Your Name: Your Address: Your City, State, Zip Code: Your Telephone Number: Representing Self or Attorney for Attorney Bar Number (if applicable): FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the Guardianship and/or Conservatorship of Adult Case Number: PB LETTERS OF APPOINTMENT AS PERMANENT GUARDIAN CONSERVATOR GUARDIAN AND CONSERVATOR AND ACCEPTANCE OF LETTERS Minor ISSUANCE OF LETTERS: 1. This person is appointed: (name) guardian, conservator, or guardian and conservator for the above captioned 2. Reason for appointment: The above captioned protected person. 3. Length of appointment: until further order of this court order: 4. Restrictions that apply to this permanent appointment, by order of the court: 5. adult or as minor. MENTAL HEALTH CARE: adult or minor is an incapacitated ward and/or OUTPATIENT MENTAL HEALTH CARE. The Guardian has the authority to consent for the Ward/Incapacitated Person to receive outpatient mental health care and treatment. INPATIENT MENTAL HEALTH CARE. The Guardian has the authority to place the ward in a level one behavioral health facility for inpatient mental health care and treatment. This authority expires on (date). 6. DRIVING PRIVILEGES. The Ward/Incapacitated Person’s right to obtain or retain a driver’s license is suspended. OR The Ward/Incapacitated Person’s right to obtain or retain a driver’s license is not suspended. WITNESS: CLERK OF THE SUPERIOR COURT SEAL By: Deputy Clerk © Superior Court of Arizona in Maricopa County June 20, 2007 ALL RIGHTS RESERVED Page 1 of 2 PBGC82f Use only most current version LTA American LegalNet, Inc. www.FormsWorkFlow.com Case No. ACCEPTANCE OF LETTERS OF APPOINTMENT State of Arizona Maricopa County ) ) ss. I accept the duties as permanent guardian and/or conservator of (NAME) swear or affirm that I will perform these duties according to law. and I Signature of Person to be Appointed Guardian Signed, sworn to or affirmed before me this date: Michael K. Jeanes, Clerk of Superior Court Notary OR My commission expires: By: Deputy Clerk of Court © Superior Court of Arizona in Maricopa County June 20, 2007 ALL RIGHTS RESERVED Page 2 of 2 PBGC82f Use only most current version LTA American LegalNet, Inc. www.FormsWorkFlow.com