Fill and Sign the Incapacity Form

- 1 - NOTICE OF CONFIDENTIALITY RIGHTS: IF YOU ARE A NATURAL PERSON, YOU MAY REMOVE OR STRIKE ANY OF THE FOLLOWING INFORMATION FROM THIS INSTRUMENT BEFORE IT IS FILED FOR RECORD IN THE PUBLIC RECORDS: YOUR SOCIAL SECURITY NUMBER OR YOUR DRIVER’S LICENSE NUMBER. I, _____________________________, make this Declaration of Guardian, to operate if the need for a guardian for me later arises.DECLARATION OF GUARDIAN IN THE EVENT OF LATER INCAPACITY OR NEED OF GUARDIAN (Texas Estates Code Section 1104.204) I, _____________________________, make this Declaration of Guardian, to operate if the need for a guardian for me later arises. 1. I designate _____________________________ to serve as guardian of my person, _____________________________ as first alternate guardian of my person, _____________________________ as second alternate guardian of my person, and _____________________________ as third alternate guardian of my person. 2. I designate _____________________________ to serve as guardian of my estate, _____________________________ as first alternate guardian of my estate, _____________________________ as second alternate guardian of my estate, and _____________________________ as third alternate guardian of my estate. 3. If any guardian or alternate guardian dies, does not qualify, or resigns, the next named alternate guardian becomes my guardian. 4. I expressly disqualify the following persons from serving as guardian of my person:_____________________________ 5. I expressly disqualify the following persons from serving as guardian of my estate: - 2 - _____________________________ Signed this __________ day of _____________________________, 20 __________. ______________________________________________________________________________ Declarant ______________________________________________________________________________ Witness ______________________________________________________________________________ Witness SELF–PROVING AFFIDAVIT Before me, the undersigned authority, on this date personally appeared the declarant, and ____________________________ and ____________________________ and ____________________________ as witnesses, and all being duly sworn, the declarant said that the above instrument was his or her Declaration of Guardian and that the declarant ha d made and executed it for the purposes expressed in the declaration. The witnesses declared to m e that they are each 14 years of age or older, that they saw the declarant sign the decla ration, that they signed the declaration as witnesses, and that the declarant appeared to them to be of sound mind. __________________________________ Declarant __________________________________ __________________________________ Affiant Affiant Subscribed and sworn to before me by the above named declarant and affiants on this ___ day of __________, 20___. _________________________________ Notary Public in and for the State of Texas My Commission expires: - 3 - _________________________________ As an alternative to the self-proving affidavit above, a declaration of guardian in the event of later incapacity or need of guardian may be simultaneously executed, attested, and made self- proved by using the following: I, ____________________________, as declarant, after being duly sworn, declare to the undersigned witnesses and to the undersigned authority that this instrument is my Declarat ion of Guardian in the Event of Later Incapacity or Need of Guardian, and that I have made a nd executed it for the purposes expressed in the declaration. I now sign this declaration in t he presence of the attesting witnesses and the undersigned authority on this ___ day of __________, 20___ _________________________________ Declarant The undersigned, ____________________________ and ____________________________, each being 14 years of age or older, after being duly sworn, declare to the declarant and to the undersigned authority that the declarant declared to us that this instrument is the declarant's Declaration of Guardian in the Event of Later Incapacity or Need of Guardian and that the declarant execute d it for the purposes expressed in the declaration. The declarant then signed this declaration and we believe the declarant to be of sound mind. We now sign our names as attesting witnesses on this _____ day of __________, 20___. _________________________________ Witness _________________________________ Witness - 4 - Subscribed and sworn to before me by the above named declarant, and affiants, this ___ day of ___________________, 20___. _________________________________ Notary Public in and for the State of Texas My Commission expires: _________________________________