AFFIDAVIT
FOR _________________________________________________________________________________ We, ___________________________________ and _______________________________________ , state that _____________________________________‘s presence in the Duchesne County School District is not for the primary purpose of attending public school; instead, his/her mental and emotional health would be best served by transfer of guardianship to ______________________________________ .
We are aware that designation of a guardian is equivalent to a court established guardianship and will suspend or terminate any existing guardianship rights in the same manner as a court established guardianship.
We consent and submit to suspension or termination of parental or guardianship rights. We submit to jurisdiction of Utah State courts in Duchesne County School District for any action related to guardianship or custody of the student. We designate _____________________________________________ to accept service of process and notice and it is our intent that _________________________________________ become a permanent resident of Duchesne County School District under the supervision of ________________________________________.
___________________________________ Signature
___________________________________ Signature
___________________________________ Date
___________________________________ Witness
___________________________________ Witness
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