Form G-4 - Affidavit of parent
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF
________X
Proceeding for the Appointment of a
Guardian for AFFIDAVIT OF PARENT
File No. ________
An infant.
________X
STATE OF NEW YORK )
COUNTY OF ) ss.:
The undersigned, ________, being duly sworn, deposes and says:
1. I am a competent person over the age of eighteen (18) years and I am the natural/adoptive parent
________ of
_______________
(Mother/Father) (Infant)
and I reside at ________
2. As the natural/adoptive parent of the above-named infant, I have determined that it would be in the best interests of the child if ____________
____________________________
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
was/were appointed guardian(s) of the infant for the following reasons:
____________
____________
____________
____________
3. No guardian has ever been appointed for the infant nor has custody thereof been surrendered by me nor otherwise judicially awarded to any other person or agency except as listed below:
____________
____________
____________
4. I understand that I am relinquishing all rights to care, custody and control of my infant ____________,
in favor of ________, in favor of ________, the proposed guardian(s) of the person of said infant.
I further understand that such care, custody and control of the infant shall remain in ____________ as guardian of the person
_________
(I) [FN3] ( ____________ and I jointly and severally) undertake that defendant will appear in
_______
(Infant)
until the infant shall attain the age of eighteen (18) years, and that the proposed guardian(s) is/are capable of assuming such care, custody, and control over the infant.
______________
Signature of Parent
Sworn to before me this
________ day of ________, ________
__________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
G-4 (9/00)