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SURROGATE’S COURT OF THE STATE OF NEW YORK
COUNTY OF _______________________________
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Proceeding for the Appointment of a
Guardian for
_____________________________________________
an Infant.
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Filing Fee Paid $ ___________
__________ Certs $ ___________
__________ Certs $ ___________
$ _________ Bond, $ ___________
Receipt No: ________ No:________
PETITION FOR APPOINTMENT OF
GUARDIAN OF PERSON ONLY
File No._______________________
TO THE SURROGATE’S COURT, COUNTY OF ___________________________
It is respectfully alleged:
1. The name, permanent address, date of birth and telephone number of the petitioner, and the petitioner’s relationship to the
infant are as follows:
Name:_________________________________________________ Telephone Number:____________________________________
Permanent Address:__________________________________________________________________________________________
(Street and Number)
___________________________________________________________________________________________________________
(City, Village, Town) (State) (Zip Code)
Mailing address: ______________________________________________________________________________________
(If different from permanent address)
Date of Birth:___________________________ Relationship to Infant:______________________________________________
Name:_________________________________________________ Telephone Number:___________________________________
Permanent Address:__________________________________________________________________________________________
(Street and Number)
___________________________________________________________________________________________________________
(City, Village, Town) (State) (Zip Code)
Mailing address: ______________________________________________________________________________________
(If different from permanent address)
Date of Birth:___________________________ Relationship to Infant:______________________________________________
2. The name, permanent address, date of birth and marital status of the infant of this proceeding is as follows:
Name:_____________________________________________________________________________________________________
Permanent Address:__________________________________________________________________________________________
(Street and Number)
__________________________________________________________________________________________________________
(City, Village, Town) (State) (Zip Code)
Mailing address:______________________________________________________________________________________
(If different from permanent address)
Date of Birth:___________________________ Marital Status: ________________________________________
[Attach certified copy of birth certificate]
3. The names and permanent addresses of the parents of the infant and, if the infant is married, the infant’s spouse are:
[If both parents of the infant are deceased, give date of death and complete Number 5 and Number 6]
Name of Father:_____________________________ Date of Birth:________________ Date of Death:_______________
Permanent Address:________________________________________________________________________________
(Street and Number)
_________________________________________________________________________________________________
(City, Village, Town) (State) (Zip Code)
Mailing Address:_____________________________________________________________________________
(If different from permanent address)
G-2A (9/00)
Resume Templates 1210 Document(s)
