Fill and Sign the Custody Agreement Form

STATE OF LOUISIANA PARISH OF __________ CUSTODY AGREEMENT BEFORE ME, the undersigned, duly commissioned and qualified Notaries in and for the Parish and State aforesaid personally came and appeared ______________ , a resident of __________ Parish, Louisiana, and ______________ , a resident of __________ Parish, Louisiana, after being duly sworn did state: ______________ , is the maternal Uncle and the duly appointed Tutor of the minor child, ______________ , whose date of birth is _______ ___ , 20 ___ , and that he has had physical custody of the minor child since the death of the minor child = s mother and that he hereby grants unto ______________ , the grandmother and duly appointed Undertutrix of the minor child, the care, custody and control of the minor child, ______________ , authorizing ______________ to make all decisions regarding the child = s health, education, and welfare, to include authorizing any type of medical treatment that is necessary, to sign any and all documents that are required on behalf of the minor child. ______________ hereby agrees to accept the custody of the minor child, ______________ , and accept full responsibility for same. WITNESSES: ___________________________ _______________________________ ______________ ___________________________ SWORN TO AND SUBSCRIBED before me the _________ day of ____________________, 20 ___ , at ______________ , ________ . ______________________________ NOTARY PUBLIC My Commission Expires: ________ WITNESSES: ___________________________ _______________________________ ______________ ___________________________ SWORN TO AND SUBSCIRBED before me the ________ day of __________________, 20 ___ , at ________ Parish, Louisiana. _______________________________ NOTARY PUBLIC My Commission Expires: __________