State of Minnesota County of _____________________ District Court Probate Division Judicial District: ___________________ Court File No. ______________________ Case Type: 14,______________________ In Re: Guardianship and Conservatorship of ______________________________, Ward and Protected Person Guardian: Letters of Guardianship and Conservatorship (MINOR) Minn. Stat. § 524.5-110 _______________________________________, is qualified and is hereby authorized to act as Guardian of_____________________________________, after being appointed as guardian by the Court; the ward's spouse; or 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. § 524.5-207, as follows: all powers therein, 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) or only those under paragraphs 1, 2, 3, 4, 5 and 6; all powers therein, and each guardian and conservator has such other powers and duties granted under applicable law. Dated:______________, 20_____ ____________________________ Judge of District Court GAC 4-UM State ENG Rev 09/13 www.mncourts.gov/forms Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com