State of Minnesota County of _________________ District Court Probate Division Judicial District: _______________ Court File No. _________________ Case Type: 14, _____________________ In Re: Guardianship Conservatorship of __________________________ Guardian: Letters of: Guardianship Conservatorship Minn. Stat. § 524.5-110 ______________________________________, is qualified and is hereby authorized to act as Guardian of the Ward, after being appointed as guardian by or the Court; the ward's spouse; the ward's parent, with all of the powers and authority prescribed by statute as shown on the order appointing guardian the terms of which order are incorporated herein by reference including the powers under M.S. § 524.5-313 subd. (c), as follows: all powers therein, or only those under paragraphs Conservator: _______________________________________, is qualified and is hereby authorized to act as Conservator of the protected person, with all of the powers and authority prescribed by statute as shown on the order appointing conservator, the terms of which order are incorporated herein by reference including the powers under M.S.§524.5-417 subd.(c) as follows: all powers therein, or only those under paragraphs 1, 2, 3, 4, 5 and 6; 1, 2, 3, 4, 5, 6 and 7; and and each has such other powers and duties granted under applicable law. Dated:______________, 20____ Judge of District Court GAC 4-U State ENG Rev 09/13 www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com