MANDATORY CHECKLIST FOR NONPROFESSIONAL GUARDIANSHIP APPLICATION This form must be submitted by all nonprofessional guardians with every Application for Appointment as Guardian . Please fill out the appropriate box for either the initial or renewal applicat ion. Guardianship of Case # Division Format Must Be PRCYYNNNNNNN Name of Guardian Applicant Any other name (s) used by Guardian Applicant Address of Guardian Applicant Street Address City State Zip Guardian Applicant Relationship to Ward Guardian Applicant SS# Guardian Applicant DOB Guardian Applicant Race Guardian Applicant Sex Name(s) of Guardian Applicant Child(ren) Guardian Applicant Employer Telephone Number of Guardian Applicant Employer Supervisor INITIAL APPLICATION FOR APPOINTMENT OF NONPRO FESSIONAL GUARDIAN 1 . Mandatory Checklist Yes 2 . Application for Appointment Attached 3. Fingerprint s Submitted electronica lly 4 . Check in the amount of $50.00 payable to the Broward County Clerk of Court (Court Monitor Criminal/Credit Investigation) Attached Waived by Court 5 . Request Copy of Court Monitor Results Yes No (If yes, in clude a self - addressed , stamped envelope and check in the amount of $1.00 payable to the Broward Coun ty Clerk of Court . ) RENEWAL APPLICATION FOR NONPROFESSIONAL GUARDIANS 1 . Mandatory Checklist Yes 2 . Application for Appointment Attached 3 . Check in the amount of $50.00 payable to the Broward County Clerk of Court (Court Monitor Criminal/Credit Investigation) Attached Waived by Court 4. Certificate for Education Requirement Attached Waived by Court (Copy only , see Fl. Prob. R. 5.625) 5 . Request Copy of Court Monitor Results Yes No (If yes, include a self - addressed, stamped e nvelope and check in the amount of $1.00 payable to the Broward County Clerk of Court.) I hereby acknowledge that I am aware of, have read, and agree to abide by the Fees and Expenses section of the 17 th ntly exists and as may be amended from time to time. I hereby give my consent for a background check in accordance with chapter 744, Florida Statutes including, but not limited to, a credit history investigation, an FDLE, FBI, employment, and Department of Children and Families background check. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true. Guardian Applicant Signature Date Name [ ] American LegalNet, Inc. www.FormsWorkFlow.com