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SUPREME COURT OF THE STATE OFNEW YORI( -'9-',Yl 91:_Y_1i9_:5 In the Matter of the Application _________.________x of Index No. Petitioner, for the Appointment of a Guardian for g-lT3-p-19i11'-9-l-'-:'-93,----x coMMrssloN To GUARDIAN(S) T}IE PEOPLE OF THE STATE OF NEW YORK, TO ALL TO WHOM THESE PRESENTS SHALL COME, GREETING. WHEREAS, an Order and Judgment (a copy of which is annexed hereto), dated ,was issued and filed in the matter captioned above appointing the following person(s)as Guardian(s) of the incapacitated person named above: and 20 (I ) a bond having been filed or waived; and (2) a designation of the Clerk to accept service of process _. upon each such Guardian(s) above appointed having been filed on NOW, TI{EREFORE, KNOWYE THAT WE HAVE GRANTED, GIVENAND COMMITTED, AND DO GIVE, GRANT AND COMMIT TINTO THE ABOVE-NAMED GUARDIAN(S) THE POWERS SET FORTH IN SAID ANNEXED ORDERAND ruDGMENT. By the Court this _ ,r day of 20 Clerk of the County of Suffolk American LegalNet, Inc. www.FormsWorkFlow.com