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Consent Oath And Designation (SCPA Article 17-A) GMD-4 - New York

Consent Oath And Designation (SCPA Article 17-A) Form. This is a New York form and can be used in Guardianship Surrogates Court Statewide .
 Fillable pdf Last Modified 11/13/2009
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SURROGATE'S COURT OF THE STATE OF NEW YORK COUNTY OF ______________________________ --------------------------------------------------------------------X Proceeding for the Appointm ent of a Guardian for CONSENT, OATH AND DESIGNATION File No. _______________________________ Pursuant to SCPA Article 17-A --------------------------------------------------------------------X STATE OF NEW YORK ) COUNTY OF _______________) ss.: ___________________________________________________________________, being duly sworn, deposes and says: I am an adult com petent person and I do hereby consent to the relief requested in the petition and m y appointm ent as [ ] standby guardian [ ] first alternate standby guardian [ ] second alternate standby guardian of the [ ] person [ ] property [ ] person and property [ ] lim ited guardianship of the property of the above-nam ed Respondent and I waive the issuance and service of process upon m e herein. I will m ake an application for confirm ation in accordance with SCPA ยง1757 and will be subject to a form al hearing if the Respondent is eighteen years of age or over. I agree that upon the death, incapacity, renunciation or rem oval of the last guardian who has been designated to serve prior to m e, I will im m ediately assum e the duties of guardian of the [ ] person [ ] property [ ] person and property [ ] lim ited guardianship of the property and will seek to have this Court confirm m y appointm ent within (180) days of m y assum ption of duties. 1. OATH OF [ ] ST ANDBY GUARDIAN [ ] FIRST ALTERNATE STANDBY GUARDIAN [ ] SECOND ALTERNATE STANDBY GUARDIAN: I am over eighteen (18) years of age and a citizen of the United States; that I will well, faithfully and honestly discharge the duties of [ ] standby guardian [ ] first alternate standby guardian [ ] second alternate standby guardian of the [ ] person [ ] property [ ] person and property [ ] lim ited guardianship of the property of the above nam ed Respondent, that I am acquainted with the estate of the Respondent; and that I am not ineligible to receive letters. 2. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I do hereby designate the Clerk of the Surrogate's Court of ____________________ County, and his/her successor in office, as a person on whom service of any process issuing from such Surrogate's Court m ay be m ade, in like m anner and with like effect as if it were served personally upon m e whenever I cannot be found and served within the State of New York after due diligence used. GMD-4 (7/2016) -1- American LegalNet, Inc. www.FormsWorkFlow.com My perm anent address is : ___________________________________________________________________________ (Street Address) (City/Town/Village) (State) (Zip) _____________________________________________ (Signature of Proposed Guardian) _____________________________________________ (Print Nam e) On __________________________________________________________, ________, before m e personally cam e _________________________________________________________________________________________________ to m e known to be the person described in and who executed the foregoing instrum ent. Such person duly swore to such instrum ent before m e and duly acknowledged that he/she executed the sam e. __________________________________ Notary Public Com m ission Expires: (Affix Notary Stam p or Seal) -2- American LegalNet, Inc. www.FormsWorkFlow.com
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