State of Minnesota County of ___________________ District Court Probate Division Judicial District: ________________ Court File No. ___________________ Case Type: 14 ___________________ In Re: Emergency Guardianship of Conservatorship of ______________________________ Order Appointing Emergency Guardian Emergency Conservator This matter came on for hearing before the district court on a petition seeking an emergency appointment of a Guardian a Conservator for the Respondent named above. The matter, having been considered by the Court and the Court being duly advised in the premises now makes the following: FINDINGS OF FACT 1. 2. A petition for appointment of a general guardian for Respondent has been filed, or will be filed in the immediate future with this court. Compliance with the procedures for appointment of a general guardian will likely result in substantial harm to the Respondent's health, safety, or welfare, and no other person appears to have the authority and the willingness to act on Respondent's behalf. Respondent's needs for health, safety, or welfare are at risk because: (Describe behavior and circumstances supporting this allegation): ________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________. A petition for appointment of a general conservator of the estate for Respondent has been filed, or will be filed in the immediate future with this court. Compliance with the procedures for appointment of a general conservator will likely result in the immediate loss, waste, or dissipation of Respondent's assets or income unless management is provided, or money is needed for support, care, education, health, and welfare of the Respondent or for individuals who are entitled to the support of Respondent and that protection is necessary or desirable to obtain or provide money, and no other person appears to have the authority and the willingness to act on Respondent's behalf. The Respondent's needs for health, safety, or welfare are at risk, or the Respondent's assets must be immediately preserved, because: (Describe behavior and circumstances supporting this allegation): ___________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________. 3. 4. 5. 6. GAC 18-U State ENG Rev 8/10 www.mncourts.gov/forms Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 7. 8. 9. No alternative less restrictive of civil rights and liberties exists, including the use of appropriate technological assistance. The Court finds that the Guardian is the most suitable and best qualified among those available and willing to discharge the trust and is not excluded from appointment pursuant to M.S. � 524.5-309(c) or such Guardian has been approved by prior Order of a court pursuant to M.S. � 524.5-302(d). The Court finds that the Conservator is the most suitable and best qualified among those available and willing to discharge the trust and is not excluded from appointment pursuant to M.S. � 524.5-413(d). CONCLUSIONS OF LAW 1. 2. The Respondent will likely suffer from substantial harm if an emergency guardian is not appointed. The Respondent's assets require an order of this Court need to be preserved; property is needed for the support of the Respondent or for individuals who are in fact dependent upon the Respondent for support. ORDER NOW, THEREFORE, IT IS ORDERED: 1. 2. 3. That: ______________________________, is hereby appointed Guardian of Respondent; and ______________________________, is hereby appointed Conservator of Respondent. That: letters of Emergency Guardianship shall issue to ______________________, upon the filing of an acceptance of appointment; and letters of Emergency Conservatorship shall issue to ________________________________, upon the filing of an acceptance of appointment; and such letters shall reflect the expiration date for said appointment. Appointment of powers and duties: The Guardian shall have the power and duty to: Exercise all of the rights and powers on behalf of the Ward under M.S. � 524.5313(c) paragraphs 1, 2, 3, 4, 5, 6 and 7. (If the Guardian is granted limited powers and duties, specify which powers and duties are vested in the Guardian by this Order.) Have custody of the Ward and establish the place of abode for the Ward within or without the State, M.S. � 524.5-313(c)(1); Provide for the Ward's care, comfort and maintenance needs, M.S. � 524.5313(c)(2); Take reasonable care of the Ward's clothing, furniture, vehicles and other personal effects, M.S. � 524.5-313(c)(3); Give any necessary consent to enable, or to withhold consent for, the Ward to receive necessary medical or other professional care, counsel, treatment or service, M.S. � 524.5-313(c)(4); GAC 18-U State ENG Rev 8/10 www.mncourts.gov/forms Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Approve or withhold approval of any contract, except for necessities, which the Ward may make or wish to make (only given if no conservator is appointed), M.S. � 524.5-313(c)(5); Exercise supervision authority over the Ward, M.S. � 524.5-313(c)(6); Apply on behalf of the Ward for any assistance, services, or benefits available to the Ward through any unit of government, M.S. � 524.5-313(c)(7); (other) _____________________________________________________; To exercise all other powers, duties and responsibilities conferred on the Guardian under applicable law. The Conservator shall have the power and duty to: Exercise all of the rights and powers under M.S. � 524.5-417(c) paragraphs 1, 2, 3, 4, 5 and 6. (If the Conservator is granted limited powers and duties, specify which powers and duties are vested in the Conservator by this Order.) Pay reasonable charges for the support, maintenance, and education of the Protected Person in a manner suitable to the Protected Person's station in life and the value of the Protected Person's estate, M.S. � 524.5-417(c)(1); Pay out of the Protected Person's estate all lawful debts of the Protected Person, M.S. � 524.5-417(c)(2); Possess and manage the estate of the Protected Perso