Military Power of Attorney
Principal Information
Full Name
Rank/Grade
Branch of Service
SSN (Last 4 Digits)
Unit/Organization
Attorney-in-Fact (Agent) Information
Full Name
Relationship to Principal
Address
Phone Number
Powers Granted
Describe the specific powers being granted:
Effective Date & Expiration
Effective Date
Expiration Date
Additional Instructions
Signature & Authorization
Principal's Signature
Date
Notary / Legal Officer
Name
Title/Rank
Signature & Seal
Date