Fill and Sign the Designation Standby Guardian Form

Superior Court of Washington County of In the Guardianship of: _______________________________, Incapacitated Person No . Designation of Standby Guardian RCW 11.88.125 (DSGSBG) Designation of Standby Guardian The guardian for the person and/or estate named above designates the following to serve as standby guardian: Name: _______________________________________________________________ Address: _______________________________________________________________ _______________________________________________________________ Phone* _______________________________________________________________ Email Address: _______________________________________________________________ This individual is over the age of 18, of sound mind, and has never been convicted of a felony or a misdemeanor involving moral turpitude, or been removed as a fiduciary in any proceeding for cause. I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signed at (city) _______________________ , (state) ___________, on (date) ____________________. ___________________________________ ___________________________ ________________ Signature of Guardian Print Name of Guardian WSBA CPG# ________________________________________ ____________________________________ Address City, State, Zip Code ________________________________________ ____________________________________ *Telephone/Fax Number Email Address Designation of Standby Guardian (DSGSBG) - Page 1 of 2 WPF GDN 04.0350 (01/2013) RCW 11.88.125 Acceptance I ________________________________, acknowledge and accept the designation as standby guardian in this matter. I certify that I am over the age of eighteen, of sound mind, and have never been convicted of a felony or a misdemeanor involving moral turpitude, or been removed as a fiduciary in any proceeding for cause. I certify (or declare) under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at (city) _______________________, (state) ___________ on (date) ____________________. ________________________________ _______________________________ _______________ Signature Print Name WSBA CPG# ________________________________________ ____________________________________ Address City, State, Zip Code ________________________________________ ____________________________________ *Telephone/Fax Number Email Address *If you do not want your personal phone number on this public form, you may list your telephone number on a separate form which may be available to parties and the court, as well as its staff and volunteers, but will not be made available to the public. Use Form WPF GDN 03.0100, Guardianship Confidential Information form (Telephone Numbers), for this purpose . Designation of Standby Guardian (DSGSBG) - Page 2 of 2 WPF GDN 04.0350 (01/2013) RCW 11.88.125