PROFESSIONAL GUARDIANSHIP CHECKLIST ­ ADDITIONAL APPOINTMENTS DURING CALENDAR YEAR ____________ This form must be submitted with each additional case the professional guardian seeks appointment as the guardian during the calendar year stated above. Please make sure to "x" or "check" the appropriate boxes. Guardianship of ___________________________ Reference #__________________________ Name of Guardian/Employee Applicant ___________________________________________________ Any other name used by Applicant/Employee _______________________________________________ Address of Applicant ________________________________________________________________ Street Address City State Zip Guardian Applicant Relationship to Ward ____________________________________________ 1 2 3 4 5 Professional Guardian Checklist Application for Appointment ( Check payable to Clerk of Court for $7.50 ( (Professional Guardian Processing Fee) Registered with SPGO ( (Statewide Public Guardianship Office) Blanket Bond ( (A copy of the blanket bond must be attached) ) Attached ) Attached ( ) Not Applicable ) Yes ( ) No ) Yes ( ) No I hereby give my consent for a background check in accordance with Florida Statutes, Chapter 744 to include, but may not be limited to, a check of credit, FDLE, FBI, employment, and Department of Children & Families background. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true. ____________________________________ Guardian Applicant Signature _______________________ Date American LegalNet, Inc. www.FormsWorkFlow.com Effective - DRAFT