AFFIDAVIT
FOR _________________________________________________________________________________ We, _______________________________ and ____________________________ , are residents of Duchesne County School District and desire to become the guardian of ______________________________________.
We will accept responsibilities of guardianship to provide adequate supervision, discipline, food, shelter, educational and emotional support, medical care and pay all school fees.
We accept the parents’ appointment of agency.
___________________________________ Signature
___________________________________ Signature
___________________________________ Date
___________________________________ Witness
___________________________________ Witness
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