FOR CLERK’S USE ONLY Name of Person Filing: _______________________________________ Mailing Address: _______________________________________ City, State, Zip Code: _______________________________________ Day/Evening Telephone: _______________________________________ ATLAS Number (if applicable) _______________________________________ Attorney Bar Number (if applicable) __________________________________ Representing: Self Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case No. ______________________________ In the Matter of the Guardianship and/or Conservatorship of LETTERS OF TEMPORARY GUARDIAN AND/OR CONSERVATOR AND ACCEPTANCE OF APPOINTMENT _____________________________ A Minor ISSUANCE OF LETTERS: 1. This person is appointed: (name)________________________________________ as temporary guardian and/or conservator for the above captioned minor. 2. Reason for appointment: ___________________________________________________________ 3. Length of appointment: until further order of this court:_____________________________________ 4. Restrictions that apply to this temporary appointment, by order of the court;_____________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ DATE: VIRLYNN TINNELL Clerk of the Superior Court By Deputy Clerk ACCEPTANCE OF APPOINTMENT STATE OF ARIZONA County of Mohave ) ) ss. ) I hereby accept the duties of temporary guardian and/or conservator of ___________________________ and do solemnly swear that I will perform these duties according to law. _____________________________________ Subscribed & sworn to before me this ______day of , 20____. By _____________________________________ My Commission Expires:____________________ _______________________________ Notary Public / Deputy Clerk 04/24/07 American LegalNet, Inc. www.FormsWorkflow.com