DURABLE POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, that I ______________________________ of ____________________, ________ made, constituted and appointed, and by these presents, do make, constitute and appoint __________________________________ of ___________________________, _____________ my true and lawful attorney in fact, with the power herein granted with respect to for me and in my name, place and stead to do and perform any and all of the following actions, to-wit: 1. To be my attorney in my behalf and to appear with me in all actions and proceedings to which I may be party in the courts of this state of __________, or in any administrative proceedings; to commence or defend actions and proceedings in my name when necessary; to sign and verify in my name on all complaints, petitions, answers and other pleadings of every description; to represent me and to act for me and to make, execute and deliver receipts, waivers, consents, and other documents or instruments in connection with my dealings with the _____________ Departments of Division of Family Services (DFS), Child Protection Services (CPS), the Juvenile Courts and all of their associates; 2. To take charge of, manage, execute and deliver any agreements or other instruments relating to my affairs and concerns regarding my children who are being held from me by the ___________ Departments of Family Services (DFS), Child Protection Services (CPS), the Juvenile Courts, and all of their associates. To carry out the terms of any agreements, change or rescind of any agreements previously executed by my signatures to all above mention parties by me in my behalf and that of my children as he deems necessary; 3. To request and receive any and all records or other documents or copies of the same, whether or not confidential or restricted, or other information under my control, information, records or any documents held pertaining to myself, my husband and my children by the ____________ DFS, CPS, or Juvenile Court and their associates; to make, execute, acknowledge and / or deliver any and all written instruments or documents of any kind or type whatsoever. Be it known I ___________________________________ who executes the forgoing instrument did so of my free act and deed. Grantor Signature: ______________________________ ______/______ , 2002 STATE OF } _________________________ COUNTY OF } _________________________ On _____/_____/ 2002 before me,____________________________________ ,personally appeared __________________________ , personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. Signature ____________________________ Affiant Known 0 Unknown 0 (Notary) Type of ID Produced ________________________________ (Seal) Together for the Cause Brother Cletus A Note To Our Supporters: "FAMILIES AT RISK of AMERICA is a sane prescription for what ails our children, our schools and our communities. It's a no-nonsense, say-it-the-way-that-it-is, type of group. I hope that every parent and teacher will continue to have access to FAMILIES AT RISK'S outstanding up-to-date factual data. I also hope that every parent and teacher takes FAMILIES AT RISK'S superb advice to heart. Do not allow harmful CPS psychiatric diagnoses, treatments and drugs to ruin another child's life, another child's future." "I am only one, but I am one. I cannot do everything, but I can do something and because I cannot do everything, I will not refuse to do the something that I can do. What I do, I should do and what I should do, by the grace of God, I will do." ~ Edward Everett Hale United You Bargain! Divided You Beg! You can make a difference today! FAMILIES AT RISK of AMERICA needs your support to continue its work fighting for the right of Americans to be free of government tyranny at all levels and for restoration of the US Constitution as America's guiding charter. Come Join the cause! Please contact Families At Risk of America to see how you can support us. familiesatrisk@aol.com