Page 1 of 1 Approved by the Coalition for Court Access
CCA-GU-0520-4013
www.indianalegalhelp.org
STATE OF INDIANA IN THE ___________________________ COURT
COUNTY OF ___________________ CAUSE NO. _______________________________
IN RE THE GUARDIANSHIP OF:
________________________
Minor Child
MINOR CHILD’S NOTICE OF AND CONSENT TO THE APPOINTMENT OF
GUARDIAN(S) OF THE PERSON OF MINOR CHILD
I, _______________________________________________ being duly sworn upon
my oath, say that I am a minor. My birthdate is ____________________________. I know
about the Petition for Appointment of Guardian(s) of me. I know that
_____________________________________________________________________________
plan to ask for guardianship of me.
I hereby consent to the appointment of
______________________________________________________________________________
as Guardian(s) of me. I waive service of summons and notice of hearing on said
guardianship petition and understand that if there is a hearing in court the court will
not send me a notice of the date and time of the hearing.
I affirm under the penalties of perjury that the foregoing representations are true.
__________________________________ ____________________________________
Date Signature
____________________________________
Printed Name
STATE OF INDIANA
COUNTY OF__________________
Before me, ___________________________a notary public in and for
_________________________County, State of Indiana, personally appeared
___________________________________, and he/she having been first duly sworn upon
his/her oath, says that the facts all alleged in the foregoing instrument are true.
Date _____________________________ ____________________________________
Notary Public
My Commission Expires: ___________________________
