AUTHORIZATIONAGREEMENTFORNONPARENTRELATIVEdoc.docVIP

AUTHORIZATION AGREEMENT FOR NONPARENT RELATIVE BROAD AUTHORITY GRANTED BY SINGLE PARENT – OTHER PARENT DECEASED The parent of the children named below authorizeS the nonparent relative named below to act as described below as permitted by Chapter 34 of the Texas Family Code. Date: ____________________________ Parent: Name: ____________________________ Signature: ___________________________ Address: ___________________________________________________________________________ Telephone/Best Way to Contact: _____________________________________________________________ THE STATE OF TEXAS COUNTY OF ____________ The foregoing instrument was subscribed and sworn before me on the ____ day of _____________, 20____, by ________________________ Parent . _________________________________________ Notary Public in and for the State of Texas Agent: Name: ____________________________ Signature: ________________________ Address: __________________________________________________________________ Telephone/Best Way to Contact: ________________________________________________ Relationship to Children check one : ___Grandparent ___Aunt ___Uncle ___Adult Sibling THE STATE OF TEXAS COUNTY OF ____________ The foregoing instrument was subscribed and sworn before me on the ____ day of _____________, 20____, by ________________________ Agent . _________________________________________ Notary Public in and for the State of Texas Children Subject to This Authorization: Name: _______________________________ Birthdate: ___________________________ Name: _______________________________ Birthdate: ___________________________ Name: _______________________________ Birthdate: ___________________________ Name: _______________________________ Birthdate: ___________________________ Name: _______________________________ Birthdate: ___________________________ Name: _______________________________ Birthdate: ___________________________ 1. The Parent named above authorizes the Agen