Fill and Sign the Order Appointing Form

F.C.A. §661 Form 6-9 S.C.P.A.§§ 1707, 1726 (Order Appointing Standby Guardian of a Person) 8/2010 At a term of the Family Court of the State of New York, held in and for the County of , at New Yorkon , . P R E S E N T: Hon. ____________________________________________ Proceedings for the Appointment of Docket No. a Standby Guardian of the Person of ORDER APPOINTING STANDBY GUARDIAN OF THE PERSON , A Minor ____________________________________________ Upon reading and filing the petition, duly verified on , , applying for the appointment of a Standby Guardian of the person of the above-named child; and it appearing that the petitioner suffers from a progressively chronic or fatal illness; and that the interests of the child will be promoted by the appointment of a Standby Guardian of (his)(her) person; and that [specify]: is in all respects competent to act as such Standby Guardian; it is hereby ORDERED that [specify]: is appointed Standby Guardian of the person of the child, whose authority shall be effective upon (receipt of a determination of Petitioner's incapacity) (receipt of the certificate of Petitioner' death) (upon receipt of a determination of Petitioner's incapacity or certificate of Petitioner's death, whichever occurs first) [delete inapplicable provision]. The authority of the Standby Guardian shall also be effective upon the Petitioner's written consent pursuant to Section 1726(3) of the Surrogate's Court Procedure Act (and it is further) (ORDERED that ). Form 6-9 Page 2 PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER ____________________________________ JUDGE OF THE FAMILY COURT Dated: , . Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________