Form 126P (Rev. 11/10) The Family Court of the State of Delaware In and For Petitioner Name Street Address P.O. Box Number City/State/Zip Code Phone Number Relation to Child(ren) D.O.B. New Castle Kent Sussex County PETITION FOR PERMANENT GUARDIANSHIP OF A MINOR Respondent Name Street Address P.O. Box Number City/State/Zip Code Phone Number Relation to Child(ren) D.O.B. File Number Petition Number Attorney Name Attorney Name ) ) No No If a hearing is scheduled in this matter, will Petitioner need an interpreter? Yes (If yes, specify language If a hearing is scheduled in this matter, will Respondent need an interpreter? Yes (If yes, specify language Petitioner (if any) Name Street Address P.O. Box Number City/State/Zip Code Phone Number D.O.B. Respondent (if any) Name Street Address P.O. Box Number City/State/Zip Code Phone Number D.O.B. Relation to Child(ren) Relation to Child(ren) Attorney Name Attorney Name ) ) No No If a hearing is scheduled in this matter, will Petitioner need an interpreter? Yes (If yes, specify language If a hearing is scheduled in this mater, will Respondent need an interpreter? Yes (If yes, specify language Guardian Ad Litem (if any) Name Street Address P.O. Box Number City/State/Zip Code Phone Number Attorney for Guardian Ad Litem If a hearing is scheduled in this matter, will Guardian Ad Litem need an interpreter? Yes (If yes, specify language ) No 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Form 126P (Rev. 11/10) IN THE INTEREST OF THE FOLLOWING CHILD(REN): (Complete the table below for each child for whom permanent guardianship is sought. Attach additional sheets if necessary.) Child's Name Child's Date of Birth Child's Place of Birth (City, State) Child's Gender (Check one) Male Male Male Female Female Female 1. Complete the table below regarding the child(ren)'s parents (individuals holding parental rights): NAME Address Date of Birth MOTHER FATHER 2. If you do not know the name/address of the child(ren)'s mother and/or father, write in the space provided below what you have done to try to locate him/her/them. I have attached to this Petition the following affidavits: Affidavit that a Party's Address is Unknown 3. Name(s) of the person(s) or organization holding parental rights of the child(ren): Address of person(s) or organization: 4. Name(s) of the person(s) or organization having the guardianship, care, control or custody of the child(ren): Address of person(s) or organization if address is different from address of Petitioner(s): 5. Name(s) of the person(s) to whom permanent guardianship shall be vested if this Petition is granted Address of person(s) or organization if address is different from address of Petitioner(s): 6. Proposed permanent guardian(s)' relationship to child(ren) if proposed permanent guardian is NOT the Petitioner: 7. Please check all that apply: The following child(ren) is/are not yet 14 years of age or older: OR 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Form 126P (Rev. 11/10) The child(ren) is/are 14 years of age or older and consents to (agree with) this Petition (Attach Affidavit of Consent executed by each child(ren) who consents) Name(s) of child(ren) 14 years of age or older who consent(s): The child(ren) is/are 14 years of age or older does/do NOT consent to (agree with) this Petition. Name(s) of child(ren) 14 years of age or older who do NOT consent: 8. I am filing this petition because: (Check ALL that apply) The child(ren)'s parent(s) agree that I/we should become the guardian(s) of the child(ren) (Attach an Affidavit of Consent executed by the parent(s) who agree). The child(ren)'s parent(s) are deceased. (Attach a certified copy of the death certificate) The child(ren) is/are dependant and/or neglected based on the following reason(s): 9. I acknowledge the following is true for the child(ren) named in this petition: Adoption of the child is not possible or appropriate; Permanent Guardianship is in the best interests of the child The proposed permanent guardian: i. Is emotionally, mentally, physically and financially suitable to become the permanent guardian; ii. Is a blood relative or a foster parent(s) iii. Has expressly committed to remain the permanent guardian and assume the rights and responsibilities for the child for the duration of the child's minority (until the child is 18 years old); AND iv. Has demonstrated an understanding of the financial implications of becoming a permanent guardian; If the child is at least 14 years old, the child consents to the permanent guardianship being granted. If the proposed permanent guardian is a foster parent(s): i. The child is at least 12 years old; OR ii. The proposed permanent guardian is the permanent guardian of one of the child's siblings; OR iii. The child receives substantial governmental benefits for a serious physical and/or mental disability which would no longer be available to the child if parental rights were terminated and/or if the child was adopted. I/We have made the following efforts to place the child for adoption (if applicable): 10. I have attached the Grounds for Permanent Guardianship for each child named above. I have indicated at least one Ground for Permanent Guardianship for each child named in this petition. 3 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Form 126P (Rev. 11/10) WHEREFORE, Petitioner(s) seek appointment as Permanent Guardian(s) of the above-named minor child(ren). Petitioner Sworn to subscribed before me: Date 2nd Petitioner (if any) Sworn to subscribed before me: Date Clerk of Court/Notary Public Date Clerk of Court/Notary Public Date 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Form 126P (Rev. 11/10) GROUNDS FOR PERMANENT GUARDIANSHIP Complete the following for each child named in the Petition for Permanent Guardian NAME OF CHILD: Indicate the grounds for Permanent Guardianship (Place an "X" next to the grounds that apply.) 1. The parent(s) of the child, or the person(s) or organization holding parental rights over such child agree (consent) that this Petition should be granted. (Attached is/are the parent(s) affidavit of consent.) Respondent has abandoned the child AND intended to abandon the child as evidenced by the fact that: (Place an "X" next to which reason applies) a. The child is younger than 6 months old and at the time of filing this Petition, Respondent did not do ANY of the following: Pay reasonable prenatal, natal and postnatal expenses in accordance with Respondent's f