Petition For Appointment Of Guardian For An Incapacitated Person {MPC 120}

NOTARIZED WAIVER AND CONSENT TO PETITION FOR GUARDIANSHIP OF MINOR In the Interests of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Last Name Minor I STATE THAT: 1. I am the mother the father a person interested as of the above-named minor 2. I acknowledge that a Petition for Guardianship of Minor requesting the appointment of (name) First Name M.I. Last Name as guardian(s) of the person of the above-named minor has been or will be filed. 3. I understand that if the court appoints a temporary guardian, the guardianship will continue for 90 days and can be extended for additional 90 day periods. 4. I understand that if the court appoints a permanent guardian, the guardianship will continue until the minor attains age 18 or upon marriage, or until otherwise terminated by the court. 5. I understand if the court appoints a temporary or permanent guardian, I may be required to pay child support, if I otherwise have an obligation to do so under the law. By signing this document, I consent to this guardianship and waive my rights to notice of hearings as required by the statutes. Signature of Father or Interested Person (Print name) (Street address) Signature of Mother or Interested Person (Print name) (Apt, Unit, No. etc.) (Street address) (Apt, Unit, No. etc.) (City/Town) (State) (Zip) (City/Town) (State) (Zip) Date Date NOTARIZATION , ss Date , 20 , personally appeared On this day of before me, the undersigned notary public, and proved to me through satisfactory evidence of identification, which was , to be the person whose name is signed on the preceeding or attached document in my presence. Signature of Notary Public (Print name) My Commission Expires MPC 440 (5/30/11) page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Docket No. In the Interests of: First Name Middle Name Last Name NOTARIZATION , ss On this day of , 20 , Date personally appeared before me, the undersigned notary public, and proved to me through satisfactory evidence of identification, which was , to be the person whose name is signed on the preceeding or attached document in my presence. Signature of Notary Public (Print name) My Commission Expires MPC 440 (5/30/11) page 2 of 2 www.FormsWorkFlow.com