Skip to index of sample documents Skip to main page content
  Home > Publications > Grandparents Manual > Public Benefits > Power of Attorney
Legal Services for Prisoners with Children (LSPC)
  Home | About Us | Publications | News & Events | Issues In Depth | Healing Wall Online | Donations / Interns | Contact Us | Links
printer-friendly format
Manual for Grandparent-Relative Caregivers and Their Advocates:
About the Grandparents Manual
Dependency Proceedings
Getting a Child out of a Shelter
Visitation Rights of Grandparents
When Permanent Custody is Necessary
Foster Care
Public Benefits
Relative Caregivers Options Chart
School Issues
Statewide Listings for County Boards of Education
Resource Guide Statewide
Resource Guide Northern California
Resource Guide Central California
Resource Guide Southern California
Donate Now through Network for Good
via Network on
Women in Prison

Power of Attorney

I, ______________________________, being of sound mind and body, declare the following:

  1. That I am the natural mother (father) of ________________________________________________________________.
  2. That I am presently incarcerated at ________________________________________________________________.
  3. That, during this time, my ___________________________ is being cared for by _________________________________________.
  4. That I wish to give full Power of Attorney to ___________________________ with respect to the care and custody of my ____________________________________.
  5. That, specifically, I give ___________________________ full Power of Attorney with respect to the care and custody of ______________________________ in matters affecting _____ medical needs, schooling, public assistance and Medi-Cal, legal matters, and all other matters pertaining to the well-being of my child.

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.


                              )     SS.
COUNTY OF ____________________)

Subscribed and sworn to before me a notary public this _____ day of __________, 20____.

     Notary Public

My commission expires:



Legal Services for Prisoners with Children
1540 Market St., Suite 490  •  San Francisco, CA 94102
(415) 255-7036  •