42 conf)
page_check__1 was page_0_check_0 (0.34 conf)
page_check__2 was page_0_check_1 (0.33 conf)
page_check__3 was page_0_check_2 (0.33 conf)
page_check__4 was page_0_check_3 (0.33 conf)
page_check__5 was page_0_check_4 (0.33 conf)
users1_signature was sign_here (1.00 conf)
page_field__17 was page_1_field_1 (0.36 conf)
users1_address_line_one was address (1.00 conf)
page_field__18 was page_1_field_3 (0.36 conf)
users1_phone_number was phone (1.00 conf)
page_field__19 was page_1_field_5 (0.36 conf)
users1_name was name (1.00 conf)
known_satisfactory_form was who_is_known_to_me_or_who_presented_satisfactory_identification__in_the_form_of (0.32 conf)
page_field__20 was page_1_field_8 (0.36 conf)
e_mail was e_mail (0.45 conf)
page_field__21 was page_1_field_10 (0.36 conf)
page_field__22 was page_1_field_11 (0.36 conf)
date_certify was on_this_date__i_certify_that (0.39 conf)
page_field__23 was page_1_field_13 (0.36 conf)
page_field__24 was page_1_field_14 (0.36 conf)
page_field__25 was page_1_field_15 (0.36 conf)
page_field__26 was page_1_field_16 (0.36 conf)
page_field__27 was page_1_field_17 (0.36 conf)
page_field__28 was page_1_field_18 (0.36 conf)
page_field__29 was page_1_field_19 (0.36 conf)
oath_declared_true was presence_and_while_under_oath_or_affirmation__voluntarily_signed_this_document_and_declared_that_it_is_true (0.41 conf)
page_field__30 was page_1_field_21 (0.36 conf)
notary_seal was notary_seal (0.37 conf)
page__2 was page_2_of_2 (0.42 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Power of Attorney over Protected Person or Minor Child

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02