Kansas Host Families Act Power Of Attorney

Information you will need

• Child (1) DOB
• Child (2) DOB
• Child (3) DOB
• Attorney In Fact Personal Phone Number
• Attorney In Fact Work Phone Number
• Powers Granted
• Specific Powers
• Effective Time
• Effective Year
• Termination Year
• Child (1) Name
• Child (3) Name
• Child (2) Name
• Attorney In Fact Name
• Notary Only: Day
• Notary Only: Month
• Notary Only: Year
• Notary Only: Title
• Notary Only: Commission Expires
• Notary Only: Name of Attorney In Fact
• Notary Only: State
• Notary Only: County
• Additional Attorney In Fact Name
• Notary Only: Name of Parent/Legal Custodian

…and 5 more fields in the PDF.

The form includes 5 signature lines, a notary acknowledgment.