Page 1 of 1 Approved by the Coalition for Court Access
CCA-GU-0520-4005
www.indianalegalhelp.org
STATE OF INDIANA IN THE ___________________________ COURT
COUNTY OF ___________________ CAUSE NO. _______________________________
IN RE THE GUARDIANSHIP OF:
________________________
Minor Child
PARENT AND OTHER INTERESTED PERSON’S WAIVER OF NOTICE AND
CONSENT TO THE APPOINTMENT OF GUARDIAN(S) OF THE PERSON OF
MINOR CHILD
I _____________________________________________, being duly sworn upon my
oath, state that I am an adult, and my date of birth is _________________________. I am
the _____________________________ of the following child(ren):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I am familiar with the Verified Petition For Appointment Of Guardians Of The Person
Of A Minor and hereby consent to the appointment of Petitioner,
______________________________________________________________________________
as guardian of the above named child(ren). I expressly waive service of summons and
notice on this Petition.
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: ___________________________
