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This version of the form is not currently in use and is provided for reference only. Download this version of
DA Form 5841
for the current year.
DA Form 5841 Power of Attorney
What Is 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 is necessary for every selected guardian to have.
The latest version of the form - previously known as DA Form 5841-R - was released by the U.S. Department of the Army (DA) on September 1, 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.
DA Form 5841 Instructions
The Power of Attorney DA Form 5841 is not required when filing DA Form 5305, Family Care Plan. Under certain circumstances, depending on the law or other conditions, a Power of Attorney (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 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 be shown to all childcare-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?
- 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.
- The third blank line is for the applicant's current place of residence.
- 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.
- The sixth and the seventh lines are for the full names of the child or children that are subject to custody.
- Line 8 in the second part is for stating the date when the current POA will become invalid unless revoked or terminated sooner.
- 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.
- 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.
Download DA Form 5841 Power of Attorney
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