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Power of Attorney
I, ______________________________, being of sound mind and body, declare the following:
I declare under penalty of perjury that the preceding statement is true and correct, and that I signed this statement with full knowledge of its contents, this _____ day of _________, 20___, in ____________________, California.
STATE OF CALIFORNIA )
Subscribed and sworn to before me a notary public this _____ day of __________, 20____.
My commission expires:
Legal Services for Prisoners with Children
1540 Market St., Suite 490 San Francisco, CA 94102
(415) 255-7036 email@example.com