How to Fill Out DA Form 5841: Fields, Notarizing, and Revoking

To fill out DA Form 5841, enter your full legal name, Social Security number, state of legal residence, and address; name the person you are appointing as attorney-in-fact along with their address; list every child covered by the guardianship; set an expiration date; and then sign the form in front of a qualified military notary who will verify your identification and apply a seal.¹ The form has few fields, but each one carries legal weight, and none of them take effect until the notarized signature is in place.²

What DA Form 5841 Covers

DA Form 5841 is a special power of attorney limited to child guardianship, used as an attachment to DA Form 5305 in your Family Care Plan.³ It authorizes your agent to house, feed, clothe, and care for your children; consent to medical, surgical, or dental treatment; sign the consent and liability forms medical facilities require; enroll the children in school; handle other matters affecting their health, education, and welfare; and hire an attorney to carry out the document.¹

It does not give your agent authority over your bank accounts, taxes, real estate, vehicles, or any other personal business. Those require separate special powers of attorney drafted through your installation’s legal assistance office.⁴

What to Gather Before You Start

Have this information in front of you before you open the form:

Your full legal name, Social Security number, state of legal residence, and current residential address.
The full legal name and current residential address of the person you are appointing as attorney-in-fact.
The full legal name of every child covered by the guardianship.
The date you want the power of attorney to expire. One, two, and three years are common durations for military powers of attorney, and the guidance is to pick the shortest period that covers your expected absence.⁵

Confirm the spelling of every name against a birth certificate or ID. Typos in a guardian’s name or a child’s name give banks, schools, and hospitals a reason to refuse the document.

Filling In the Form Field by Field

The form opens with the standard legal preamble “KNOW ALL PERSONS BY THESE PRESENTS.”¹ Work through it top to bottom:

In the opening paragraph, enter your full legal name, your Social Security number, and the state you claim as your legal residence.
Write in the full legal name of your attorney-in-fact and their current residential address. This is the person who will act as guardian.
List the full legal name of each child the guardianship covers. If you have more than one, include all of them here; the form’s authority extends only to the children you name.
Read through the enumerated powers already printed on the form. You are not editing them; you are confirming that the standard guardianship authority (daily care, medical consent, school enrollment, hiring counsel) is what you intend to grant.¹
Fill in the expiration date. The form’s durability language keeps it valid if you become incapacitated, and a separate provision extends it if you are classified as missing, missing in action, or a prisoner of war on the expiration date or within the 60 days before it — the document then stays in effect until 60 days after you return to U.S. military control.¹
Leave the signature block blank. You sign it in front of the notary, not before.

If you are preparing the form as part of your Family Care Plan packet in advance of a possible deployment, the packet is held unsigned until activation or deployment is actually imminent. You keep the completed but unsigned form on file and take it to a notary when the time comes.⁶

Signing and Notarizing the Form

DA Form 5841 has no legal effect until you sign it in front of a qualified notary. Under 10 U.S.C. § 1044a, these people can notarize military documents at no charge:

Judge advocates, including reserve judge advocates.
Civilian attorneys serving as legal assistance attorneys.
Adjutants and personnel adjutants.
Civilian paralegals at military legal assistance offices, when supervised by a legal assistance counsel.
Other service members designated by regulation or statute.²

No fee may be charged for any notarial act performed under this authority.²

Bring identification. Acceptable ID is a valid state or federally issued ID card, driver’s license, or passport with a signature. A Common Access Card can be used when retrieving other identification is impractical, but it is not the default.⁷ The notary verifies your identity, watches you sign, then affixes a seal or stamp and signs the attestation block. That seal is what tells outside institutions the document is authentic.

One boundary worth knowing: a properly notarized military power of attorney is protected under 10 U.S.C. § 1044b and must be recognized in every state, the District of Columbia, Puerto Rico, and U.S. territories, regardless of state-specific form requirements.⁸ In practice, some banks and insurance companies still push their own proprietary POA forms, so check ahead with any institution your guardian will need to deal with, and complete their forms too if required.⁴

Where to Keep It and Who Gets a Copy

Keep the signed and sealed original in a secure location such as a fireproof safe or safe deposit box. If deployment is imminent, hand the original to your designated guardian. Many institutions will not accept photocopies or digital scans, so the guardian should present the original and let the third party copy it for their records.⁵

If an institution refuses to honor a valid military POA, contact your installation’s legal assistance office. They can intervene and, if needed, help draft any supplemental documentation the institution insists on.⁴

If You Need to Cancel It Before It Expires

The simplest ending is the expiration date you wrote on the form. Once it passes, the document is void with no further action needed, which is why setting the shortest reasonable duration matters.⁵ The power of attorney also terminates immediately if you or the agent dies, with no paperwork required.

To end it earlier, do two things. Retrieve the original document and every copy you handed out — to the agent, banks, schools, landlords, or anyone else relying on it.⁵ Then prepare and sign a formal Revocation of Power of Attorney, have it notarized, and deliver a copy to the agent and to every third party that held a copy of the original. Send the revocation by certified mail with a return receipt so you have proof of delivery.⁹ The revocation takes effect as to the agent when the agent receives notice, and as to third parties when they receive notice; until then, anyone who reasonably relies on the original in good faith is protected.¹⁰

You can revoke the power of attorney at any time as long as you are mentally competent. Your legal assistance office can prepare and notarize the revocation at no cost under the same authority that covered the original.²

1
Mississippi National Guard. DA Form 5841-R Power of Attorney Guardianship
2
Office of the Law Revision Counsel. 10 USC 1044a – Authority to Act as Notary
3
U.S. Army JBLM. AR 600-20 Army Command Policy
4
Military OneSource. Understand Military Power of Attorney – A Family Primer
5
U.S. Army Carlisle Barracks. Powers of Attorney
6
U.S. Army Stuttgart. Family Care Plan
7
MCAS Yuma. 10 USC 1044a Notary Training
8
Office of the Law Revision Counsel. 10 USC 1044b – Military Powers of Attorney Requirement for Recognition by States
9
U.S. Army Monterey. Understanding Your Power of Attorney
10
TJAGLCS. Client Services Deskbook