Plaintiff's Amended Complaint

SURROGATE'S COURT OF THE STATE OF NEW YORK
GUARDIANSHIP FORMS

COUNTY OF

Proceeding for the Appointment of a Guardian for , an Infant.

FILE NO.

PETITION FOR APPOINTMENT OF GUARDIAN OF PERSON ONLY

1. The name, permanent address, date of birth and telephone number of the petitioner, and the petitioner's relationship to the infant are as follows:

Name: Telephone Number:

Permanent Address: (Street and Number)

(City, Village, Town) (State) (Zip Code)

Mailing Address:

Date of Birth: Relationship to Infant:

Name: Telephone Number:

Permanent Address: (Street and Number)

(City, Village, Town) (State) (Zip Code)

Mailing Address:

Date of Birth: Relationship to Infant:

2. The name, permanent address, date of birth and marital status of the infant of this proceeding is as follows:

Name:

Permanent Address: (Street and Number)

(City, Village, Town) (State) (Zip Code)

Mailing Address:

Date of Birth: Marital Status:

3. The names and permanent addresses of the parents of the infant and, if the infant is married, the infant's spouse are:

[If both parents of the infant are deceased, give date of death and complete Number 5 and Number 6]

Name of Father: Date of Birth: Date of Death:

Permanent Address: (Street and Number)

(City, Village, Town) (State) (Zip Code)

Mailing Address:

Name of Mother: Date of Birth: Date of Death:

Permanent Address: (Street and Number)

(City, Village, Town) (State) (Zip Code)

Mailing Address:

Name of Spouse: Date of Birth: Date of Death:

Permanent Address: (Street and Number)

4. The names and addresses if the adult persons with whom the infant resides if other than parents are:

Name:

Permanent Address: (Street and Number)

(City, Village, Town) (State) (Zip Code)

Mailing Address:

Relationship to infant:

5. If father and mother are deceased, list the names and addresses of the nearest distributees of full age who live within the state. [If not applicable, so state]

6. The names and permanent addresses of the infant's grandparents: [If not applicable, so state and if deceased, add date of death]

Name: Permanent Address:

Maternal Grandmother    Maternal Grandfather    Paternal Grandmother    Paternal Grandfather

7. Petitioner is requesting appointment as guardian of the infant's person only and alleges that the petitioner is capable of providing care, custody and control of the infant during minority and is motivated solely by the best interests of the child in requesting this appointment.

8. (a) The infant has never had, at any time, a guardian appointed for him/her, and

(b) Custody of the infant has never been surrendered by any person lawfully charged therewith nor has custody been the subject of any court order, except as hereinafter listed:

9. Petitioner (has) (does not have) knowledge that a person nominated to be a guardian, or any individual eighteen years of age or over who resides in the home of the proposed guardian:

a. Is the subject of a reported filed with the Statewide Central Register of Child Abuse and Maltreatment...

b. Has been the subject of, or the respondent in a Child Protective Proceeding...

If petitioner has such knowledge, attach an affidavit explaining in detail.

10. Petitioner has completed and annexed the Request For Information Guardianship Form (OCFS 3909) required to be submitted to the New York State Central Register of Child Abuse and Maltreatment.

11. The infant (is) (is not) a Native American child under the Indian Child Welfare Act of 1978.

12. There are no other persons interested in this proceeding upon whom process is required to be served other than those listed above.

13. No prior application has been made to any Court for the relief requested herein.

WHEREFORE, your petitioner respectfully prays that:

Letters of Guardianship of the Person be granted to

or such other person or corporation as may be entitled thereto and that process issue to all interested persons who have not waived issuance of same requiring them to show cause why such relief should not be granted.

Dated:

State of ) ss.:

County of ) ss.:

Sworn to before me this day of ,

COMBINED OATH & DESIGNATION

I, being duly sworn, depose and says:

1. OATH OF GUARDIAN: I am over eighteen (18) years of age and a citizen of the United States...

2. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I hereby designate the Clerk of the Surrogate's Court County...

My permanent address is:

Signature of Attorney:

Print Name:

Firm Name: Tel. No.:

Address of Attorney:

JOINDER AND STATEMENT OF PREFERENCE OF INFANT 14 YEARS AND OVER

FILE NO.

I, , the infant, hereby join in the foregoing petition and request that of be appointed guardian of my person and/or property.

Person    Property

Date:

AFFIDAVIT OF PROPOSED GUARDIAN OF THE PERSON

To the Surrogate's Court, County of :

The undersigned being duly sworn, deposes and says:

1. I am a competent person over the age of eighteen (18) years, and I submit this affidavit in support of my petition to be appointed guardian of the person of , an infant.

AFFIDAVIT OF PARENT

STATE OF NEW YORK )

COUNTY OF ) ss.:

The undersigned, , being duly sworn, deposes and says:

I am a natural/adoptive parent

and I reside at

I have determined that it would be in the best interests of the child if were appointed guardian(s).

Signature of Parent: