S.F. 540 Section 1. NEW SECTION . 633F.1 Definitions. 1 1. “Agent” means a person granted authority to act for a 2 parent, guardian, or legal custodian under a power of attorney 3 created under this chapter. 4 2. “Child” means a person under eighteen years of age. 5 3. “Power of attorney” means a writing that grants authority 6 to an agent to act in the place of a parent, guardian, or legal 7 custodian regarding the care or custody of a child. 8 Sec. 2. NEW SECTION . 633F.2 Power of attorney —— temporary 9 delegation of parental authority. 10 1. A parent, guardian, or legal custodian of a child, by a 11 properly executed power of attorney, may delegate to another 12 person any authority regarding the care or custody of the child 13 except for any of the following powers: 14 a. The power to consent to the child’s marriage. 15 b. The power to consent to the child’s adoption. 16 c. The power to consent to the performance or inducement of 17 an abortion on or for the child. 18 d. The power to consent to the termination of the parental 19 rights of a parent of the child. 20 e. The power to transfer the power of attorney to another 21 person unless the other person is designated as a successor 22 agent in the power of attorney. 23 2. A power of attorney executed under this chapter must be 24 signed by all parents, guardians, and legal custodians. The 25 power of attorney must be acknowledged before a notary public 26 or other individual authorized by law to take acknowledgments. 27 An agent named in the power of attorney shall not notarize the 28 principal’s signature. An acknowledged signature on a power of 29 attorney is presumed to be genuine. 30 3. A parent, guardian, or legal custodian of the child shall 31 have the authority to revoke or terminate a power of attorney 32 created under this chapter at any time by giving notice of the 33 revocation in writing to the agent. 34 4. A power of attorney created under this chapter shall be 35 -1- SF 540 (2) 88 hb/rh/jh 1/ 8

S.F. 540 for a period of time not to exceed three months. A parent, 1 guardian, or legal custodian of the child may execute a new 2 power of attorney for an additional period of three months, but 3 in no case shall a power of attorney created under this chapter 4 be valid for more than six months. If a parent, guardian, or 5 legal custodian revokes or terminates the power of attorney, 6 the child shall be returned to the care and custody of the 7 parent, guardian, or legal custodian within twenty-four hours 8 of the date of the revocation or termination. 9 5. An agent shall exercise parental or legal authority on a 10 continuous basis without compensation for the duration of the 11 power of attorney and shall not be considered to be a foster 12 parent subject to licensure by the department of human services 13 pursuant to chapter 237. 14 6. A power of attorney executed under this chapter by a 15 parent, guardian, or legal custodian shall not constitute 16 abandonment, abuse, or neglect of the child under chapter 232 17 by the parent, guardian, or legal custodian unless the parent, 18 guardian, or legal custodian fails to take custody of the child 19 upon the expiration of the power of attorney. 20 7. A power of attorney executed under this chapter by a 21 parent, guardian, or legal custodian shall not be valid if the 22 purpose is to avoid the filing of a child in need of assistance 23 petition. 24 8. This chapter shall not apply to a power of attorney 25 created pursuant to section 598C.204. 26 Sec. 3. NEW SECTION . 633F.3 Power of attorney temporary 27 delegation of parental authority —— form. 28 A document substantially in the following form may be used 29 to create a power of attorney temporary delegation of parental 30 authority that has the meaning and effect prescribed by this 31 chapter: 32 POWER OF ATTORNEY TEMPORARY DELEGATION OF PARENTAL AUTHORITY 33 FORM 34 1. POWER OF ATTORNEY 35 -2- SF 540 (2) 88 hb/rh/jh 2/ 8

