FOR CLERK’S USE ONLY Name of Person Filing: _______________________________________ Mailing Address: _______________________________________ City, State, Zip Code: _______________________________________ Day/Evening Telephone: _______________________________________ Attorney Bar Number (if applicable):__________________________________ Licensed Fiduciary Number (if applicable): __________________________ Self or Representing: Attorney for: __________________________ SUPERIOR COURT OF ARIZONA MOHAVE COUNTY In the Matter of the Guardianship of Case Number ________________________ ORDER TO GUARDIAN AND ACKNOWLEDGMENT _______________________________ (Ward’s Name) A Minor An Adult The welfare and best interest of the person named above (“your ward”) are matters of great concern to this Court. By accepting appointment as guardian, you have subjected yourself to the power and supervision of the Court. Therefore, to assist you in the performance of your duties, this order is entered. You are required to be guided by it and comply with its provisions as it relates to your duties as guardian of your ward to your duties as his/her guardian as follows: 1. You have powers and responsibilities similar to those of a parent of a minor child, except that you are not legally obligated to contribute to the support of your ward from your own funds. 2. Unless the order appointing you provides otherwise, your duties and responsibilities include (but are not limited to) making appropriate arrangements to see that your ward’s personal needs (such as food, clothing, and shelter) are met. 3. You are responsible for making decisions concerning your ward’s educational, social, and religious activities. If your ward is 14 years of age or older, you must take into account the ward’s preferences to the extent they are known to you or can be discovered with a reasonable amount of effort. 4. You are responsible for making decisions concerning your ward’s medical needs. Such decisions include (but are not limited to) the decision to place your ward in a nursing home or other health care facility and the employment of doctors, nurses, or other professionals to provide for your ward’s health care needs. However, you are to use the least restrictive means and environment available that meets your ward’s needs. Revised: 1/1/2011 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ 5. You may arrange for medical care to be provided even if your ward does not wish to have it, but you may not place your ward in a level one behavioral health facility against your ward’s will unless the Court specifically has authorized you to consent to such placement. 6. You may handle small amounts of money or property belonging to your ward without being appointed conservator. As a general rule, “small amount” means that the ward does not receive income (from all sources) exceeding $10,000 per year, does not accumulate excess funds exceeding that amount, and does not own real property. If more than these amounts come into your possession, or are accumulated by you, you are required to petition the Court for the appointment of a conservator. 7. If you handle any money or property belonging to your ward, you have a duty to do each of the following: a. Care for and protect your ward’s personal effects; b. Apply any monies you receive for your ward’s current support, care, and education needs; c. Conserve any excess funds not so spent for your ward’s future needs; d. Maintain your ward’s funds in a separate account, distinct from your own and identified as belonging to the ward; e. Maintain records of all of the ward’s property received and expended during the period of the guardianship; f. Account to your ward or your ward’s successors at the termination of the guardianship, if requested; and g. Not to purchase, lease, borrow, or use your ward’s property or money for your benefit or anyone else’s, without prior Court approval. 8. You shall not accept any remuneration of any kind for placing your ward in a particular nursing home or other care facility, using a certain doctor, or using a certain lawyer. “Remuneration” includes, but is not limited to, direct or indirect payments of money, “kickbacks”, gifts, favors, and other kinds of personal benefits. 9. You will need to obtain a certified copy of the Letters that are issued to you by the Clerk of the Superior Court. Your certified copy is proof of your authority to act as guardian of your ward, and you should have this document available when acting on behalf of your ward. You may need to obtain additional (or Revised: 1/1/2011 Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________ updated) copies from time to time for delivery to, or inspection by, the people with whom you are dealing. 10. You are required to report annually, in writing, with respect to your ward’s residence, physical and mental health, whether there still is a need for a guardian, and (if there is no conservator) your ward’s financial situation. Your report is due each year on the anniversary date of your appointment. In addition to sending copies to the other persons named in the statute, you are directed to lodge a copy of your annual report with the appropriate Judge of this Court. 11. If your ward’s physical address changes, you shall notify the Court by updating the probate information form within three days of learning of the change in your ward’s physical address. If your ward dies, you shall notify the Court in writing of the ward’s death within ten days of learning that the ward has died. 12. You must be conscious at all times of the needs and best interests of your ward. If the circumstances that made a guardianship necessary should end, you are responsible for petitioning the Court to terminate the guardianship and obtaining your discharge as guardian. Even if the guardianship should terminate by operation of law, you will not be discharged from your responsibilities until you have obtained an order from this Court discharging you. 13. If you should be unable to continue with your duties for any reason, you (or your guardian or conservator, if any) must petition the Court to accept your resignation and appoint a successor. If you should die, your personal representative or someone acting on your behalf must advise the Court and petition for the appointment of a successor. 14. If you have any questions about the meaning of this order or the duties that it and the statutes impose upon you by reason of your appointment as guardian, you should consult an attorney or petition the Court for instructions. 15. If you are not a licensed fiduciary and are not related by blood or marriage to the ward, you are not entitled to compensation for your services as the ward’s guardian. See A.R.S. 14-5651(J)(I). 16. The Guardian shall immediately notify the Court in writing of any change in the physical or mailing address of himself or herself or the minor/protected person and shall be responsible for all costs resulting from failure to do so. § This is an outline of some of your duties as guardian. It is your responsibility to obtain proper legal advice about your duties. Failure to do so may result in personal financial liability for any losses. Revised: 1/1/2011 Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No._____________________________ WARNING: FAILURE TO OBEY THE ORDERS OF THIS COURT AND THE STATUTORY PROVISIONS RELATING TO GUARDIANS MAY RESULT IN YOUR REMOVAL FROM OFFICE AND OTHER PENALTIES. IN SOME CIRCUMSTANCES, YOU MAY BE HELD IN CONTEMPT OF COURT, AND YOUR CONTEMPT MAY BE PUNISHED BY CONFINEMENT IN JAIL, FINE, OR BOTH. DATED this day of , 20 ____ Judge/Commissioner ACKNOWLEDGEMENT The undersigned acknowledges receiving a copy of this order and agrees to be bound by its provisions, whether or not he or she read it before signing, as long as he or she is guardian. ______________________________________ ______________________ Signature of Guardian Date Revised: 1/1/2011 Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com