ORDER APPOINTING TEMPORARY GUARDIAN OF A MINOR Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division In the Interests of: Middle Name First Name Last Name Ward After hearing on the Motion for Appointment of Temporary Guardian, The Court finds: 1. That venue is proper. 2. Notice pursuant to G.L. c. 190B, §§5-204(d-f) was: Properly given. Shortened or waived in whole or in part because the Court finds that an immediate emergency situation exists which requires the immediate appointment of a Temporary Guardian. The nature of the emergency is: 3. It is necessary to appoint a Temporary Guardian because of the likelihood of immediate and substantial harm to the health, safety, or welfare of the Ward and that no other person appears to have authority to act in the circumstances. 4. The ward is over 14 years of age and requested to be present. The ward was not present as the court finds that his/her best interests would not be served thereby. The Court appoints the following person(s) as Temporary Guardian(s): 1. Name: First Name (Address) Last Name M.I. (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: 2. Name: First Name (Address) Last Name M.I. (Apt, Unit, No. etc.) (City/Town) (State) (Zip) Primary Phone #: The Court orders the following: 1. If this Order was issued without full notice, post-appointment notice must be given together with a statement that the appointment may be vacated and heard as a de novo matter as expeditiously as possible. Said notice must be given within seven days from the date of this appointment to the those persons named in the petition who were not previously given notice in accordance with G.L. c. 190B, §5-204(d). A certification stating such notice has been given must be filed within seven days of the appointment or the appointment may be vacated sua sponte. MPC 742 (5/30/11) page 1 of American LegalNet, Inc. www.FormsWorkFlow.com 3 2. The Temporary Guardian(s) shall serve: without surety on his/her/their bond: minor has no estate without surety on his/her/their bond for the following good cause: with personal sureties corporate surety on his/her bond in the amount of pursuant to G.L. c. 190B, §5-410. NO LETTERS OF TEMPORARY GUARDIANSHIP SHALL ISSUE UNTIL THE BOND IS FILED AND APPROVED. 3. The Guardian may not establish or move the Minor's custodial dwelling outside the Commonwealth of Massachusetts without a Court order. The Guardian may establish or move the Minor's custodial dwelling outside the Commonwealth of Massachusetts without a Court order. 4. The authority of the Temporary Guardian does not include the authority to consent to extraordinary medical treatment, G. L. c. 190B, §5-306A. 5. This temporary guardianship expires on appointment without basis listed below). (date not to exceed 90 days from (Date) The Court finds the following extraordinary circumstances necessitate a longer period of appointment to a date certain. 6. A hearing shall be held on this matter on : a.m. p.m. at the at Probate and Family Court. 7. The Court further orders: The parties shall comply with a stipulation or agreement dated today, which is filed with the Court and expressly made part of this Order. Other: Date JUSTICE OF THE PROBATE AND FAMILY COURT MPC 742 (5/30/11) page 2 of American LegalNet, Inc. www.FormsWorkFlow.com 3 EXTENSION OF APPOINTMENT For good cause shown, the appointment of the Temporary Guardian(s) is extended for an additional period of time and shall expire on . Date The Bond of the Temporary Guardian(s) is hereby re-examined and re-approved. hearing shall be held on this matter on A : a.m. p.m. at the at Probate and Family Court. Date JUSTICE OF THE PROBATE AND FAMILY COURT MPC 742 (5/30/11) page 3 of American LegalNet, Inc. www.FormsWorkFlow.com 3