IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division LETTERS OF LIMITED GUARDIANSHIP OF THE PERSON (Partial Incapacity ­ Advance Directive) TO ALL WHOM IT MAY CONCERN: WHEREAS, the person of has been appointed limited guardian of (the Ward) and has taken the prescribed oath and performed all other acts prerequisite to issuance of limited letters of guardianship of the person of the Ward, NOW THEREFORE, I, the undersigned circuit judge, declare duly qualified under the laws of the State of Florida to act as limited guardian of the person of , with full power to exercise the following powers and duties pertaining to the Ward's person: The ward, prior to incapacity, appointed a health care surrogate pursuant to Florida Statutes Chapter 765. Such advance directive: (___) is superseded and the guardian shall exercise all delegable rights otherwise assigned to the health care surrogate (___) shall remain in effect until further order of this court (___) shall remain in effect to the following extent: ORDERED on , . Circuit Judge Bar Form No. G-3.108 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com