IN THE CIRCUIT COURT OF EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA Case No.: _______________________ IN RE: THE GUARDIAN ADVOCACY OF ____________________________________ Name of Person with a Developmental Disability OATH OF GUARDIAN ADVOCATE, DESIGNATION OF RESIDENT AGENT & ACCEPTANCE (Form E) STATE OF FLORIDA COUNTY OF BREVARD THE Before me, the undersigned authority, this day personally appeared _______________________ ____________________________, to me known, who being by me first duly sworn, says: 1. That the Petitioner has been appointed Guardian Advocate of the Person of ___________________________________________________________________________. 2. That the Petitioner will faithfully administer the duties of such Guardian according to law. 3. That the Petitioner's place of residence is _________________________________________ and the Petitioner's post office box is ____________________________________________. 4. That the Petitioner hereby designates ____________________________________________, who is a resident of the county where this case is filed, and whose address is ______________ ___________________________________________, and whose post office address is ______________________________________________________as Petitioner's agent for service of process in any action against the Petitioner in the Petitioner's representative capacity, or personally, if that personal action accrued in the performance of the Petitioner's duties. Page 1 of 2 of Form E American LegalNet, Inc. www.FormsWorkFlow.com Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief. Signature of Guardian Advocate STATE OF FLORIDA COUNTY OF BREVARD Sworn to and subscribed before me this day of ___________________________________ (Guardian Advocate). , 20 , by Signature of Notary Public Print, Type or Stamp Commissioned Name of Notary Personally known OR Produced Identification __ Type of Identification Produced: ACCEPTANCE I certify that I am a permanent resident of Brevard County, Florida, whose place of residence and post office address are as set forth above. I hereby accept the foregoing designation as Resident Agent. Executed this day of , 20 . Resident Agent Page 2 of 2 of Form E American LegalNet, Inc. www.FormsWorkFlow.com