STATEMENT OF AGENT
I, .... (name and address of agent), understand that .... (name(s) of parent(s)) has (have) delegated to me the powers specified in this Power of Attorney regarding the care and custody of .... (name(s) of child(ren)). I further understand that this Power of Attorney may be revoked in writing at any time by a parent who has legal custody of .... (name(s) of child(ren)). I hereby declare that I have read this Power of Attorney, understand the powers delegated to me by this Power of Attorney, am fit, willing, and able to undertake those powers, and accept those powers.
Agent's signature ....   Date ....
APPENDIX
(Here the parent(s) may indicate where they may be located during the term of the Power of Attorney if different from the address(es) set forth above.)
.... I can be located at:
Address(es) ....
Telephone number(s) ....
E-mail address(es) ....
.... Or, by contacting:
Name ....
Address ....
Telephone number ....
E-mail address ....
.... Or, I cannot be located
314,11 Section 11. 948.25 of the statutes is created to read:
948.25 Unauthorized interstate placements of children. (1) Any person who sends a child out of this state, brings a child into this state, or causes a child to be sent out of this state or brought into this state for the purpose of permanently transferring physical custody of the child to a person who is not a relative, as defined in s. 48.02 (15), of the child is guilty of a Class A misdemeanor.
(2) Subsection (1) does not apply to any of the following:
(a) A placement of a child that is authorized under s. 48.98, 48.988, or 48.99.
(b) A placement of a child that is approved by a court of competent jurisdiction of the sending state or receiving state.
314,12 Section 12. Nonstatutory provisions.
(1) Study of adoption disruption and dissolution. The joint legislative council is requested to study adoption disruption and dissolution in this state. If the joint legislative council undertakes such a study, the joint legislative council shall do all of the following:
(a) Study the extent of adoption disruption and dissolution in this state and the efforts by the department of children and families, counties, and child welfare agencies to prevent such disruption and dissolution.
(b) Recommend legislation to accomplish all of the following:
1. Define adoption disruption and adoption dissolution.
2. Prevent adoption disruption and adoption dissolution in this state.
3. Require the department of children and families, county departments of human services or social services that are authorized to place children for adoption, and child welfare agencies that are licensed to place children for adoption to track and report on disrupted or dissolved adoptions.
(c) Consider legislative options to prepare prospective adoptive parents for adoption and to support adoptive parents after an adoption.
(d) Submit its findings, conclusions, and recommendations to the 2015 legislature when it commences.
314,13 Section 13. Initial applicability.
(1) Advertising related to adoption or other permanent physical placements of a child. The treatment of section 48.825 (1) (a) and (c), (2) (a), (b), and (c), and (3) (a) and (e) of the statutes first applies to advertising placed or posted on the effective date of this subsection.
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