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Here is the text we could read:

Power of Attorney over Protected Person or Minor Child 

Poder Notarial sobre una persona bajo cuidado 
 o un hijo(a) menor de edad 

 swear that the following is true: 

Juro que lo siguiente es cierto: 

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

Yo soy el [  ]  padre  [  ]  tutor designado por el tribunal de 
____________________________________________________ (nombre), 
nacido el  _______________________________ (fecha). 

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

Designo a la siguiente persona como mi apoderado para la persona 
identificada en el Párrafo (1). 

Name / Nombre 

Address / Dirección 

City, State, Zip  
Ciudad, Estado, Código Postal 

Phone / Teléfono 

E-mail / Correo electrónico 

 

 

 

 

 

 

(1) 

2) 

  (

  I

  (

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

(Seleccione (3) o (4), no ambas. Si selecciona (4), describa la autoridad delegada.) 

(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. 

[  ]    Yo delego a mi apoderado el poder y autoridad que poseo como 
padre o tutor, excepto el poder de consentir al matrimonio o 
adopción. 

(4) 

[  ]   

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

[  ] 

Yo delego a mi apoderado únicamente la autoridad específica de y 
para: 

Power of Attorney over Protected Person or Minor Child 
 

Revised May 9, 2017 

Page 1 of 2 

(5) 

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

Este Poder Notarial tiene duración hasta el 
____________________________ (fecha). (Esta fecha deberá ser dentro de los 
próximos 6 meses.) 

(6) 

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

[  ] 

Este Poder Notarial tiene duración inclusive luego de mi 
incapacidad. 

Typed or printed name / Nombre en letra de molde 

Sign here / 
Firme Aquí ► 

 

Address / Dirección 

City, State, Zip / Ciudad, Estado, Código Postal 

Phone / Teléfono 

E-mail / Correo electrónico 

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 

 

 

 

 

 

 

 

 

 

       

ate / 
Fecha 

  D

 

  O

   

Power of Attorney over Protected Person or Minor Child 
 

Revised May 9, 2017 

Page 2 of 2

Poder Notarial sobre una persona bajo cuidado o un hijo(a) menor de edad

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): 80
Average fields per page: 40
Reading Level: Grade 10
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)
juro_que_lo_siguiente_cierto was juro_que_lo_siguiente_es_cierto (0.55 conf)
page_field__4 was page_0_field_5 (0.31 conf)
born was born_on (0.43 conf)
page_field__5 was page_0_field_7 (0.31 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)
nacido_el was nacido_el (0.41 conf)
page_field__9 was page_0_field_13 (0.31 conf)
soy_el_padre_tutor_de was yo_soy_el_padre_tutor_designado_por_el_tribunal_de (0.59 conf)
page_field__10 was page_0_field_15 (0.31 conf)
fecha was fecha (0.48 conf)
page_field__11 was page_0_field_17 (0.31 conf)
page_field__12 was page_0_field_18 (0.31 conf)
page_field__13 was page_0_field_19 (0.31 conf)
page_field__14 was page_0_field_20 (0.31 conf)
page_field__15 was page_0_field_21 (0.31 conf)
page_field__16 was page_0_field_22 (0.31 conf)
page_field__17 was page_0_field_23 (0.31 conf)
page_field__18 was page_0_field_24 (0.31 conf)
page_field__19 was page_0_field_25 (0.31 conf)
page_field__20 was page_0_field_26 (0.31 conf)
page_field__21 was page_0_field_27 (0.31 conf)
page_field__22 was page_0_field_28 (0.31 conf)
la_como_mi_para was designo_a_la_siguiente_persona_como_mi_apoderado_para_la_persona (0.49 conf)
ciudad_estado_c_digo_postal was ciudad__estado__código_postal (0.51 conf)
page__1 was page_1_of_2 (0.42 conf)
page_check__1 was page_0_check_0 (0.34 conf)
swear_following_true was i_swear_that_the_following_is_true (0.38 conf)
page_check__2 was page_0_check_2 (0.33 conf)
page_check__3 was page_0_check_3 (0.33 conf)
af_f was AFF036 (0.51 conf)
page_check__4 was page_0_check_5 (0.33 conf)
mi_el_poder_que_como was yo_delego_a_mi_apoderado_el_poder_y_autoridad_que_poseo_como (0.50 conf)
page_check__5 was page_0_check_7 (0.33 conf)
page_field__23 was page_1_field_0 (0.31 conf)
page_field__24 was page_1_field_1 (0.36 conf)
page_field__25 was page_1_field_2 (0.36 conf)
power_attorney_lasts was this_power_of_attorney_lasts_until (0.36 conf)
page_field__26 was page_1_field_4 (0.36 conf)
date was date_this (0.43 conf)
este_poder_tiene_hasta_el was este_poder_notarial_tiene_duración_hasta_el (0.55 conf)
page_field__27 was page_1_field_7 (0.36 conf)
fecha_esta_ser_dentro_de_los was fecha_esta_fecha_deberá_ser_dentro_de_los (0.56 conf)
date_must_within_next_months was date_must_be_within_the_next_6_months (0.34 conf)
page_field__28 was page_1_field_10 (0.36 conf)
page_field__29 was page_1_field_11 (0.36 conf)
pr_ximos_meses was próximos_6_meses (0.43 conf)
page_field__30 was page_1_field_13 (0.36 conf)
users1_signature was sign_here (1.00 conf)
typed_printed_name_nombre_en_letra_de_molde was typed_or_printed_name_nombre_en_letra_de_molde (0.50 conf)
firme_aqu was firme_aquí (0.48 conf)
address_direcci_n was address_dirección (0.36 conf)
phone_tel_fono was phone_teléfono (0.32 conf)
users1_name was name (1.00 conf)
page_field__31 was page_1_field_20 (0.36 conf)
known_satisfactory_form was who_is_known_to_me_or_who_presented_satisfactory_identification__in_the_form_of (0.32 conf)
page_field__32 was page_1_field_22 (0.36 conf)
e_mail_correo_electr_nico was e_mail_correo_electrónico (0.45 conf)
page_field__33 was page_1_field_24 (0.36 conf)
page_field__34 was page_1_field_25 (0.36 conf)
page_field__35 was page_1_field_26 (0.36 conf)
date_certify was on_this_date__i_certify_that (0.39 conf)
page_field__36 was page_1_field_28 (0.36 conf)
page_field__37 was page_1_field_29 (0.36 conf)
page_field__38 was page_1_field_30 (0.36 conf)
page_field__39 was page_1_field_31 (0.36 conf)
page_field__40 was page_1_field_32 (0.36 conf)
page_field__41 was page_1_field_33 (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__42 was page_1_field_35 (0.36 conf)
notary_seal was notary_seal (0.37 conf)
page__2 was page_2_of_2 (0.42 conf)
lasts_even_event_disability was this_power_of_attorney_lasts_even_in_the_event_of_my_disability (0.35 conf)
page_check__6 was page_1_check_1 (0.26 conf)

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

Poder Notarial sobre una persona bajo cuidado o un hijo(a) menor de edad

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