IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division LETTERS OF EMERGENCY TEMPORARY GUARDIANSHIP TO ALL WHOM IT MAY CONCERN: WHEREAS, guardian of the of has been appointed emergency temporary (the Ward), and has taken the prescribed oath and performed all other acts prerequisite to issuance of letters of emergency temporary guardianship of the Ward, NOW THEREFORE, I, the undersigned circuit judge, declare duly qualified under the laws of the State of Florida to act as emergency temporary guardian of the of exercise the following powers and duties: , with full power to The guardian shall not exercise authority over any health care surrogate appointed by any valid advance directive executed by the Ward pursuant to Chapter 765, Florida Statutes, nor designate a health care surrogate pursuant to Chapter 765, Florida Statutes, except upon further order of this Court. The authority of the emergency temporary guardian expires ninety (90) days after the date hereof, unless earlier terminated by the appointment of a guardian or extended by order of this court. ORDERED on , . Circuit Judge Bar Form No. G-3.110 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com