Affidavit Of Proposed Guardian (Standby) {CSMD-5}

SURROGATE222S COURT OF THE STATE OF NEW YORKCOUNTY OF ----------------------------------------------------------------------------XIn the Matter of the Application of forAFFIDAVIT OF PROPOSEDAppointment/Confirmation as Standby Guardian ofGUARDIAN OF THE[ ] PERSON[ ] PROPERTY[ ] PERSON AND PROPERTY(a)I have never been convicted of an offense against the law, except (b)I have never forfeited bail or other collateral, except CSMD-5 (/201) -1- American LegalNet, Inc. (c) I do not have any criminal charges pending against me, except 6.I have no physical or mental impairment, or medical condition, which would interfere with my ability to perform theduties of guardian of the Respondent, except 7.I am not addicted to narcotics or to alcohol.8.I am willing and able to undertake and perform the duties and responsibilities of guardian of the Respondent until thecourt determines otherwise.9.I believe that my appointment as guardian would be in the best interests of the Respondent for the following reasons: (Signature of Proposed Guardian) (Print Name)Sworn to before me this day of , Notary PublicCommission Expires:(Affix Notary Stamp or Seal)-2- American LegalNet, Inc. www.FormsWorkFlow.com