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 SG-1 - Petition for standby guardianship

Current through Register Vol. 46, No. 28, July
					 10, 2024
For Office Use Only
(Filling Fee Paid $ ________)
(Receipt No: ________ No: ________)
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________x PETITION FOR
Proceeding for the Appointment STANDBY
						GUARDIANSHIP
of a Standby Guardian for (SCPA
						1726(3))
File No. ________
An Infant.
________x
TO THE SURROGATE'S COURT, COUNTY OF
						____________,
It is respectfully alleged:
1. The name, relationship, domicile, and
						telephone number of the petitioner are as follows:
[Petitioner must be a parent or legal
						guardian of the infant. If legal guardian submit a copy of the order of
						appointment.]
Name:____________ [ ] Mother [ ]
						Father
Domicile: ____________
(Street Address)
						(City/Town/Village)
____________
(County) (State) (Zip) (Telephone
						Number)
Mailing address: ____________
(if different from domicile)
2. The name, domicile, date of birth and
						marital status of the infant are as follows: [Birth Certificate must be filed
						with this petition]
Name: ____________
(Date of Birth)
Domicile: ____________
(Street Address)
						(City/Town/Village)
____________
(County) (State) (Zip)
Mailing address: ____________
(if different from domicile)
SG-1 (4/98)
3. The names and addresses of the adult
						persons with whom the infant resides are: [If same as above so state]
Name: ____________
Domicile: ____________
(Street Address)
						(City/Town/Village)
____________
(County) (State) (Zip)
Mailing address: ____________
(if different from domicile)
4. The name and domicile of the proposed
						standby guardian are as follows:
Name: ____________
(Relationship, if any, to infant)
Domicile: ____________
(Street Address)
						(City/Town/Village)
____________
(County) (State) (Zip)
Mailing address: ____________
(if different from domicile)
5. The name and domicile, of the other
						parent of the infant and, if the infant is married, the infant's spouse, or if
						the other parent is deceased and there is no spouse, the grandparents residing
						within the county, are as follows:
Father/Mother: ____________
Domicile: ____________
Spouse: ____________
(Date of Birth)
Domicile: ____________
Maternal Grandparents: ____________
Domicile: ____________
Paternal Grandparents: ____________
Domicile: ____________
The foregoing persons are adult and
						competent, except: [If any of the above is an infant attach a Schedule
						containing the name of the infant, with whom he or she resides, whether he or
						she has a court-appointed guardian, and if so, provide the name and address of
						the guardian. If disability is other than infancy, fill out and attach Schedule
						A.]
6. No other persons or agencies are
						interested in this proceeding other than those mentioned above, except:
____________
____________
____________
7a. No guardian or standby guardian ever
						has been appointed for the infant except as follows: [See SCPA Section 1704
						(3)]
____________
____________
b. Custody of the infant never has been
						surrendered by a person lawfully charged therewith, nor has custody of the
						infant been the subject of any court order, except as hereinafter listed: [So
						specify and attach copies of all surrenders, court orders, or divorce
						decrees]
8. [If you seek the appointment of a
						Standby Guardian of the person only, DO NOT complete this paragraph]
The estimated value of all real and
						personal property owned by the infant and the infant's resources are as
						follows:
a. PERSONAL PROPERTY [State exact title of
						all bank accounts with account number and balance. List insurance policies by
						Company, policy number, amount insured, name of insured and relationship to
						infant. List the value of infant's interest.]
____________
____________
____________
The personal property of the infant is not
						subject to the control of the infant's spouse under the laws of a jurisdiction
						other than New York. [If property is so subject, so state]
b. REAL PROPERTY [State whether the real
						property is encumbered and the amount of the encumbrance. Indicate whether
						property is to be occupied as a residence by the infant. Indicate rental income
						in (c.)(3) below. If a sale of the property is contemplated so state.]
Location of Property ____________
Gross Value $ ____________
Infant's interest ____________
c. ANNUAL INCOME OF INFANT FROM ALL
						SOURCES:
(1) Compensation or pension to be received
						from: ____________ $ ________
(2) Income from Trusts ____________ $
						________
(3) Income from Real Property ____________
						$ ________
(4) Other Income ____________ $
						________
9. The authority of the standby guardian
						is to become effective upon the petitioner's [Check appropriate box]
a. [ ] incapacity only b. [ ] death only
						c. [ ] incapacity or death.
10. Petitioner suffers from a:
[ ] progressively chronic illness
[ ] fatal illness
[State the basis for the above statement,
						such as the date and source of the medical diagnosis. You need not identify the
						illness.]
11. The infant (is) (is not) a Native
						American Child subject to the Indian Child Welfare Act of 1978 (25 USC
						Section 1901 -
						1963).
12. Petitioner (has) (does not have)
						knowledge that the person nominated to be Standby Guardian has ever been named
						as a subject of an indicated report filed pursuant to Title 6 of Article 6 of
						the Social Services Law, or has been the subject of or the respondent in a
						child protective proceeding commenced under Article 10 of the Family Court Act,
						which proceeding resulted in an order finding that the child is an abused or
						neglected child. [If the petitioner has such knowledge, attach an affidavit
						explaining in detail].
13. Completed and annexed hereto is the
						Request for Information Guardianship Form required to be submitted to the New
						York Central Register of Child Abuse and Maltreatment.
14. [Check appropriate box]:
a. [ ] Petitioner is able to attend any
						hearing to be scheduled by the court.
b. [ ] The petitioner is medically unable
						to appear and asks that the court dispense with his/her appearance.
15. No prior application has been made to
						any Court for the relief requested herein.
WHEREFORE, your petitioner respectfully
						prays that: [Check and complete all relief requested]
(a) Letters of Standby Guardianship of
						the
[ ] Person and Property
[ ] Person only
[ ] Property only be granted to
						____________
____________
or such other person or corporation as may
						be entitled thereto upon petitioner's (death) (incapacity) (death or
						incapacity) [Delete if inapplicable] 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.
(b) The standby guardian of the property
						be prohibited from collecting or receiving any money or property of the infant
						until he or she qualifies and complies with the provisions of SCPA 1708.
Dated: ________
______________
(Signature of Petitioner)
______________
(Print Name)
STATE OF NEW YORK)
) ss.:
COUNTY OF)
________, 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.
Swore to before me this
________ day of ________ 19________
______________
(Signature of Petitioner)
______________
Notary Public
______________
(Print Name)
Commission Expires:
(Affix Notary Stamp or Seal)
Signature of Attorney: ____________
Print Name: ____________
Firm Name:____________ Tel.
						No.:________
Address of Attorney:____________
File #________
SURROGATE'S COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________X
Proceeding for the Appointment SCHEDULE
						A
of a Standby Guardian for PERSONS UNDER
						DISABILITY
OTHER THAN INFANTS
An Infant.
________X
[use additional sheets if more than
						one]
1. Name:____________
						Relationship:____________
Residence: ____________
With whom does this person reside?
						____________
If this person is in prison, name of
						prison: ____________
Does this person have a court-appointed
						fiduciary? Yes [ ] No [ ]
If yes, give name, title and address:
						____________
____________
If no, describe nature of disability:
						____________
____________
If no, give name and address of relative
						or friend interested in his or her welfare:
____________