S.F. 540 This power of attorney authorizes another person (your 1 agent) to make decisions concerning your child or children for 2 you (the principal). Your agent will be able to make decisions 3 and act with respect to your child or children. The meaning 4 of authority over the child or children listed on this form is 5 explained in Iowa Code chapter 633F. This power of attorney 6 does not grant the agent the power to consent to a child’s 7 marriage or adoption, to the performance or inducement of an 8 abortion on or for a child, or to the termination of parental 9 rights of a parent of a child or to the transfer of the power 10 of attorney to a person other than to a person designated as a 11 successor agent in this power of attorney. 12 You should select someone you trust to serve as your agent. 13 Your agent is not entitled to compensation unless you state 14 otherwise in the optional Special Instructions. 15 This form provides for designation of one agent. If you 16 wish to name more than one agent, you may name a coagent in the 17 optional Special Instructions. Coagents must act by majority 18 rule unless you provide otherwise in the optional Special 19 Instructions. 20 If your agent is unable or unwilling to act for you, your 21 power of attorney will end unless you have named a successor 22 agent. You may also name a second successor agent. 23 This power of attorney becomes effective immediately upon 24 signature and acknowledgment unless you state otherwise in the 25 optional Special Instructions. 26 If you have questions about this power of attorney or the 27 authority you are granting to your agent, you should seek legal 28 advice before signing this form. 29 DESIGNATION OF AGENT 30 I _________________________ (name of principal) name the 31 following person as my agent: 32 Name of Agent ____________________________________________ 33 Agent’s Address __________________________________________ 34 Agent’s Telephone Number _________________________________ 35 -3- SF 540 (2) 88 hb/rh/jh 3/ 8

S.F. 540 DESIGNATION OF SUCCESSOR AGENT(S) (OPTIONAL) 1 If my agent is unable or unwilling to act for me, I name as 2 my successor agent: 3 Name of Successor Agent __________________________________ 4 Successor Agent’s Address ________________________________ 5 Successor Agent’s Telephone Number _______________________ 6 If my successor agent is unable or unwilling to act for me, I 7 name as my second successor agent: 8 Name of Second Successor Agent ___________________________ 9 Second Successor Agent’s Address _________________________ 10 Second Successor Agent’s Telephone Number ________________ 11 GRANT OF GENERAL AUTHORITY 12 I grant my agent and any successor agent general authority to 13 act for me with respect to my child or my children as defined in 14 Iowa Code chapter 633F. 15 SPECIAL INSTRUCTIONS 16 You may give special instructions including the name and 17 date of birth of the child on the following lines: 18 ___________________________________________________________ 19 ___________________________________________________________ 20 ___________________________________________________________ 21 ___________________________________________________________ 22 ___________________________________________________________ 23 ___________________________________________________________ 24 ___________________________________________________________ 25 ___________________________________________________________ 26 ___________________________________________________________ 27 ___________________________________________________________ 28 ___________________________________________________________ 29 __________________________________________________________. 30 EFFECTIVE DATE 31 This power of attorney is effective immediately upon 32 signature and acknowledgment unless I have stated otherwise in 33 the optional Special Instructions. 34 RELIANCE ON THIS POWER OF ATTORNEY 35 -4- SF 540 (2) 88 hb/rh/jh 4/ 8

S.F. 540 Any person, including my agent, may rely upon the validity of 1 this power of attorney or a copy of it unless that person knows 2 it has terminated or is invalid. 3 SIGNATURE AND ACKNOWLEDGMENT 4 _____________________________ _________________________ 5 Your Signature Date 6 _____________________________ 7 Your Name Printed 8 _____________________________ 9 _____________________________ 10 Your Address 11 _____________________________ 12 Your Telephone Number 13 State of ____________________ 14 County of ___________________ 15 This document was acknowledged before me on _______________ 16 (date), by __________________________ (name of principal) 17 _____________________________ (Seal, if any) 18 Signature of Notary 19 My commission expires ________________ 20 This document prepared by 21 ___________________________________________________________ 22 ___________________________________________________________ 23 2. IMPORTANT INFORMATION FOR AGENT 24 AGENT’S DUTIES 25 When you accept the authority granted under this power of 26 attorney, a special legal relationship is created between the 27 principal and you. This relationship imposes upon you legal 28 duties that continue until you resign or the power of attorney 29 is terminated or revoked. You must do all of the following: 30 Act in good faith. 31 Do nothing beyond the authority granted in this power of 32 attorney. 33 Disclose your identity as an agent whenever you act for the 34 principal by writing or printing the name of the principal and 35 -5- SF 540 (2) 88 hb/rh/jh 5/ 8

