IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF KING In the Guardianship of: ________________________________, An Incapacitated Person. ) ) ) ) ) ) Case No.: DESIGNATION OF STANDBY GUARDIAN RCW 11.88.125 (DSGSBG) DESIGNATION OF STANDBY GUARDIAN The Guardian for the Person and/or Estate named above designates the following to serve as Standby Guardian: Name: Address: Phone: Email Address: ______________________________ ______________________________ ______________________________ ______________________________ This individual is over the age of eighteen, of sound mind, and has never been convicted of a felony or a misdemeanor involving moral turpitude, filed personal bankruptcy or been removed as a fiduciary in any proceeding for cause. DESIGNATION OF STANDBY GUARDIAN-1 Updated 9/7/12 American LegalNet, Inc. www.FormsWorkFlow.com I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. Signed at ________________, Washington, ___________, ____20___. Signature of Guardian Address City, State, Zip Code Printed Name of Guardian Telephone/Fax Number Email Address ACCEPTANCE I ______________________, acknowledge and accept the designation as Standby Guardian in this matter. I certify that I am over the age of eighteen, of sound mind, and never been convicted of a felony or a misdemeanor involving moral turpitude, filed personal bankruptcy or been removed as a fiduciary in any proceeding for cause. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. Signed at ________________, Washington, ___________, ____20___. Signature Address City, State, Zip Code Printed Name Telephone/Fax Number Email Address DESIGNATION OF STANDBY GUARDIAN-2 Updated 9/7/12 American LegalNet, Inc. www.FormsWorkFlow.com