We, ______ residing at authorize and appoint Christine Ann

We, _____________ residing at ______________________ authorize and appoint
Christine Ann Nungester to hold our power of attorney in the matter of our
Haitian adoption in the following specific areas:
1. To sign for any and all documents, papers, and or forms that may be
required to process the adoption of (child or children's full names as appear
on court papers) born on (date)or to obtain the visa for said children that
we as parents would be required to sign;
2. To authorize medical work or tests for the said children as the need may
arise;
3.
To make all necessary travel arrangements both within Haiti and the US
and to accompany the said children on all necessary forms of transportation;
4. To apply and sign for all documents pertaining to the application for
said children's passports and to receive the passports after they are issued.
This Power of Attorney shall commence on the date below and shall continue
until withdrawn or the adoption is finished.
Signed this ______________ day of __________________2006
______________________
(father's signature
_____________________
(mother's signature)
(notarization)
I (your names here)________________ both residing at___________, do hereby
bestow upon Mrs. Gaelle Woolley and/or Ketlie T. Woolley, complete and full
power of attorney to act in all matters in our behalf, to represent us in all
court and legal proceedings, to make all legal applications, sign any
pertinent documents, and perform all acts necessary and pertaining to
adoption by us, of Haitian children through His Home for Children. We assume
full responsibility for all acts, signings, agreements, petitions, and
related matters which Gaelle Woolley and/or Ketlie T. Woolley may perform on
our behalf the same as if we personally were to perform such deeds ourselves.
This power of attorney shall expire upon completion of all adoption
proceeding in Haiti.
Dated this_________day of_______20_____
Your signatures______________________________
(notarization)
POWER OF ATTORNEY
PROCURATION
We,
______________________________,
residing at ____________________authorize
and appoint Christine Ann Nungester to hold
our power of attorney in the matter of our
Haitian adoption in the following specific areas:
Nous,____________________, demeurant au
________________________, autorisons et
nommons Christine Ann Nungester et lui
donnons procuration comme mandataire pour
le dossier d’adoption Haïtienne dans les
domaines suivants:
1. To sign for any and all documents, papers, 1. Pour signer tous les documents, papiers et
and or forms that may be required to
ou formulaires qui pourront être
process the adoption of ________________,
nécessaires pour traiter l’adoption de
born on __________________ and the
_______________ né le _____________
adoption of _______________________
et l’adoption de _____________ né le
born____________________ or to obtain
_____________, ou pour obtenir le visa
the visa for said children that we as parents
pour lesdits enfants pour lesquels notre
would be required to sign;
signature en tant que parents pourrait être
exigée.
2. To authorize medical work or tests for the 2. Pour autoriser les examens et soins
said children as the need may arise;
médicaux pour lesdits enfants si le besoin
se présente.
3. To make all necessary travel arrangements 3. Pour prendre toutes les dispositions de
both within Haiti, the US, and Canada and
voyage nécessaires tant en Haïti qu’aux
to accompany the said children on all
États-Unis
et
au
Canada
pour
necessary forms of transportation;
accompagner lesdits enfants sur tous les
moyens de transport nécessaires.
4. To apply and sign for all documents 4. Pour demander et signer tous les
pertaining to the application for said
documents se rapportant à la demande de
children's passports and to receive the
passeport pour lesdits enfants et pour
passports after they are issued.
recevoir les passeports après emission.
This Power of Attorney shall commence on the
date below and shall continue until withdrawn
or the adoption and all necessary documents for
travel to Canada are finished.
Signed in _________,
____20____
this
____day
Cette Procuration commencera à la date
indiquée ci-dessous et continuera jusqu'à
l’arrêt des procédures ou à la fin de la
procédure d'adoption ainsi que l’obtention de
tous les documents nécessaires pour le voyage
au Canada.
of Signé à _________, le __ jour de _______
20__.
Printed name and signature
Signature du Père
Printed name and signature
Signature de la Mère