Form G-5 - Waiver, renunciation and consent
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________X WAIVER OF PROCESS,
Proceeding for the Appointment of a RENUNCIATION AND CONSENT
TO LETTERS OF GUARDIANSHIP
An Infant. File No. ________
________ X
The undersigned ________ whose permanent address is:
____________________
(Street and Number) (City, Village, Town)
____________________
(State) (Zip Code)
and who is a competent person over the age of eighteen (18) years and whose interest in the above-entitled proceeding is as follows:
[Check appropriate interest]
[ ] Parent of the above-named
[ ] Grandparent of the above named infant
[ ] Other (Specify) ________
hereby personally appears in this proceeding and
(1) renounces all right to Letters of Guardianship of the [ ] person and property [ ] person
[ ] property of said infant.
(2) waives the issuance and service of process in this matter, and
(3) consents that ________ be appointed the guardian of the
a. [ ] Person of the above-named infant
b. [ ] Property of the above-named infant
c. [ ] Person and Property of the above-named infant and
that such letters may be granted to said person or to any other person entitled thereto without notice to the undersigned.
Date: ________
______________
(Signature)
______________
(Print Name)
STATE OF ________) ss.:
COUNTY OF ________)
On ________, ________, before me personally came
________ known to me to be the individual described in and who executed the foregoing instrument, and to me such person duly acknowledged that ________ executed the same.
__________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
G-5 (9/00)