"Minor Visitor(S) Notarized Permission Form" - Maine

Minor Visitor(S) Notarized Permission Form is a legal document that was released by the Maine Department of Corrections - a government authority operating within Maine.

Form Details:

  • The latest edition currently provided by the Maine Department of Corrections;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Maine Department of Corrections.

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Minor Visitor(s) Notarized Permission
(Ink only, no pencil)
Prisoner Name: ________________________________________________ MDOC#:_____________________
MDOC Policy 21.4, C. 2.
“A minor visitor must be accompanied at the visit by a parent or legal guardian who is an approved adult
visitor, has listed the minor on his or her application, and has provided proof of parental status (minor’s birth
certificate or court adoption order) or proof of legal guardianship (court order). A power of attorney or grant
of guardianship document other than a court order is not acceptable.”
MDOC Policy 21.4, C. 3.
“An adult who is not a parent or legal guardian and is an approved visitor may also be allowed to bring in a
minor visitor with the written permission of a parent or a legal guardian and with the prior approval of the
Chief Administrative Officer, or designee. The written permission must be notarized and be accompanied by
proof of parental status (minor’s birth certificate or court adoption order) or proof of legal guardianship (court
order). A power of attorney or grant of guardianship document other than a court order is not acceptable. The
parent or legal guardian giving permission is not required to be an approved visitor. A person giving permission
cannot be a prisoner unless the prisoner provides proof that the rights of the other parent have been terminated
(court order) or that the prisoner has been granted sole parental rights (court order). All documentation must
be received by the Chief Administrative Officer, or designee, at least two (2) business days prior to requesting
the visit.”
I affirm that I have legal custody and/or legal guardianship of minor child(ren):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(list full name and date of birth of all minors this authorization applies to)
I give the below named individual(s) permission to bring the minor child(ren) for visitation with the above-named
prisoner at any Maine Department of Corrections facility that the above-named prisoner may be housed at:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(list specific visitors and date of birth)
Printed Name: ____________________________________________________ Date of Birth: ____________________
Signature: ________________________________________________________ Date: __________________________
The foregoing instrument was acknowledged before me this ______ day of ____________________, 20_____, by
______________________________________________.
Notary Public
My Commission Expires: __________________
*Be sure to include a copy of the minor’s birth certificate and/or a copy of the court ordered legal guardianship
assignment.*
Minor Visitor(s) Notarized Permission
(Ink only, no pencil)
Prisoner Name: ________________________________________________ MDOC#:_____________________
MDOC Policy 21.4, C. 2.
“A minor visitor must be accompanied at the visit by a parent or legal guardian who is an approved adult
visitor, has listed the minor on his or her application, and has provided proof of parental status (minor’s birth
certificate or court adoption order) or proof of legal guardianship (court order). A power of attorney or grant
of guardianship document other than a court order is not acceptable.”
MDOC Policy 21.4, C. 3.
“An adult who is not a parent or legal guardian and is an approved visitor may also be allowed to bring in a
minor visitor with the written permission of a parent or a legal guardian and with the prior approval of the
Chief Administrative Officer, or designee. The written permission must be notarized and be accompanied by
proof of parental status (minor’s birth certificate or court adoption order) or proof of legal guardianship (court
order). A power of attorney or grant of guardianship document other than a court order is not acceptable. The
parent or legal guardian giving permission is not required to be an approved visitor. A person giving permission
cannot be a prisoner unless the prisoner provides proof that the rights of the other parent have been terminated
(court order) or that the prisoner has been granted sole parental rights (court order). All documentation must
be received by the Chief Administrative Officer, or designee, at least two (2) business days prior to requesting
the visit.”
I affirm that I have legal custody and/or legal guardianship of minor child(ren):
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(list full name and date of birth of all minors this authorization applies to)
I give the below named individual(s) permission to bring the minor child(ren) for visitation with the above-named
prisoner at any Maine Department of Corrections facility that the above-named prisoner may be housed at:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(list specific visitors and date of birth)
Printed Name: ____________________________________________________ Date of Birth: ____________________
Signature: ________________________________________________________ Date: __________________________
The foregoing instrument was acknowledged before me this ______ day of ____________________, 20_____, by
______________________________________________.
Notary Public
My Commission Expires: __________________
*Be sure to include a copy of the minor’s birth certificate and/or a copy of the court ordered legal guardianship
assignment.*