General Power of Attorney - Maine

POWER OF ATTORNEY
KNOW ALL PERSONS that I, ______________________________________, of
____________________________, Maine, appoint ________________________________,
of ____________________________, Maine, to be my lawful attorney-in-fact regarding my
minor child[ren]:
______________________________ born on _____________________________
______________________________ born on _____________________________
______________________________ born on _____________________________
I hereby grant to my attorney-in-fact, _________________________________, all of my
powers regarding the care and custody of the above-named children, except my power to consent
to marriage or adoption of my minor child[ren] and my power to sell, transfer, convey or
otherwise manage any real or personal property belonging to my minor child[ren].
I hereby intend that my attorney-in-fact have the same full authority as I have to consent
to, or withhold consent to, any medical or other professional care, counsel, treatment or service
to said minor child[ren] by a licensed or certified professional person or institution engaged in
the practice of, or providing, a healing art.
The rights, power and authority herein granted shall remain in full force and effect until
____________________________ (up to 12 months) or until terminated by a written Revocation
of Power of Attorney signed by me, whichever happens first. This Power of Attorney shall not
be affected by my disability or incapacity. The authority herein granted to my attorney-in-
fact,_______________________________, is exercisable by him or her, notwithstanding my
later disability or incapa city or later uncertainty as to whether I am dead or alive.
IN WITNESS WHEREOF I have hereunto set my signature this _____day of _____________,
20 __.
____________________________________
(Signature)
STATE OF MAINE
______________________________, ss.
Personally appeared the above named ____________________________________and
acknowledged the foregoing instrument to be his free act and deed.
Before me,
___________________________________
Notary Public/Attorney at Law
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