REQUEST TO NOMINATE GUARDIAN
I, .................... (insert your name), residing at ................... (insert your address), am executing this notarized document as my written declaration and request for the person(s) designated below to be appointed as my guardian should it become necessary. I am advising the court and all persons and entities as follows:
(YOU MUST DATE AND SIGN THIS DOCUMENT)
I sign my name to this document on ................. (date)
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(Signature)
(YOU MUST HAVE TWO QUALIFIED ADULT WITNESSES DATE AND SIGN THIS DOCUMENT)
I declare under penalty of perjury that the principal is personally known to me, that the principal signed this request to nominate a guardian in my presence, that the principal appears to be of sound mind, has the mental capacity to understand and execute this document and is under no duress, fraud or undue influence, and that I have no interest, financial or otherwise, in the estate of the principal.
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(Signature of first witness)
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(Print name)
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(Date)
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(Signature of second witness)
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(Print name)
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(Date)
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
State of Nevada }
}
County of ........................... }
On this .......... day of ..............., in the year ......., before me, .................... (insert name of notary public), personally appeared .................... (insert name of principal), .................... (insert name of first witness) and .................... (insert name of second witness), personally known to me (or proved to me on the basis of satisfactory evidence) to be the persons whose names are subscribed to this instrument, and acknowledged that they have signed this instrument.
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(Signature of notarial officer)
(Seal, if any)
NRS 159.0753