Person Filing: Mailing Address: City, State, Zip: Phone Number: COCONINO COUNTY SUPERIOR COURT In the Matter of the Guardianship and/or Conservatorship of: Case Number: GC Ward 1: Ward 2: Ward 3: Ward 4: [ ] An Adult [ ] A Minor ISSUANCE OF LETTERS: LETTERS AND ACCEPTANCE OF LETTERS FOR: [ ] GUARDIANSHIP ONLY [ ] CONSERVATORSHIP ONLY [ ] GUARDIANSHIP AND CONSERVATORSHIP is appointed [ ] guardian and/or [ ] conservator of the ward until further order of this court. Sign the Acceptance of Letters, but leave the rest of the form blank. This is for the court to fill in. The following restrictions apply: For Guardianship of an Adult Only: 1. [] The ward's right to obtain or retain a driver's license is suspended. 2. The guardian may consent to the ward's outpatient mental health care and treatment. 3. [] The guardian may place the ward in a level one behavioral health facility for inpatient mental health care and treatment. This authority expires on Witness: Seal: Clerk of the Superior Court By Deputy Clerk: Page 1 of 2 Revised March 2017 American LegalNet, Inc. www.FormsWorkFlow.com � 2017 Coconino County Law Library ACCEPTANCE OF LETTERS: I accept the duties of a guardian and/or conservator and swear or affirm that I will perform them according to law. Guardian and/or Conservator: State of Arizona County of Subscribed and sworn before me this date: Seal: ) ) ) by: Notary Public: Notary Expiration Date: I accept the duties of a guardian and/or conservator and swear or affirm that I will perform them according to law. Guardian and/or Conservator: State of Arizona County of Subscribed and sworn before me this date: Seal: ) ) ) by: Notary Public: Notary Expiration Date: Page 2 of 2 Revised March 2017 American LegalNet, Inc. www.FormsWorkFlow.com � 2017 Coconino County Law Library