Fill and Sign the Designation of Standby Guardian Georgia Form

DESIGNATION OF STANDBY GUARDIAN (See Georgia Code Title 29, Chapter 2, Article 1, Part 4) Instructions: A designation of a standby guardian shall be in writing and shall be signed by the designating individual or some other individual in the designating individual’s presence and at the designating individual’s express direction. The designation shall be attested to and subscribed by two or more competent witnesses. Neither the witness nor an individual signing on behalf of the designating individual may be named the standby guardian. A standby guardian designation shall set forth the name, address, and county of domicile of the designating individual and of the standby guardian; the name, address, county of domicile, and date of birth of the minor; and the circumstances which define the parent or guardian as a designating individual. With regard to a parent of the minor who is not the designating individual, the designation shall state, to the extent known, that the parent’s name and address and if that parent is deceased, has his or her parental rights terminated, and whether that parent cannot be located. The designation shall include a statement of consent, signed by the standby guardian, to serve in such capacity. DESIGNATION OF STANDBY GUARDIAN (1) INDENTIFICATION OF DESIGNATING INDIVIDUAL: I, ______________________________ , whose address is ______________________________ and whose county and state of domicile are ______________________________ , am: (Check and complete the ones which apply) (A) The parent with physical custody of the minor child or children listed below and my parental rights are not terminated; and the other parent, whose name is ______________________________ and whose address is _______________________ , of the minor child or children listed below: (A-1) Is deceased; (A-2) Has his or her parental rights to the minor or minors terminated; (A-3) Cannot be found after a diligent search has been made; or (A-4) Has consented to the designation of and service by the standby guardian as set forth below; or (B) The guardian of the minor child or children listed below, who is duly appointed and serving pursuant to the court order. (2) INDENTIFICATION OF MINOR(S): The minor or minors for whom I am designating a standby guardian are: ADDRESS (Include county of domicile): _________________________________ DATE OF BIRTH: ____________ ADDRESS (Include county of domicile): _________________________________ DATE OF BIRTH: ____________ ADDRESS (Include county of domicile): _________________________________ DATE OF BIRTH: ____________ (3) DESIGNATION AND INDENTIFICATION OF STANDBY GUARDIAN: Pursuant to Part 4 of Article 1 of Chapter 2 of Title 29 of the Official Code of Georgia Annotated, I hereby designate ______________________ , whose address is ______________________ and whose county and state of domicile are ______________________ , to serve as the standby guardian of the minor(s) whom I have identified above. (4) POWERS OF STANDBY GUARDIAN: The standby guardian whom I have designated above shall have all the rights, duties, and responsibilities under Georgia law of a guardian of a minor who has been appointed by a court. (5) DURATION OF STANDBY GUARDIANSHIP: I understand that upon a health care professional determining in writing that, due to my physical or mental health condition, I am not able to care for the minor(s) identified above, this standby guardianship shall become effective and the person whom I have designated above shall become the standby guardian of the person of the minor(s). I understand that I can revoke this standby guardianship by destroying this document, obliterating it, or by revoking it in writing with proper witnesses. I understand that if I wish to revoke the standby guardianship after the health determination has been made I must file a notice of the revocation of the standby guardianship with the probate court and mail a copy of the notice of revocation to the standby guardian. Finally, I understand that this standby guardianship will automatically end in 120 days after the health care professional makes the determination that I am unable to care for the minor(s), unless the standby guardian has filed a petition for guardianship of the minor. If the standby guardian files such a petition, the standby guardianship will remain in effect, unless otherwise revoked, until the judge rules on the petition. In considering such a petition for guardianship, I understand that the judge will give preference for the appointment to the individual whom I name as the standby guardian in this document. (6) SIGNATURE: I certify that the statements contained herein are true and correct, this _______ day of ______________ , _______ . _________________________________________ (Designating individual sign here) _________________________________________ (Print name of designating individual) We, the undersigned witnesses, are at least 18 years of age, are not designated as the standby guardian, and state that the designating individual signed this designation in our presence. _______________________________ ______________________________ (Signature of first witness) (Print first witness’s address) _______________________________ ______________________________ (Signature of second witness) (Print second witness’s address) (7) CONSENT OF PARENT (To be completed only if line A-4 in paragraph (1) above has been checked): I, { insert name of parent other than the one designating the standby guardian }, am the parent of the above named minor(s). I understand that by this form, an individual is being designated to serve as a standby guardian of my child(ren). I understand that this standby guardian will have all the rights, duties, and responsibilities under Georgia law of a guardian of the person of a minor who has been appointed by a court. I further understand that I may object to this designation. Knowing this, I consent to the designation of _________________________ . This ______________ day of _______ , 20 _______ . ________________________________________ (Other parent signs here) ________________________________________ (Print name of other parent) We, the undersigned witnesses, are at least 18 years of age, are not designated as the standby guardian in this document, and state that the above-named parent signed this consent in our presence. _______________________________ ______________________________ (Signature of first witness) (Print first witness’s address) _______________________________ ______________________________ (Signature of second witness) (Print second witness’s address) (8) ACCEPTANCE OF DESIGNATION BY STANDBY GUARDIAN: I, ______________________________ , am the individual designated as the standby guardian in this document. I hereby accept this designation with full knowledge that upon a health care professional making a written determination that the parent of the minor(s) is not able to care for the minor(s) due to his or her physical or mental health condition, I automatically take on this guardianship. Further, I understand that I must file a notice of my becoming a standby guardian, a copy of this designation, and a copy of the health determination with the probate court as soon as the health determination has been made. I understand that within 120 days of the health determination being made I must petition the probate court to name me as guardian of the minor(s). This _______ , day of _______ , 20 _______ . ________________________________________ (Standby guardian signs here) ________________________________________ (Print name of standby guardian) We, the undersigned witnesses, are at least 18 years of age, are not designated as the standby guardian in this document, and state that the above-named parent signed this consent in our presence. _______________________________ ______________________________ (Signature of first witness) (Print first witness’s address) _______________________________ ______________________________ (Signature of second witness) (Print second witness’s address)