New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter VII - Surrogate's Court Forms
Subchapter A - Forms Authorized By Section 207.52
Surrogate's Forms
Form G-3 - Affidavit of proposed guardian
SURROGATE'S COURT OF THE STATE OF NEW YORK
COUNTY OF ________
________X
Proceeding for the Appointment of a AFFIDAVIT OF PROPOSED
Guardian for GUARDIAN OF THE PERSON
File No. ________
An infant.
________ X
STATE OF ________)
COUNTY OF ________)ss.:
To the Surrogate's Court, County of ________:
The undersigned ________, being duly sworn, deposes and says:
1. I am a competent person over the age of eighteen (18) years, and I submit this affidavit in support of my petition to be appointed guardian of the person of ________, an infant.
2. I have know the infant since ________ by reason of the following: [State relationship, if any. Set forth when and by whom the custody of the infant was transferred to you]
________
________
________
________
3. I reside at ________, and the other resident members of the household are: [Include all persons residing there and their respective ages]
________ ________
________ ________
________ ________
4. Not including minor traffic offenses and adjudications as a youthful offender, wayward minor or juvenile delinquent,
(a) I have never been convicted of an offense against the law, except ____________
____________
(b) I have never forfeited bail or other collateral, except ____________
____________
(c) I do not have any criminal charges pending against me, except ____________
____________
5. I have no physical or mental impairment, or medical condition, which would interfere with my ability to perform the duties of guardians of the infant, except ____________
____________
6. I am not addicted to unlawful narcotics or to alcohol.
G-3 (9/00)
-1-
7. I am willing and able to undertake care, custody and control of the infant until the infant attains the age of eighteen (18) or until the court determines otherwise.
8. I believe that my appointment as guardian would be in the best interest of the infant for the following reasons:
________
________
________
________
______________
(Signature of Proposed Guardian)
______________
(Print Name)
Sworn to before me this
________ day of ________, ________
__________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
-2-
