J DF 828 SC R 9/18 ORDER APPOINTING TEMPORARY GUARDIAN FOR MINOR Page 1 of 2 District Court Denver Probate Court County, Colorado Court Address: In the Interests of: Minor COURT USE ONLY Case Number: Division Courtroom ORDER APPOINTING TEMPORARY GUARDIAN FOR MINO R PURSUANT TO 247 15 - 14 - 204 ( 4 ), C.R.S. Upon consideration of the Petition for Appointment of Temporary Guardian for the above minor and/or hearing on (date), The c ourt finds , determines and orders : 1. Venue is proper and require d notices have been given or waived. 2. The minor was born on (date). 3. A qualified person seeks appointment. 4. An immediate need exists for the appointment of a temporary guardian and the appointment would be in the best interest of the minor . 5. The temporary guardianship cannot exceed six months from appointment . 6. The c ourt appoints the following person as t emporary g uardian for the m inor: Name: Street a ddress: C ity: State: Zip Code: Mailing a ddress , if different : City: State: Zip Code: Primary phone: Alternate phone: Email a ddress: 7. The guardian must promptly notify the c ourt if home address, email address, or phone number change s and of any change of address for the minor . 8. The g uardian may not establish or move the m custodial dwelling outside the s tate of Colorad o without a c ourt order . American LegalNet, Inc. www.FormsWorkFlow.com J DF 828 SC R 9/18 ORDER APPOINTING TEMPORARY GUARDIAN FOR MINOR Page 2 of 2 9. Copies of all future c ourt filings must be provided to the following interested persons : Name Relationship to Minor Minor if 12 years or older at time of mailing Parent or adult nearest in kinship Parent or adult nearest in kinship 10. The guardian must provide a copy of this Order Appointing Temporary Guardian for Mi nor to the minor ( if 12 years of age or older) and interested persons within 5 days after the appointment pursuant to 247 15 - 14 - 204(4), C.R.S. 11. guardian is protected health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2). 12. Letters of temporary guardianship will be issued . This temporary guardianship expires on (date not to exceed 6 months from appointment.) The powers and duties of the temporary guardian are unrestricted. The powers and duties of the temporary guardian are limited by the following restrictions: 13. The c ourt further orders: Date: Judge Magistrate American LegalNet, Inc. www.FormsWorkFlow.com