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We(I) designate _______________________________________ who reside(s) at __________________________ to act as guardian(s) of the minor child(ren) stated above upon our(my) incapacity to so act.

Should he/she/they be unable or unwilling to serve as guardian(s), we(I) nominate ________________________ who reside(s) at _______________________ to act as the guardian(s) of the minor child(ren) stated above in the place of our(my) above nominee.

Upon our(my) disability, the designated guardian shall have the following authority:

1) Residential custody of the minor child(ren),
2) To approve medical treatment of any kind or type or to disapprove the same within the bounds of the law,
3) To designate schooling for the minor children, and access to any and all of their educational records,
4) To generally act in loco parentis.

In the event that formal legal proceedings are commenced to establish a guardian for the child(ren), it is our(my) desire that the guardians mentioned herein have priority in appointment for the following reasons:

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The failure to list an individual as guardian or successor guardian is intentional.

Signed this ______ day of ____________ in the year of our Lord 199___.

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This document will be valid when it is signed and witnessed by two witnesses or by a Notary Public of and for California.

I declare under penalty of perjury under the laws of California that the person who signed or acknowledged this document is personally known to me to be the principal, or that the identity of the principal was proved to me by convincing evidence, that the principal signed or acknowledged this durable power of attorney in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence.

Signature _________________________________

Name ___________________________________

Date ____________________________________

Address _________________________________

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Signature _________________________________

Name ___________________________________

Date ____________________________________

Address _________________________________

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At least one of the above witnesses must also sign the following declaration.

I further declare under penalty under the laws of California that I am not related to the principal by blood, marriage, or adoption, and, to the best of my knowledge I am not entitled to any part of the estate of the principal upon the death of the principal under a will now existing or by operation of law.

Signature _________________________________

COUNTY OF FRESNO

On this, the __________ day of _______________ in the year of our Lord 199____, 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 subscribed to this instrument, and acknowledged that he or she executed it, I declare under penalty of perjury that the person whose name subscribed to this instrument appears to be of sound mind and under no duress, fraud, or undue influence.

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(Signature of Notary Public)