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NOTARIZED WAIVER AND CONSENT TO PETITION FOR GUARDIANSHIP OF MINOR Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division In the Interests of Middle Name First Name Last Name Minor I STATE THAT 1. I am the mother the father a person interested as of the above-named minor 2. I acknowledge that a Petition for Guardianship of Minor requesting the appointment of name M. I. click to add click to remove as guardian s of the person of the above-named minor has been or will be filed* 3. I understand that if the court appoints a temporary guardian the guardianship will continue for 90 days and can be extended for additional 90 day periods. age 18 or upon marriage or until otherwise terminated by the court. 5. I understand if the court appoints a temporary or permanent guardian I may be required to pay child support if I otherwise have an obligation to do so under the law. By signing this document I consent to this guardianship and waive my rights to notice of hearings as required by the statutes. Signature of Father or Interested Person Print name Apt Unit No* etc* Street address City/Town State Zip Date NOTARIZATION ss On this day of personally appeared before me the undersigned notary public and proved to me through satisfactory evidence of identification which was to be the person whose name is signed on the preceeding or attached document in my presence. Signature of Notary Public My Commission Expires MPC 440 5/30/11 page of remove add notary Reset Form. I am the mother the father a person interested as of the above-named minor 2. I acknowledge that a Petition for Guardianship of Minor requesting the appointment of name M. I. click to add click to remove as guardian s of the person of the above-named minor has been or will be filed* 3. I. click to add click to remove as guardian s of the person of the above-named minor has been or will be filed* 3. I understand that if the court appoints a temporary guardian the guardianship will continue for 90 days and can be extended for additional 90 day periods. I understand that if the court appoints a temporary guardian the guardianship will continue for 90 days and can be extended for additional 90 day periods. age 18 or upon marriage or until otherwise terminated by the court. 5. I understand if the court appoints a temporary or permanent guardian I may be required to pay child support if I otherwise have an obligation to do so under the law. age 18 or upon marriage or until otherwise terminated by the court. 5. I understand if the court appoints a temporary or permanent guardian I may be required to pay child support if I otherwise have an obligation to do so under the law. By signing this document I consent to this guardianship and waive my rights to notice of hearings as required by the statutes. By signing this document I consent to this guardianship and waive my rights to notice of hearings as required by the statutes. Signature of Father or Interested Person Print name Apt Unit No* etc* Street address City/Town State Zip Date NOTARIZATION ss On this day of personally appeared before me the undersigned notary public and proved to me through satisfactory evidence of identification which was to be the person whose name is signed on the preceeding or attached document in my presence.

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