T OF THE STATE OF NEW YORK COUNTY OF ----------------------------------------------------------------------------X Proceeding for the Appointment of a Guardian for an Infant. ----------------------------------------------------------------------------X AFFIDAVIT OF PROPOSED GUARDIAN OF THE PERSON File No. STATE OF ) COUNTY OF ) ss.: The undersigned , being duly sworn, deposes and says: 1. I am a competent person over the age of eighteen (18) years, and I submit this affidavit in support of my petition to be appointed guardian of the person of , an infant. 2. I have known the infant since by reason of the following: [State relationship, if any. Set forth when and by whom the custody of the infant was transferred to you] 3. I reside at , and the other resident members of the household are: [Include all persons residing there and their respective ages] 4. Not including minor traffic offenses and adjudications as a youthful offender, wayward minor or juvenile delinquent, (a) I have never been convicted of an offense against the law, except (b) I have exceptcollateral,otherorbailforfeitednever (c) exceptme,againstpendingchargescriminalanyhavenotdoI 5. I have no physical or mental impairment, or medical condition, which would interfere with my ability to perform the duties of guardian of the infant, except 6. I am not addicted to unlawful narcotics or to alcohol. G-3 (9/00) American LegalNet, Inc. www.FormsWorkFlow.com -10- 7. I am willing and able to undertake care, custody and control of the infant until the infant attains the age of eighteen (18) or until the court determines otherwise. 8. I believe that my appointment as guardian would be in the best interest of the infant for the following reasons: (Signature of Proposed Guardian) (Print Name) Sworn to before me this day of , Notary Public Commission Expires: (Affix Notary Stamp or Seal) American LegalNet, Inc. www.FormsWorkFlow.com