§ 5621. Designation
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 23 Pa.C.S.A. Domestic RelationsEffective: December 24, 2018
Effective: December 24, 2018
23 Pa.C.S.A. § 5621
§ 5621. Designation
(1) A designation of a temporary guardianship shall identify the custodial parent, the minor or minors, any other parent, the temporary guardian and the triggering event or events upon which a named temporary guardian shall become a coguardian or guardian. The designation shall also include the signed consent of the temporary guardian and the signed consent of any other parent or an indication why the other parent's consent is not necessary.
(Insert name of designator) do hereby appoint |
(Insert name, address and telephone number of temporary guardian) |
as the temporary guardian of |
(Insert name(s) of minor(s) to take effect upon |
................... (Date). |
I am the mother/father/other to |
(Insert name(s) of minor(s)). |
(Insert name(s) of other parent(s) of minor(s)) is the |
father/mother/other of |
(Insert name(s) of minor(s)). |
By this designation, I am granting |
(Insert name of temporary guardian) the authority to act for |
90 days following the occurrence of |
as a coguardian with me or as guardian of my minor |
child(ren). |
It is my intention to retain full parental rights to the |
extent consistent with my condition and to retain the |
authority to revoke the temporary guardianship if I so |
choose. |
This designation is made after careful reflection, while I am |
of sound mind. |
(Date) | (Designator's signature) |
(Witness's signature) | (Witness's signature) |
(Number and Street) | (Number and Street) |
(City, State and Zip Code) | (City, State and Zip Code) |
If applicable: I, , |
(Insert name of other parent) |
hereby consent to this designation. |
(Date) | (Signature of other parent) |
(Address of other parent) |
I, |
(Insert name of temporary guardian), hereby accept my |
nomination as temporary guardian of |
(Insert minor(s)'s name(s)). I understand that my rights and |
responsibilities toward the minor child(ren) named above will |
become effective upon ........................................ (Date) |
I further understand that in order to continue as temporary |
guardian for the child(ren), I must file a petition with the |
court of common pleas within 30 days of the order granting |
the petition for temporary guardianship. |
(Date) | (Signature of temporary guardian) |
NOTARY SEAL |
I hereby revoke the above temporary guardianship agreement. |
.................................................. (Parent signature) |
............................. (Date) |
NOTARY SEAL |
Credits
2018, Oct. 23, P.L. 583, No. 88, § 4, effective in 60 days [Dec. 24, 2018].
23 Pa.C.S.A. § 5621, PA ST 23 Pa.C.S.A. § 5621
Current through Act 11 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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