JV-074 (Rev. 03/15/2013)
PARENT(S)' CONSENT TO PETITION
FOR GUARDIANSHIP OF MINOR
DOCKET NUMBER
Trial Court of Massachusetts
Juvenile Court Department
Guardianship of Minor
DIVISION
I state that:
Then personally appeared before me the above named parent(s)
who made oath that the foregoing acceptance was his/her
free act and deed.
PRINT OR TYPE FULL NAME
NOTARY PUBLIC/JUSTICE OF THE PEACE
My Commission Expires:
NOTARIZATION
2. I/we acknowledge that a Petition for Guardianship of Minor has been filed requesting
be appointed as guardian(s) of the above
named child.
1. I am/we are the mother the father
4. I/we understand that if the court appoints a guardian(s), I/we may be required to pay child support.
3. I/we understand that if the court appoints a guardian(s), the guardianship will continue until my/our child
attains the age of 18, or upon marriage, or when otherwise terminated by the court.
By signing this document, I/we consent to this guardianship.
SIGNATURE OF MOTHER SIGNATURE OF FATHER
PRINT OR TYPE FULL NAME
DATE DATE
ADDRESS ADDRESS
, ss
DATE
