DA FORM 5841-R, APR 1999 DA FORM 5841-R, SEP 89 IS OBSOLETE USAPA V1.00
POWER OF ATTORNEY
For use of this form, see AR 600-20; the proponent agency is DCSPER
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.
PRINCIPAL PURPOSE: To designate a guardian to care for your child(ren) in your absence.
ROUTINE USES: None.
DISCLOSURE: Mandatory; failure to maintain a Family Care Plan could subject you to separation, administrative action,
or, disciplinary action under the UCMJ.
KNOW ALL PERSONS BY THESE PRESENTS:
That I, ___________________________________________________________________________, Social Security Number
__________________________________, of the state of _____________________________________________________________, a
member of the United States Armed Forces, currently residing in _______________________________________________________
______________________________________________________________________, pursuant to Military Orders, do hereby appoint
_____________________________________________________, presently residing at _____________________________________
___________________________________________________________, my true and lawful attorney-in-fact to do the following acts or
things in my name and in my behalf:
To assume and maintain guardianship of my child(ren),
to do all acts necessary or desirable for maintaining health, education, and welfare; and to maintain customary living standards, including,
but not limited to,