New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter VII - Surrogate's Court Forms › Subchapter A - Forms Authorized By Section 207.52 › Surrogate's Forms › Form G-2A - Petition for appointment of a guardian (person only)

Current through Register Vol. 46, No. 28, July
					 10, 2024
Filing Fee Paid $ ________
________ Certs $ ________
SURROGATE'S COURT OF THE STATE OF NEW YORK
						________ Certs $ ________
COUNTY OF ________ $ ________ Bond, $
						________
________ X Receipt No: ________ No:
						________
Proceeding for the Appointment of a
						PETITION FOR APPOINTMENT OF
Guardian for GUARDIAN OR AN INFANT
						[PERSON]
an infant. File No. ________
________X
TO THE SURROGATE'S COURT, COUNTY OF
						________
It is respectfully alleged:
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:
(if different from permanent
						address)
Date of Birth: ________ Relationship to
						Infant: ________
Name: ________ Telephone Number:
						____________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip
						Code)
Mailing address:
(if different from permanent
						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:
(if different from permanent
						address)
Date of Birth: ________ Marital Status:
						________
[Attach certified copy of birth
						certificate]
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:
(if different from permanent
						address)
G-2A (9/00) -1-
Name of Mother: ____________ Date of
						Birth: ________ Date of Death: ________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip
						Code)
Mailing address:
(if different from permanent
						address)
Name of Spouse: ____________Date of Birth:
						________ Date of Death: ________
Permanent Address:
(Street and Number)
(City, Village, Town) (State) (Zip
						Code)
Mailing address:
(if different from permanent
						address)
4. The names and addresses of 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:
(if different from permanent
						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]
Name Permanent Address Relationship
____________
____________
____________
____________
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.
-2-
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: [Attach copies of all
						surrenders, court orders, or divorce decrees].
________
________
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 report filed with
						the Statewide Central Register of Child Abuse and Maltreatment pursuant to the
						rules of Child Protective Services, following an investigation which determines
						that some credible evidence of alleged abuse or maltreatment exists and/or b.
						Has been the subject of, or the respondent in a Child Protective Proceeding
						commenced pursuant to law, which proceeding resulted in an order finding that
						the child is an abused or neglected child.
[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 (25
						U.S.C. Sections 1901 -
						1963).
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 the issuance of same requiring them to show cause why such relief
						should not be granted.
Dated: ________
____________
(Signature of Petitioner)
____________
(Signature of Petitioner)
____________
(Print Name)
____________
(Print Name)
-3-
STATE OF ________)
COUNTY OF ________) ss.:
________, being duly sworn deposes and
						says that I am the petitioner above named. I have read the foregoing petition
						and the same is true of my own knowledge except as to matters therein stated to
						be alleged upon information and belief and as to those matters I believe them
						to be true.
Sworn to before me this
________ day of ________, ________
____________
(Signature of Petitioner)
____________
(Print Name)
____________
Notary Public
____________
(Signature of Petitioner)
Commission Expires:
(Affix Notary Stamp or Seal)
____________
(Print Name)
COMBINED OATH & DESIGNATION
STATE OF ________)
COUNTY OF ________) ss.:
________ being duly sworn, deposes and
						says:
1. OATH OF 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 such guardian: That I am
						acquainted with the estate of said infant and have read the statement contained
						in the foregoing petition as to the estimated value of same, and believe same
						to be correct, and that I am not ineligible to receive letters.
2. DESIGNATION OF CLERK FOR SERVICE OF
						PROCESS: I 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 may be made in like manner and with
						like effect as if it were served personally upon me, whenever I cannot be found
						within the state of New York after due diligence used.
My permanent address is:
(Street Address) (City/Town/Village)
						(State) (Zip)
____________
(Signature of Proposed Guardian)
____________
(Signature of Proposed Guardian)
____________
(Print Name)
____________
(Print Name)
On ________, ________, before me
						personally came ________ to me known to be the person described in and who
						executed the foregoing instrument. Such person duly swore to such instrument
						before me and duly acknowledged that he/she executed the same.
____________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.:
						________
Address of Attorney: ____________
-4-
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF ________
________ X JOINDER AND STATEMENT OF
Proceeding for the Appointment of a
						PREFERENCE OF INFANT 14 YEARS AND OVER
Guardian for
FILE NO. ________
An Infant.
________ X
I, ________, the infant, hereby join in
						the foregoing petition and request that ________ of ________ be appointed
						guardian of my
[ ] person and property
[ ] person
[ ] property
STATE OF ________)
COUNTY OF ________) ss.:
________being duly sworn, says: that I am
						the infant in the foregoing petition and joinder statement, that I have read
						the same and believe them to be true, and join in the prayer for the relief
						requested.
____________
(Signature of Infant)
____________
(Print Name)
Sworn to before me this
________ day of ________, ________
____________
Notary Public
Commission Expires:
(Affix Notary Stamp or Seal)
Note: If the petition is prepared by an
						attorney, the attorney's name, address and telephone number must be set
						forth.
Signature of Attorney: ____________
Print Name: ____________
Firm Name: ____________ Tel. No.:
						________
Address of Attorney: ____________