SURROGATE222S COURT: BROOME COUNTYSTATE OF NEW YORKIn the Matter of the Guardianship forAFFIDAVITFile No.Ward.STATE OF NEW YORK: SS:COUNTY OF BROOME:, being sworn, deposes and says as follows:1.I am petitioning for appointment as fiduciary in the above named guardianshipand this affidavit is made to confirm my eligibility to receive Letters pursuant toSurrogate222s Court Procedure Act 247707. 2.I am 18 years of age or older.3.I have not been judicially declared incompetent to manage my affairs.4.I am not a non-domiciliary alien.5. I have never been convicted of a felony; or I have been convicted of a felony and attached is my Certificate of Relief from Disabilities.6.I do possess the qualifications required of a fiduciary and am not ineligiblebecause of substance abuse, dishonesty, improvidence, want or understanding.7.I can read and write the English language.(signature)(print name)Sworn to before me this day of , 20.Notary Public American LegalNet, Inc. www.FormsWorkFlow.com