Form G-2A - Petition for appointment of a guardian (person only)
Filing Fee Paid $ ________
________ Certs $ ________
SURROGATE'S COURT OF THE STATE OF NEW YORK ________ Certs $ ________
COUNTY OF ________ $ ________ Bond, $ ________
________ X Receipt No: ________ No: ________
Proceeding for the Appointment of a PETITION FOR APPOINTMENT OF
Guardian for GUARDIAN OR AN INFANT [PERSON]
an infant. File No. ________
________X
TO THE SURROGATE'S COURT, COUNTY OF ________
It is respectfully alleged:
1. The name, permanent address, date of birth and telephone number of the petitioner, and the petitioner's relationship to the infant are as follows:
Name: ____________ Telephone Number: ________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing address:
(if different from permanent address)
Date of Birth: ________ Relationship to Infant: ________
Name: ________ Telephone Number: ____________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing address:
(if different from permanent address)
Date of Birth: ________ Relationship to Infant: ________
2. The name, permanent address, date of birth and marital status of the infant of this proceeding is as follows:
Name: ____________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing address:
(if different from permanent address)
Date of Birth: ________ Marital Status: ________
[Attach certified copy of birth certificate]
3. The names and permanent addresses of the parents of the infant and, if the infant is married, the infant's spouse are: [If both parents of the infant are deceased, give date of death and complete Number 5 and Number 6]
Name of Father: ____________ Date of Birth: ________ Date of Death: ________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing address:
(if different from permanent address)
G-2A (9/00) -1-
Name of Mother: ____________ Date of Birth: ________ Date of Death: ________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing address:
(if different from permanent address)
Name of Spouse: ____________Date of Birth: ________ Date of Death: ________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing address:
(if different from permanent address)
4. The names and addresses of the adult persons with whom the infant resides if other than parents are:
Name: ____________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip Code)
Mailing Address:
(if different from permanent address)
Relationship to infant: ________
5. If father and mother are deceased, list the names and addresses of the nearest distributees of full age who live within the state. [If not applicable, so state]
Name Permanent Address Relationship
____________
____________
____________
____________
6. The names and permanent addresses of the infant's grandparents: [If not applicable, so state and if deceased, add date of death]
Name Permanent Address
____________Maternal Grandmother
____________Maternal Grandfather
____________Paternal Grandmother
____________Paternal Grandfather
7. Petitioner is requesting appointment as guardian of the infant's person only and alleges that the petitioner is capable of providing care, custody and control of the infant during minority and is motivated solely by the best interests of the child in requesting this appointment.
-2-
8.(a) The infant has never had, at any time, a guardian appointed for him/her, and,
(b) Custody of the infant has never been surrendered by any person lawfully charged therewith nor has custody been the subject of any court order, except as hereinafter listed: [Attach copies of all surrenders, court orders, or divorce decrees].
________
________
9. Petitioner (has) (does not have) knowledge that a person nominated to be a guardian, or any individual eighteen years of age or over who resides in the home of the proposed guardian:
a. Is the subject of a report filed with the Statewide Central Register of Child Abuse and Maltreatment pursuant to the rules of Child Protective Services, following an investigation which determines that some credible evidence of alleged abuse or maltreatment exists and/or b. Has been the subject of, or the respondent in a Child Protective Proceeding commenced pursuant to law, which proceeding resulted in an order finding that the child is an abused or neglected child.
[If petitioner has such knowledge, attach an affidavit explaining in detail].
10. Petitioner has completed and annexed the Request For Information Guardianship Form (OCFS 3909) required to be submitted to the New York State Central Register of Child Abuse and Maltreatment.
11. The infant (is) (is not) a Native American child under the Indian Child Welfare Act of 1978 ( 25 U.S.C. Sections 1901 - 1963 ).
12. There are no other persons interested in this proceeding upon whom process is required to be served other than those listed above.
13. No prior application has been made to any Court for the relief requested herein.
WHEREFORE, your petitioner respectfully prays that:
Letters of Guardianship of the Person be granted to ____________
____________
or such other person or corporation as may be entitled thereto and that process issue to all interested persons who have not waived the issuance of same requiring them to show cause why such relief should not be granted.
Dated: ________
____________
(Signature of Petitioner)
____________
(Signature of Petitioner)
____________
(Print Name)
____________
(Print Name)
-3-
STATE OF ________)
COUNTY OF ________) ss.:
________, being duly sworn deposes and says that I am the petitioner above named. I have read the foregoing petition and the same is true of my own knowledge except as to matters therein stated to be alleged upon information and belief and as to those matters I believe them to be true.
Sworn to before me this
________ day of ________, ________
____________
(Signature of Petitioner)
____________
(Print Name)
____________
Notary Public
____________
(Signature of Petitioner)
Commission Expires:
(Affix Notary Stamp or Seal)
____________
(Print Name)
COMBINED OATH & DESIGNATION
STATE OF ________)
COUNTY OF ________) ss.:
________ being duly sworn, deposes and says:
1. OATH OF GUARDIAN: I am over eighteen (18) years of age and a citizen of the United States; that I will well, faithfully and honestly discharge the duties of such guardian: That I am acquainted with the estate of said infant and have read the statement contained in the foregoing petition as to the estimated value of same, and believe same to be correct, and that I am not ineligible to receive letters.
2. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I hereby designate the Clerk of the Surrogate's Court of ________ County, and his/her successor in office, as a person on whom service of any process issuing from such Surrogate's Court may be made in like manner and with like effect as if it were served personally upon me, whenever I cannot be found within the state of New York after due diligence used.
My permanent address is:
(Street Address) (City/Town/Village) (State) (Zip)
____________
(Signature of Proposed Guardian)
____________
(Signature of Proposed Guardian)
____________
(Print Name)
____________
(Print Name)
On ________, ________, before me personally came ________ to me known to be the person described in and who executed the foregoing instrument. Such person duly swore to such instrument before me and duly acknowledged that he/she executed the same.
____________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.: ________
Address of Attorney: ____________
-4-
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________ X JOINDER AND STATEMENT OF
Proceeding for the Appointment of a PREFERENCE OF INFANT 14 YEARS AND OVER
Guardian for
FILE NO. ________
An Infant.
________ X
I, ________, the infant, hereby join in the foregoing petition and request that ________ of ________ be appointed guardian of my
[ ] person and property
[ ] person
[ ] property
STATE OF ________)
COUNTY OF ________) ss.:
________being duly sworn, says: that I am the infant in the foregoing petition and joinder statement, that I have read the same and believe them to be true, and join in the prayer for the relief requested.
____________
(Signature of Infant)
____________
(Print Name)
Sworn to before me this
________ day of ________, ________
____________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Note: If the petition is prepared by an attorney, the attorney's name, address and telephone number must be set forth.
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.: ________
Address of Attorney: ____________