JV-073 (Rev. 03/14/2013)
NOMINATION BY MINOR OF PERSON(S)
TO BE APPOINTED AS GUARDIAN(S)
DOCKET NUMBER
Trial Court of Massachusetts
Juvenile Court Department
Guardianship of Minor
DIVISION
DATE SIGNATURE OF MINOR
I, , am 14 years of age or older. I nominate
to be appointed as my guardian(s).
and
(print or type nominated guardian's full name) (print or type nominated guardian's full name)
, being 14 years of age or older personally appeared
before me on and nominated
and as his/her guardian(s).
(print or type full name)
(print or type full name)
(print or type proposed nominee's name)
(print or type proposed nominee's name)
NOTARY PUBLIC/JUSTICE OF THE PEACE
My Commission Expires:
(date)
NOTARIZATION