Affidavit of Guardianship

I, the undersigned _________________________ (full legal name) do hereby make oath and say that:-

I am the grandmother of the minor identified as

_____________________________________________ (full names, date of birth, age) who is under my

care and custody.

I am mentally competent and have no judgements entered against me which may preclude or disqualify
me from guardianship.

I am authorized to act and legally execute agreements or applications on behalf of the minor's parents.

As verification I annex hereto, marked "A" a true copy of a Power of Attorney executed by the parents
appointing me as agent and attorney for the minor.

This affidavit is made for the purpose of:

_____________________________________________

I attest to the foregoing statements which may be relied upon for all legal intent and purposes.

_____________________________________________
SIGNATURE and FULL LEGAL NAME OF DEPONENT

DULY SWORN TO AND SUBSCRIBED BEFORE ME, on this ____ day of _______________ 20____ at

_________________________  County of _________________________

_________________________
NOTARY PUBLIC

My commission expires _________________________

Page 1 of 1