POWER OF ATTORNEY APPLICATION

POWER OF ATTORNEY (POA)
A Power of Attorney (POA) is a written instrument that allows you (the "principal") to
authorize your agent (the "attorney-in-fact") to conduct certain business on your behalf. It
is one of the strongest legal documents that you can give to another person. There are two
types of POA; "general" and "special" (or limited). A general POA gives your agent very
broad powers to act on your behalf; and a special POA limits your agent's authority to act
only on certain matters. Every act performed by your agent within the authority of the
POA is legally binding upon you. Since a POA is such a powerful document, it should be
given only to a trustworthy person, and only when absolutely necessary. Your legal
assistance office can advise you about, and prepare for you, the appropriate POA needed
for your situation.
GENERAL POWER OF ATTORNEY
A General POA (GPOA) gives your agent the authority to do most things you could do
yourself. Making a GPOA can have serious consequences. With a GPOA, your agent can
(for example) buy a car with your money, borrow money that you must repay, sell your
personal property, or remove all funds from your bank account. While a GPOA may be
helpful, it can also be very dangerous. Limit the duration of the GPOA to one year or
less. Ensure that your agent is someone that you absolutely trust with all of your money
and legal decisions. If you lose trust in your agent, consult a legal assistance attorney
about revoking the GPOA. As an alternative, consider one or more special powers of
attorney instead. If you only need specific tasks performed while you are away, then you
should not obtain a GPOA.
SPECIAL (LIMITED) POWER OF ATTORNEY
A special, or limited, POA authorizes your agent to do only a specified act, such as sell
your car, ship your household goods, or cash your paycheck. Because it is more specific,
the special POA is safer than a broad general POA and more likely to be accepted by
third parties.
SPECIAL POWER OF ATTORNEY TO ACT "IN LOCO PARENTIS"
The phrase "in loco parentis" means "in the place of the parent." This common type of
special POA grants parental authority to another (such as a caregiver) to perform a range
of functions which can include picking up a child from school, buying food and clothing,
and consenting to medical treatment of the child in the event of illness or injury. Without
this type of special POA a day care center, school, store, hospital or clinic, fearing legal
repercussions, may refuse to follow the directives of the caregiver or other agent, and
require the specific authorization of the actual parent.

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KEY CONSIDERATIONS
A POA becomes void upon the death of the principal or the agent, when
revoked, or on the expiration date specified.
A POA normally is void if the principal becomes physically or mentally
incapacitated. However, with the exception of in loco parentis POAs,
appropriate durability language may be added to ensure that the POA
remains valid during any period of incapacity.
Any third party (business, bank, etc.) has the right to refuse to accept a POA.
Many financial institutions and businesses have their own POAs which they
prefer to be used to conduct business.
A POA should be given for only a limited time period (such as six months
during a deployment). A third party is more likely to accept a POA with a
recent date than one which is many months or years old.
Never give a general POA when a special POA will accomplish the intended
purpose. There is less opportunity for abuse when only limited powers are
given.
You may revoke a POA before its expiration date by executing a revocation
of the POA. Notice of the revocation must be delivered to the agent, as well as
to all third parties who you know relied on the POA. If possible, recover
from the attorney-in-fact and destroy the original and all copies of the POA.
Even though the POA has been revoked, you may be responsible to any third
party who did not receive notice of the revocation.
A special POA should be as specific as possible. For example, if you are
authorizing an attorney-in-fact to sell a vehicle on your behalf, specify the
vehicle, license number, vehicle identification number, the make/model/year
of the vehicle, and any specific terms you will require.

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POWER OF ATTORNEY APPLICATION

PRIVACY ACT STATEMENT: Information is solicited in accordance with Title 10, US Code Section
3013, and is used to prepare a Power of Attorney (POA). Providing information is voluntary; however,
failure to provide information precludes the preparation of a power of attorney.

I. GENERAL INFORMATION

1. Client Category (circle one): SVC MBR
FAM MBR
RET SM/FM
DoD CIV

2. _______________________________ _____
____________ ______________
Name (Last, First, MI)

Rank
SSN

State Legal Residence

3. If you are a family member: __________________
_____
_______________



Sponsor’s Name

Rank

SSN

4. Do you want a “Durable” POA that will remain in effect even if you become disabled, incapacitated or
incompetent? ____ Yes _____ No

5. If you are a military member and do not want a durable POA, do you want this POA to remain in effect
if you become a prisoner of war or are declared missing? ____ Yes ____ No

6. Do you want this POA to be effective immediately or do you want it to become effective
only if you become disabled, incapacitated, or incompetent? _____ Now ____ Upon my disability

7.

_______________________________

POA Expiration Date (usually 1 year or less)



8. ______________________________________
Name of Person Receiving POA (Your Agent)

___________________________________________
____
___________
Street Address



State
Zip

II.
GENERAL POWER OF ATTORNEY ___________ (Initial here)

III.
SPECIAL POWERS OF ATTORNEY (Initial All That Apply)

1.
CLAIMS/FINANCIAL TRANSACTIONS

__________
__________
__________


Cash checks

File claims/

All Matters MilPay

Receive
payments and
Finance


__________
__________
__________

Thrift Savings Plan
Execute VA Loan
Obtain service relief loan

Allotments: __________
__________
__________


Start

Stop

Change Amount From $_______






To: $________


Bank Name/Location: ___________________________________________________


Account Number: ______________________________________________________

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2. GOVERNMENT
QUARTERS/HOUSEHOLD
GOODS

__________
__________
__________
__________

Sign For Quarters
Clear Quarters
Ship HHG
Receive HHG

3.
REAL PROPERTY

__________
__________
__________
__________
Buy/Mortgage
Refinance Sell
Manage/Lease


Street Address of Property: _______________________________________________


Legal Description of Property: ____________________________________________

4. VEHICLES


___________
__________ __________ __________
Possess/operate
Register
Buy/Sell
Ship/Receive

Year/Make/Model:
_______________________________________________________


Vehicle Identification Number: _____________________________________________

5. CHILDREN
__________
__________
________

Medical Only

*In Loco Parentis
Transport From: ______________



To:
_______________
__________
Education
Registration/Enrollment

Child(ren) Name(s) and DOB: ______________________________________________

_______________________________________________________________________

* Grants parental authority to another to include pickup from school, making medical decisions, etc.

6.
OTHER: (Mail, veterinary, house sitting, etc.) Please describe.

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