Person Filing: Mailing Address: City, State, Zip: Phone Number: COCONINO COUNTY SUPERIOR COURT In the Matter of the Guardianship and/or Conservatorship of: Ward 1: Ward 2: Ward 3: Ward 4: [ ] An Adult [ ] A Minor ISSUANCE OF LETTERS: 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: Case Number: GC LETTERS AND THEIR ACCEPTANCE FOR: [ ] GUARDIANSHIP ONLY [ ] CONSERVATORSHIP ONLY [ ] GUARDIANSHIP AND CONSERVATORSHIP 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 June 2013 American LegalNet, Inc. www.FormsWorkFlow.com � 2013 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 June 2013 American LegalNet, Inc. www.FormsWorkFlow.com � 2013 Coconino County Law Library