IN THE CHANCERY COURT OF_____________COUNTY, MISSISSIPPI

JUDICIAL DISTRICT

IN THE MATTER OF THE	CAUSE NO. __________________________

GUARDIANSHIP OF

______________________________________, A MINOR

BY PETITIONER(S) _________________________________

NOMINATION OF GUARDIAN FOR MINOR

I, ________________________________________, am a minor age 14 years of age or older, and I do hereby nominate __________________________________ as guardian of my person.

____________________________________

Signature of Minor

____________________________________

Printed Name of Minor

Prepared by:

Name: _______________________________________

Address: _____________________________________

City: _________________________ State___________

Phone: _______________________ Zip: ____________

Email address: _________________________________

ATTESTATION

STATE OF MISSISSIPPI

COUNTY OF ____________

Personally appeared before me, the undersigned authority, in and for the aforesaid jurisdiction, ___________________, who having been by me first duly sworn stated on his/her oath that the matters and things stated in the above foregoing instrument are true and correct as therein stated.

___________________________

(Type/Print Name Here)

SWORN TO AND SUBSCRIBED before me this the ____day of ________, 20____.

____________________________

NOTARY PUBLIC

My Commission Expires: _________________