STATE OF MAINE DISTRICT COURT Location Docket No. In re: ___________________________ Minor ACCEPTANCE OF APPOINTMENT BY GUARDIAN OF MINOR TEMPORARY PERMANENT LIMITED FULL My name is: ______________________________________: 1. 2. I have petitioned to be appointed guardian of the above named minor. I agree to be the appointed (CHOOSE ONE): FULL, and I am familiar with my responsibilities as guardian, as set forth in 18-A M.R.S. § 5-209. LIMITED and The specific duties and powers I will have as the guardian are:_______ _____________________________________________________________________________ _____________________________________________________________________________ The parental rights and responsibilities to be retained by the parent(s) of the minor(s) are: _____________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ 3. I understand that my appointment is (CHOOSE ONE): TEMPORARY (lasts no longer than 6 months) PERMANENT 4. I submit personally to the jurisdiction of this court in any proceeding relating to this guardianship. Notice of any proceeding relating to this guardianship may be delivered or mailed to me by ordinary mail at my address given below or at such other address as I may hereafter file with this court. Address of guardian for court records: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I accept my responsibilities as guardian willingly and without reservation, believing this acceptance to be in the best interest of the minor child. Dated: ___________________________ _____________________________________________ Signature of Guardian GS-006, Rev. 07/16 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com