Sec. 1104.204.  FORM AND CONTENT OF DECLARATION AND SELF-PROVING AFFIDAVIT.  (a)  A declaration and affidavit may be in any form adequate to clearly indicate the declarant's intention to designate a guardian.
(b)  The following form may be used but is not required to be used:
DECLARATION OF GUARDIAN
IN THE EVENT OF LATER INCAPACITY OR NEED OF GUARDIAN
I, __________, make this Declaration of Guardian, to operate if the need for a guardian for me later arises.
1.  I designate __________ to serve as guardian of my person, __________ as first alternate guardian of my person, __________ as second alternate guardian of my person, and __________ as third alternate guardian of my person.
2.  I designate __________ to serve as guardian of my estate, __________ as first alternate guardian of my estate, __________ as second alternate guardian of my estate, and __________ as third alternate guardian of my estate.
3.  If any guardian or alternate guardian dies, does not qualify, or resigns, the next named alternate guardian becomes my guardian.
4.  I expressly disqualify the following persons from serving as guardian of my person:  __________, __________, and __________.
5.  I expressly disqualify the following persons from serving as guardian of my estate:  __________, __________, and __________.
Signed this ___ day of __________, 20__.
______________________________
Declarant
____________________________   ________________________________
Witness                         Witness
SELF-PROVING AFFIDAVIT
Before me, the undersigned authority, on this date personally appeared ______________, the declarant, and ____________ and ____________ as witnesses, and all being duly sworn, the declarant said that the above instrument was his or her Declaration of Guardian and that the declarant had made and executed it for the purposes expressed in the declaration.  The witnesses declared to me that they are each 14 years of age or older, that they saw the declarant sign the declaration, that they signed the declaration as witnesses, and that the declarant appeared to them to be of sound mind.
______________________________
Declarant
____________________________   ________________________________
Affiant                         Affiant
Subscribed and sworn to before me by the above named declarant and affiants on this ____ day of __________, 20__.
__________________________
Notary Public in and for the
State of Texas
My Commission expires:
__________________________
(c)  A declaration that complies with the requirements of Section 1104.203(a-1) may, but is not required to, be in the form specified by Subsection (b), except that instead of having attached the self-proving affidavit prescribed by that subsection, the declaration shall have attached the following acknowledgment:
STATE OF __________________
COUNTY OF _________________
This instrument was acknowledged before me on the ___ day of __________, 20______,
by ________________________ (Declarant).
___________________________
Notary Public, in and for the
State of Texas
Notary's printed name:
___________________________
My commission expires:
___________________________
(d)  A declaration that complies with the requirements of Section 1104.203(a-1) that has attached the acknowledgment provided by Subsection (c) is considered self-proved.
Added by Acts 2011, 82nd Leg., R.S., Ch. 823 (H.B. 2759), Sec. 1.02, eff. January 1, 2014.
Amended by: 
Acts 2017, 85th Leg., R.S., Ch. 298 (S.B. 511), Sec. 2, eff. September 1, 2017.