STATE OF VERMONT SUPERIOR COURT Unit In re Guardianship of : PROBATE DIVISION Docket No.: AFFIDAVIT IN SUPPORT OF MOTION FOR EMERGENCY TEMPORARY GUARDIAN I, Name of Affiant , hereby state under oath: Date Signature Print Name Subscribed and sworn before me on: date My commission expires on: Date of Expiration Signature of Notary PAG95 ­ Affidavit in Support of Motion for Emergency Temporary Guardian (09/2014) American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1