Connecticut General Statutes Title 45A. Probate Courts and Procedure § 45a-624c. Written statement that designation of standby guardian in full force and effect

The written statement referred to in section 45a-624 shall be in substantially the following form:

STATEMENT THAT DESIGNATION OF A STANDBY GUARDIAN

IS IN FULL FORCE AND EFFECT

I,.... of...., state under penalty of false statement:

THAT...., of...., as principal, did on...., 20.., appoint me as standby guardian dated...., 20.., to execute a statement that a specified contingency had occurred;

THAT specified contingency was: ....

THAT specified contingency has occurred.

IN WITNESS WHEREOF, I have hereunto set my hand and seal under penalty of false statement.

....

Witness

....

....L.S.

Witness