IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division ORDER APPOINTING LIMITED GUARDIAN OF PERSON AND PROPERTY (Limited Incapacity ­ Advance Directive) On the petition of guardian of the person and property of (the Ward), the Court makes the following findings: for the appointment of a 1. The Ward was adjudicated incapacitated by Order of this Court entered on _______________________, ___________, and the Court, having considered alternatives to guardianship, found that no alternatives to guardianship sufficiently address the needs of the Ward, and that the restrictions imposed upon the Ward's rights and liberties are consistent with the Ward's welfare and safety, and are the least restrictive appropriate alternatives, reserving to the Ward the right to make decisions in all matters commensurate with the Ward's ability to do so. 2. The Order Determining Limited Incapacity established the incapacity of the Ward to exercise the following delegable rights: ( _) ( _) ( _) ( _) ( _) ( _) ( _) 3. to determine his or her residence, to consent to medical and mental health treatment, to make decisions about his or her social environment or other social aspects of his or her life, to contract, to sue and defend lawsuits, to personally apply for government benefits, to manage property or to make any gift or disposition of property. The nature of the guardianship is limited and it is necessary to appoint a limited guardian of the person and property of the Ward. 4. The Court finds that the ward, prior to incapacity, appointed a health care surrogate pursuant to Florida Statutes Chapter 765. Bar Form No. G-3.069 - 1 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com The Court having jurisdiction and being fully advised, it is ADJUDGED as follows: 1. appointed limited guardian of the person and property of is qualified to serve and is hereby . 2. ( _) ( _) ( _) ( _) ( _) ( _) (__) The following rights of the Ward are delegated to the guardian appointed by this Order: to contract, to sue and defend lawsuits, to apply for government benefits, to manage the property of the Ward, to determine the Ward's residence, to consent to medical and mental health treatment, to make decisions about the Ward's social environment or other social aspects of the Ward's life. Note: If the right of the Ward to contract has been delegated to the guardian but the right to marry is retained, then the right to marry is subject to court approval. 3. Upon taking the prescribed oath, filing designation of resident agent and acceptance, and payable to the Governor of the State of posting a bond in the amount of $ Florida and to all successors in office, conditioned on the faithful performance of all duties by the guardian, letters of guardianship shall be issued. 4. The guardian must place the following property of the Ward: in a restricted account in a financial institution designated pursuant to Florida Statutes Section 69.031. Bar Form No. G-3.069 - 2 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 5. () The Ward's designation of health care surrogate: 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-3.069 - 3 of 3 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com