JDF 8 30 SC R 9/18 LETTER S OF GUARDIANSHIP - MINOR District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Minor COURT USE ONLY Case Number: Division Courtroom LETTER S OF GUARDIANSHIP - MINOR (name of g uardian ) was appointed or confirmed by th e c ourt on (date) as : G uardian pursuant to 247 247 15 - 14 - 20 2 or 20 4, C. R.S. These letters will expire on , the th birthday, unless otherwise ordered by the c ourt. E mergency G uardian pursuant to 247 15 - 14 - 204( 5), C.R.S. These letters will expire on ( a date not to exceed 60 days from the date of appointment). T he powers are specified in the Order. T emporary G uardian pursuant to 247 15 - 14 - 204(4), C.R.S. These letters wil l expire on ( a date not to exceed six months from the date of appointment) . The g uardian is authorized to access the m g uardian is deemed to be the m oses relating to the m health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2). Th ese Letters of G uardianship for the minor whose date of birth is , are proof of the f ull authority to act pursuant to 247 15 - 14 - 207, C.R.S . , except for the f ollowing restrictions: T he place of residence must not be changed from the State of Colorado without an order of the c ourt pursuant to 247 15 - 14 - 208 (2)(b), C.R.S. Other limitations : Date: Probate Registrar / ( Deputy ) Clerk of Court CERTIFICATION Certified to be a true copy of the original in my custody and to be in full force and effect as of (date). Probate Registrar /(Deputy)C lerk of Court American LegalNet, Inc. www.FormsWorkFlow.com