-12- COUNTY OF -------------------------------------------------------------------------- X Proceeding for the Appointment of a Standby Guardian for An Infant. -------------------------------------------------------------------------- X CONSENT OF PETITIONER FOR STANDBY GUARDIAN (Pursuant to SCPA 1726 (e) ( iii )) File No. I , state that: 1. I am the petitioner in the proceeding for the appointment of a Standby Guardian of my minor child. 2. A decree was signed on appointing standby guardian effective upon the execution of this consent. 3. upon my (incapacity) (death) (incapacity or death), [Delete inapplicable provision] I uthority upon (his) (her) receipt of this written consent executed in accordance with the provisions of Section 1726 (e) ( iii ) of 4. I am physically unable to sign this written consent and have directed (Name of person other than Standby Guardian) to sign on my behalf in my presence and in the presence of two witnesses whose signatures are set forth below. [Delete if inapplicable] Dated: Signature of Person other than Petitioner I declare that the person whose name appears above (signed this consent in my presence) (was physically unable to sign and asked another to sign this document, who did so in my presence). I further declare that I am at least eighteen years old and am not the person designated as standby guardian. Dated: Witness: Signature Print Name Address Dated: Witness: Signature Print Name Address American LegalNet, Inc. www.FormsWorkFlow.com -13- I appointed or designated as such (Name of Standby Guardian) by hereby ack nowledge that I have received the foregoing consent of the following date . Signature Print Name [Note: The Standby Guardian must file this written consent with the Court within 90 days of receipt of the written consent. Failure to file Name of Attorney: Tel No. Address of Attorney: American LegalNet, Inc. www.FormsWorkFlow.com