IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE IN THE MATTER OF: _____________________________, a disabled person : : : : : C.M. # __________________ FINAL ORDER FOR APPOINTMENT OF GUARDIAN OF THE PERSON AND PROPERTY WHEREAS, on _________________________ a hearing was held in the above-matter ("hearing"); WHEREAS, Petitioner _____________________________ is the _____________ of ________________________________ (hereinafter called "the disabled person"), and the interested parties has/have waived notice and consented (agreed) to the appointment of the petitioner as guardian of the person and property of the disabled person or has/have received notice through certified mail; WHEREAS, ______________________________, Esquire, the previously appointed attorney ad litem for the disabled person has been personally served at least ten (10) days before the date of the hearing, or in the alternative has filed a waiver of service, and has rendered his/her report; WHEREAS, the Court having reviewed the petition and affidavits, considered the medical report, and considered the statements made and evidence presented at the hearing, finds that ____________________________ is a disabled person because he/she is mentally infirm and/or physically incapacitated. By 1 American LegalNet, Inc. www.FormsWorkFlow.com reason thereof such disabled person is unable to properly manage and/or care for his/her person and consequently, such disabled person without guardian is in danger of substantially endangering his/her health or becoming subject to abuse by other persons or becoming the victim of designing persons AND is unable to properly manage and/or care for his/her property and consequently, such disabled person without a guardian is in danger of dissipating or losing such property by becoming the victim of designing persons. IT IS HEREBY ORDERED, this ________ day of _______________, 20_____, as follows: 1. ___________________________ is hereby appointed guardian of the person and property of __________________________, a disabled person. 2. Before entering upon his/her duties as guardian pursuant to this Order, _____________________ shall execute a bond to be taken in the name of the State of Delaware in the amount of $_____________ with/without surety as a condition for the faithful performance of his/her duties as guardian, and shall be filed within seven days of the date of this Order. No copy of the final order will be released until the bond is filed. Any person or entity presented with a valid Order from the Court may use that Order as proof that the bond has been executed and filed. 2 American LegalNet, Inc. www.FormsWorkFlow.com 3. The guardian appointed herein is granted such powers, rights and duties which are necessary to protect, manage and care for the person and property of the disabled person as provided for in 12 Del. C., Ch. 39. 4. The guardian shall file an annual update and medical statement with the Register in Chancery every year, which is due on or before the first business day of the calendar quarter in which the guardian was appointed. The annual update and medical statement shall include the current mailing address of both the disabled person and the guardian, and a current medical statement from an approved medical practitioner setting forth the current medical status of the disabled person and addressing the need for continued guardianship. 5. The guardian is required to pay $ ________to ________________________, Esquire, within thirty days of the date of this order for his/her services as the attorney ad litem for the disabled person. The attorney ad litem is hereby discharged from further service as attorney for the disabled person. 6. The Register in Chancery of this Court is appointed agent of the guardian to accept service of process on behalf of the guardian as to any claim arising out of the guardianship if, by reason of the guardian's absence from this State, he/she cannot be served. 3 American LegalNet, Inc. www.FormsWorkFlow.com 7. An order from the Court of Chancery is required to authorize the opening of any safe deposit box of the disabled person and to sell or encumber any real property of the disabled person. 8. In the event of the disabled person's death, the guardian shall notify the Office of Register in Chancery within ten (10) days. 9. If the disabled person becomes Medicaid qualified, the guardian shall provide proof of that qualification and a copy of any signed trust instrument with the Register in Chancery's Office within thirty days. 10.The guardian is relieved of the requirement of opening a guardianship account, filing an inventory and filing annual accountings. However, if the disabled person earns more than $1,000.00 in any given month, other than Social Security benefits, the guardian shall report the earnings to the Court within thirty days for further review. If, in the future, the guardian comes into possession of additional funds or property belonging to the disabled person or the disabled person becomes gainfully employed, the guardian shall notify the Court and account for such funds or property as the Court may then direct. ___________________________________ (Vice) Chancellor or Master 4 American LegalNet, Inc. www.FormsWorkFlow.com