Authorization For Temporary Guardianship Of Minor Page 3

CONSENT OF TEMPORARY GUARDIAN

I hereby acknowledge the terms set forth above and agree to assume responsibility in

accordance with those terms.

Under penalty of perjury under the laws of the state of Texas, I attest to the truthfulness,

accuracy, and validity of the forgoing statement.

Temporary Guardian 1’s signature: _____________________________ Date: _______________

Temporary Guardian 2’s signature: _____________________________ Date: _______________

CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC

STATE OF __________________

COUNTY OF ________________

This document was acknowledged before me on ______________________ [date] by

________________________________________________ [name of principal].

[Notary Seal, if any]:

_______________________________

(Signature of Notarial Officer)

Notary Public for the State of ______________

My commission expires: __________________

PHOTO COPY OF PARENT / GUARDIAN DRIVERS LISCENSE MUST BE

PROVIDED ALONG WITH THIS FORM

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