1 Code: 1920 2 Name: _______________________________ Address: _____________________________ _____________________________ Telephone Number: ____________________ Appearing in Proper Person 3 4 5 6 IN THE FAMILY DIVISION 7 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF WASHOE 9 10 11 In the Matter of the Guardianship of The Person, The Estate, or The Person and Estate of 12 __________________________________________ 13 __________________________________________ 14 __________________________________________ A Minor Child/Minor Children. 15 / 16 Case No. ________________________ Dept. No. ________________________ LETTERS OF TEMPORARY GUARDIANSHIP (Form #5) 17 18 On the _____ day of ___________________, 20______, an Order of the Court was entered 19 appointing ______________________________________________________________________ 20 as temporary guardian(s) of the minor child(ren). The named temporary guardian(s), having duly 21 qualified, is/are legally authorized to act and have the legal authority and shall perform the duties of 22 such guardians. These Letters will expire on the _____ day of _____________________, 20_____. 23 In testimony of which, I have, this date, issued these Letters and affixed the seal of the 24 25 Court. DATED this _______ day of __________________________, 20______. RONALD A. LONGTIN, JR. CLERK OF THE COURT 26 27 By: ________________________________________ Deputy Clerk 28 Revised 2005 1 American LegalNet, Inc. www.FormsWorkflow.com 1 OATH 2 I, ____________________________________, and _______________________________ (Guardian’s Name) (Second Guardian) 3 4 and residing at ____________________________________________________________________ (Street Address) (City) (State) (Zip) 5 6 and whose mailing address is ________________________________________________________ (If the mailing and street addresses are the same, print “same”) 7 8 solemnly affirm that I/we will faithfully perform, according to law, the duties of temporary 9 guardians(s) of ( ) the person, ( ) the estate, ( ) the person and estate, and that any matters stated 10 in any petition or paper filed with the Court are true of my/our own knowledge, except as to matters 11 stated on information and belief, and as to those, I/we believe them to be true to the best of my/our 12 ability. 13 14 ________________________________________ (Guardian’s Signature) ______________________________________ (Guardian’s Signature) 15 16 17 SUBSCRIBED AND SWORN to before me 18 this _______ day of _________________________, 20______. 19 20 _______________________________________ NOTARY PUBLIC 21 22 23 24 25 26 27 28 Revised 2005 2 American LegalNet, Inc. www.FormsWorkflow.com 1 SECOND JUDICIAL DISTRICT COURT COUNTY OF WASHOE, STATE OF NEVADA 2 3 AFFIRMATION Pursuant to NRS 239B.030 4 The undersigned does hereby affirm that the preceding document, 5 6 7 (Title of Document) 8 9 filed in case number: 10 Document does not contain the social security number of any person 11 -OR- 12 Document contains the social security number of a person as required by: 13 A specific state or federal law, to wit: 14 ______________________________________________________ (State specific state or federal law) 15 16 -or- 17 For the administration of a public program 18 -or- 19 For an application for a federal or state grant 20 -or- 21 Confidential Family Court Information Sheet (NRS 125.130, NRS 125.230 and NRS 125B.055) 22 23 24 Date: (Signature) 25 26 (Print Name) 27 28 (Attorney for) Affirmation Revised December 15, 2006 American LegalNet, Inc. www.FormsWorkflow.com