-16- COUNTY OF ---------------------------------------------------------------------- X Proceeding for the Appointment CONFIRMATION AFFIDAVIT of a Standby Guardian for OF STANDBY GUARDIAN An Infant. File No. ---------------------------------------------------------------------- X STATE OF NEW YORK ) ) ss.: COUNTY OF ) The undersigned, Standby Guardian, being duly sworn says: 1. I was appointed standby guardian of the above named infant by this Court by decree dated . 2. T here has been no material change a material change in the circumstances of the infant since the filing of the petition. [If any material changes, so specify] 3. The petitioner has died been incapacitated made a written consent whereby I am now entitled to receive letters of Guardianship. 4. I have never been named as a subject of an indicated report filed pursuant to Title 6 of Article 6 of the Social Services Law, or have been the subject of or the respondent in a child protective proceeding commenced under Article 10 of the Family Court Act, which proceeding resulted in an order finding that the child is an abused or neglected child, except: [Explain in detail]. 5. OATH OF GUARDIAN: I am over eighteen years of age and domiciled in the State of New York; that I will well, faithfully and honestly discharge the duties as guardian. I am acquainted with the estate of the infant and have read the statement contained in the petition filed with the Court as to the estimated value of same, and believe same to be correct. I am not ineligible to receive letters. 6. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I hereby designated the Clerk of the manner and with like effects as if it were served personally upon me whenever I cannot be found and served within the State of New York after due diligence is used. My domicile is : (Street Number) (City,Village/Town) (State) (Zip) Signature of Proposed Guardian American LegalNet, Inc. www.FormsWorkFlow.com -17- SG-9 STATE OF NEW YORK ) ) ss.: COUNTY OF ) On , 20 , before me personally appeared to me known and known to me to be the person described in and who executed the foregoing instrument, and duly acknowledged to me that he executed the same. Notary Public Name of Attorney Commission Expires: (Affix Notary Stamp or Seal) Address Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com