JDF 827SC R6/19 ORDER APPOINTING GUARDIAN FOR MINOR Page 1 of 3 District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Minor COURT USE ONLY Case Number: Division Courtroom ORDER APPOINTING GUARDIAN FOR MINOR Upon consideration of the Petition for Appointment of Guardian for the above minor and hearing on (date), The court has considered any expressed wishes of the minor concerning the selection of the guardian. The court has considered the powers and duties of the guardian, the scope of the guardianship, and the priority and qualifications of the nominee. The court finds, determines and orders: 1. Venue is proper and required notices have been given or waived. 2. The minor was born on (date). 3. An interested person seeks appointment of a guardian. 4. The minor222s best interest will be served by the appointment of a guardian. 5. The minor222s parents222 consent to the appointment of a guardian. The minor222s parents222 parental rights have been terminated by prior court order. The minor222s parents are deceased. The minor222s parents are unwilling or unable to exercise their parental rights. Guardianship has previously been granted to a third party who has died or become incapacitated and the guardian has not appointed a successor guardian by will or written instrument. 6. The court appoints the following person as guardian for the minor: Name: Street address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone : Email Address: 7. The guardian must promptly notify the court if the guardian222s home address, email address, or phone number changes and of any change of address for the minor. 8. The guardian may not establish or move the minor222s custodial dwelling outside the State of Colorado without a court order. American LegalNet, Inc. www.FormsWorkFlow.com JDF 827SC R6/19 ORDER APPOINTING GUARDIAN FOR MINOR Page 2 of 3 9. Within 30 days of appointment, the guardian must provide a copy of this Order Appointing Guardian for Minor to the minor if 12 years or older and persons given notice of the petition and must advise those persons using Notice of Appointment of Guardian and/or Conservator (JDF 812) that they have the right to request termination or modification of the guardianship. 10. The guardian must file the annual Guardian222s Report - Minor (JDF 834) with the court each year by the minor222s birthday or by (date). 11. Copies of all future court filings must be provided to the following interested persons: Name Relationship to Minor The m inor if 12 years or older at the time of mailing Parent or adult nearest in kinship Parent or adult nearest in kinship Guardian 12. The guardian is authorized to access the minor222s medical records and information. The guardian is deemed to be the minor222s personal representative for all purposes relating to the minor222s protected health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2). 13. Letters of Guardianship will be issued. The Letters will expire on the minor222s 18th birthday, (date), unless otherwise ordered by the court. The powers and duties of the guardian are unrestricted. The powers and duties of the guardian are limited by the following restrictions: 14. The appointment is pursuant to 247 15-14-204(2.5)(b), C.R.S. Letters of Guardianship will be issued. The Letters will expire on the minor222s 21st birthday, (date), unless otherwise ordered by the court. The powers and duties of the guardian are unrestricted. The powers and duties of the guardian are limited by the following restrictions: A separate Order regarding the court222s findings establishing the minor222s eligibility for classification as a special immigrant juvenile was issued. American LegalNet, Inc. www.FormsWorkFlow.com JDF 827SC R6/19 ORDER APPOINTING GUARDIAN FOR MINOR Page 3 of 3 15. The court further orders: Date: Judge Magistrate American LegalNet, Inc. www.FormsWorkFlow.com