Parental Nomination Of Guardian Page 2

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We,_________________________________________________________
_____________________________________, the witnesses, sign our names to
this instrument, and, being first duly sworn, do each hereby declare to the
undersigned authority that _____________(name of parent), signed and executed
this Parental Nomination of Guardian and that she signed it willingly, and that
each of us, in the presence and hearing of the Signor, and each other, hereby signs
this Parental Nomination of Guardian as witness to the Parent’s signing, and that
that to the best of each of our knowledge the Testatrix is at least eighteen years of
age, of sound mind, and under no constraint , duress, fraud or undue influence.
__________________________
___________________________
Witness
Witness
Address:
Address:
COMMONWEALTH OF MASSACHUSETTS
___________, ss.
Subscribed, sworn to and acknowledged before me by the said
___________(name of parent), and subscribed and sworn to before me by the said
____________________________________________________________, as
witnesses, this _______ day of __________, 20__.
___________________________
Notary Public
My Commission expires on:
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