DA Form 5841 Power of Attorney

What Is a DA Form 5841?

DA Form 5841, Power of Attorney is a form that is used for designating a guardian for child care during a soldier’s absence and necessary for every selected guardian to have.

The latest version of the form - previously known as DA Form 5841-R - was released by the Department of the Army in September 2009 with all previous editions being obsolete. An up-to-date fillable DA Form 5841 is available for download and digital filing down below or can be found on the Army Publishing Directorate website.

If the selected guardian is a biological parent of the child, this parent needs to sign a certificate showing that they have the required documents needed for guardianship during the soldier's absence. Consult an attorney for additional information and legal guidelines.

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POWER OF ATTORNEY
For use of this form, see AR 600-20; the proponent agency is DCS, G-1.
SPECIAL INSTRUCTIONS RELATED TO EXECUTION OF POWERS OF ATTORNEY
The DA Form 5841 is a special power of attorney (POA) that may be used to authorize a person to take care
of your child(ren) in your absence. It is important that you understand that you are not required to use this POA for your
Family Care Plan. You may seek legal assistance to have a different POA drafted that better provides for your family
members if you so desire. You must also understand that depending on the law or other requirements where your child(ren)
will be living, a POA may not always be effective for your designated guardian to care for your child(ren) under any or all
circumstances. You may seek legal assistance to advise you about the effectiveness of DA Form 5841, other POAs or any
other matters in your Family Care Plan.
It is very important that the following persons be shown the POA or other appropriate documentation for the
purpose of determining whether they will honor it:
Doctors, dentists, and hospital officials or other health care providers who may be called upon to treat your
child(ren).
Any school officials or other officials who may need your permission to provide services for your child (ren)
or register your child(ren) in school.
If the persons identified above will not honor the POA, you must ask to be provided powers of attorney or other
documents that will be honored. You should show this POA or other documentation to all facilities, institutions, and
individuals to ensure they will recognize it for the purposes you have intended.
You must understand that a POA will not prevent another person, such as a non-custodial parent or relative of
your child(ren), from petitioning a court of competent jurisdiction to obtain temporary or permanent custody of your children
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PREVIOUS EDITION IS OBSOLETE.
DA FORM 5841, SEP 2009
APD LC v1.00

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DA Form 5841 Instructions

The DA 5841 or the POA (Power of Attorney) is not required for the DA Form 5305, Family Care Plan. Under certain circumstances, depending on the law or other conditions, a POA may not always be effective for the guardians to take care of the children. It is recommended to turn to legal assistance in cases when there is a need for advice about the effectiveness of the form, other POAs or any other matters in the Family Care Plan.

It is important to show the POA and other childcare-related documentation to the following people to determine if they will honor it:

  • Doctors, dentists, and hospital officials or other health care providers who may need to provide medical care to the children;
  • Any school officials or other officials who may need the permission to provide services to the children or register them at school.

In case these people refuse to honor the POA, individuals are encouraged to ask to be provided other documents that will be recognized for their intended purposes. All forms must by be shown to all child care-related facilities, institutions, and individuals to ensure that they will be recognized as effective.

The POA doesn’t hold any legal power to stop another person - such as a non-custodial parent or relative - from petitioning a court of competent jurisdiction to obtain temporary or permanent custody of the children.

How to Fill Out DA Form 5841?

  1. The form contains three fillable parts. The filing process starts with entering personal information on the first and the second blank lines on the second page of the form. This includes the first name, second name and the homeland state of the applicant.
  2. The third blank line is for the applicant’s current place of residence.
  3. The fourth and the fifth blank lines of the DA 5481 are for the name and the current address of residence of the appointed guardian respectively.
  4. The sixth and the seventh lines are for the full names of the child or children that are subject to custody.
  5. Line 8 in the second part is for stating the date when the current POA will become invalid unless revoked or terminated sooner.
  6. Line 9 requires the date when the POA goes into power. Lines 10 and 11 are for the State and the County where the POA is witnessed. This section must be signed by the grantor.
  7. Line 12 in the third part of the form requires the name of the notary public. This section is to be filled with the following information: the name of the notary public and surname, the date the POA is witnessed and acknowledged, the state and the county where the POA is being witnessed, the signature of the notary public and the date the notary public commission expires.

 

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