Amended
IN
Assembly
May 06, 2019 |
Amended
IN
Assembly
April 08, 2019 |
Amended
IN
Assembly
March 28, 2019 |
Introduced by Assembly Member Irwin (Principal coauthor: Assembly Member Robert Rivas) |
February 22, 2019 |
Standby Guardian’s Authorization Affidavit | |
Use of this affidavit is authorized by Section 2105.2 of the California Probate Code. | |
Instructions: Custodial parent/guardian shall complete this form to designate a standby guardian, and if applicable, successor standby guardian(s), to assume the care, custody, and control of a minor child when the custodial parent or guardian is incapacitated, as defined by subdivision (b) of Section 2105.2 of the Probate Code. Print clearly. | |
1. Name of the minor: | |
2. Minor’s date of birth: | |
3. Name of the designating custodial parent or
guardian: | |
4. Home address of the designating custodial parent or guardian: | |
5. Name of the designated standby guardian: | |
6. Address of the designated standby guardian: | |
7. Date of birth of the designated standby guardian: | |
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jurisdiction: | |
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If only one parent or guardian completes the Standby Guardian’s Authorization Affidavit, check one or more of the following, as applicable: | |
◻ No
other person has or shares legal custody of the minor child. ◻ I have advised the parent or other person having legal custody of the minor of my intent to designate a standby guardian and have received no objection. ◻ I am unable to contact the parent or other person having legal custody of the minor at this time to notify them of my intended designation. | |
I declare under penalty of perjury under the laws of the State of California that I am / we are the custodial parent(s) or guardian(s) and that the foregoing is true and correct to the best of my/our knowledge. | |
Date: _______________________ | Signature:_______________________________ |
Print Name: | |
Address: | |
Date: _______________________ | Signature:_______________________________ |
Print Name: | |
Address: | |
I declare under penalty of perjury under the laws of the State of California that I voluntarily assume the role of standby guardian upon the incapacitation of the custodial parent(s) or guardian(s). | |
Date: _______________________ | Standby Guardian Signature:_______________________________ |
Print Name: | |
Address: | |
I declare under penalty of perjury under the laws of the State of California that I witnessed the signing of this Standby Guardian’s Authorization Affidavit by the custodial parent(s) or guardian(s) and that I am not the person designated as the standby guardian: | |
Date: | Witness Signature: |
Print Name: | |
Contact Information: | |
NOTICES: | |
1. This declaration does not affect the rights of the minor’s parents or legal guardian regarding the care, custody, or control of the minor. 2. This declaration confers temporary legal custody of the minor to the standby guardian during the pendency of the parent or legal guardian’s incapacity. 3. A person who relies in good faith on the affidavit has no obligation to make any further inquiry or investigation beyond verifying the identity of the standby guardian through any of the following means: (a) A government-issued identification card, including the card number and issuing jurisdiction. (b) A valid California driver’s license, or a driver’s license issued by another state or by a Canadian or Mexican public agency
authorized to issue drivers’ licenses. (c) A valid consular identification document issued by a consulate of the standby guardian’s country of citizenship, or a valid passport issued by the standby guardian’s country of citizenship. 4. If the circumstance requiring the standby guardian to act ceases or if the standby guardian ceases to act, the custodial parent or guardian shall notify any person, school, daycare, health care provider, health care service plan, or other entity that relies on this affidavit. | |
TO SCHOOL OFFICIALS: | |
1. Section 48204 of the Education Code provides that this affidavit constitutes a sufficient basis for a determination of residency of the minor, without the requirement of a guardianship or other custody order, unless the school district determines from actual facts that the minor is not living with the standby guardian. 2. The school district may require additional reasonable evidence that the standby guardian lives at the address provided. | |
TO HEALTH CARE AND OTHER SERVICE PROVIDERS AND HEALTH CARE SERVICE PLANS: | |
A person who acts in good faith reliance upon a standby guardian’s authorization affidavit to provide medical or dental care, or other services, without knowledge of facts contrary to those stated on the affidavit, is not subject to civil or
criminal liability and is not subject to professional disciplinary action for that reliance. |