S.F. 540 signing your own name as agent in the following manner: 1 _______________________ (principal’s name) by 2 _______________________ (your signature) as Agent 3 Unless the Special Instructions in this power of attorney 4 state otherwise, you must also do all of the following: 5 Act loyally for the child’s or children’s and principal’s 6 benefit. 7 Avoid conflicts that would impair your ability to act in the 8 child or children’s and principal’s best interest. 9 Act with care, competence, and diligence. 10 TERMINATION OF AGENT’S AUTHORITY 11 You must stop acting on behalf of the principal if you learn 12 of any event that terminates this power of attorney or your 13 authority under this power of attorney. Events that terminate 14 a power of attorney or your authority to act under a power of 15 attorney include any of the following: 16 The principal’s revocation of the power of attorney or your 17 authority. 18 The occurrence of a termination event stated in the power of 19 attorney. 20 The purpose of the power of attorney is fully accomplished. 21 The time period specified in the power of attorney has 22 expired. 23 The three-month time period permitted under Iowa Code 24 chapter 633F has expired. 25 The three-month extension time period permitted under Iowa 26 Code chapter 633F has expired. 27 LIABILITY OF AGENT 28 The meaning of the authority granted to you is defined in 29 Iowa Code chapter 633F. If you violate Iowa Code chapter 633F, 30 or act outside the authority granted, you may be liable for any 31 damages caused by your violation. 32 If there is anything about this document or your duties that 33 you do not understand, you should seek legal advice. 34 Sec. 4. NEW SECTION . 633F.4 Agent’s certification —— 35 -6- SF 540 (2) 88 hb/rh/jh 6/ 8

S.F. 540 optional form. 1 The following optional form may be used by an agent to 2 certify facts concerning a power of attorney: 3 IOWA STATUTORY POWER OF ATTORNEY TEMPORARY DELEGATION OF 4 PARENTAL AUTHORITY AGENT’S CERTIFICATION FORM 5 AGENT’S CERTIFICATION OF VALIDITY OF POWER OF ATTORNEY AND 6 AGENT’S AUTHORITY 7 State of _________________________ 8 County of ______________________ 9 I, ______________________________ (name of agent), certify 10 under penalty of perjury that ______________________________ 11 (name of principal) granted me authority as an agent 12 or successor agent in a power of attorney dated 13 _____________________. 14 I further certify all of the following to my knowledge: 15 The principal is alive and has not revoked the power of 16 attorney or the Power of Attorney and my authority to act under 17 the Power of Attorney have not terminated. 18 If the power of attorney was drafted to become effective 19 upon the happening of an event or contingency, the event or 20 contingency has occurred. 21 If I was named as a successor agent, the prior agent is no 22 longer able or willing to serve. 23 __________________________________________________________ 24 __________________________________________________________ 25 __________________________________________________________. 26 (Insert other relevant statements) 27 SIGNATURE AND ACKNOWLEDGMENT 28 _____________________________ _________________________ 29 Agent’s Signature Date 30 _____________________________ 31 Agent’s Name Printed 32 _____________________________ 33 _____________________________ 34 Agent’s Address 35 -7- SF 540 (2) 88 hb/rh/jh 7/ 8

S.F. 540 _____________________________ 1 Agent’s Telephone Number 2 This document was acknowledged before me on _______________ 3 (date), by __________________________ (name of agent) 4 _____________________________ (Seal, if any) 5 Signature of Notary 6 My commission expires ________________ 7 This document prepared by 8 ___________________________________________________________ 9 ___________________________________________________________ 10 -8- SF 540 (2) 88 hb/rh/jh 8/ 8