The Following Page Is a Sample of the Oath and Designation

SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ______------x

In the Matter of ______, Petitioner INDEX NO. ______

OATH AND DESIGNATION As Guardian of ______, An Incapacitated Person

------x STATE OF NEW YORK COUNTY OF ______

(1) OATH OF THE GUARDIAN

I, ______, being duly sworn, depose and say: (a) I am a citizen of the United States and over the age of eighteen (18) years,

(b) I will well, faithfully and honestly discharge the duties as Guardian for ____Personal Needs ____Property Management [check one or both from Court Order] of ______, whom the Court has found to be incapacitated.

(2) DESIGNATION OF THE CLERK FOR SERVICE OF PROCESS:

I, ______, residing at ______, as Guardian for______, who resides at ______, ______County, hereby designate the Clerk of the Supreme Court,______County, and his successor in office as the person on whom service of any process issuing from said Court in the proceeding, or in any other proceeding, which shall affect the person or property of ______, the incapacitated person, in like manner and with like effect as if it were served personally upon me whenever I cannot be found and served within the State of New York after due diligence is used.

[Signed in front of Notary] ______

[Print name of Guardian] ______

ACKNOWLEDGMENT

STATE OF NEW YORK : COUNTY OF______:

On the___ day of ______, 200_, before me personally appeared ______, to me known and known to me to be the individual described in and who executed the foregoing Combined Oath and Designation of Guardian, and [s]he personally acknowledged to me that [s]he executed the same.

______NOTARY PUBLIC