DATE FILEDFORCOURT USE ONLY Name of MinorRespondentStreet AddressCity/TownStateZipCodePhoneNumberPetitioner:NameRelationship to RespondentStreet AddressCity/TownStateZipCodePhoneNumberTo the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.Signature of PetitionerDateRespectfully represents:There is occasion for the appointment of a guardian of the person and/or estate of the above named minor and that the parent(s)/legal guardian(s) of said minor respondent hereby consent to the granting of this petition.Name of Parent/Legal GuardianDate of Death, if applicableStreet AddressCity/TownStateZip CodeE-mailPhone NumberParent/Legal Guardian Signature Notary:Name of NotaryStateCountyOn day of , 20the petitioner, known to me or proved through satisfactory evidence, signed the Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal MINOR GUARDIANSHIPRIGL 33-15.1-1 et seq.PC-2.2 (Rev. 07/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 3 STATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town ofNo. SIGN HERE SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com Name of Parent/Legal GuardianDate of Death, if applicableStreet AddressCity/TownStateZip CodeE-mailParent/Legal Guardian SignatureNotary:Name of NotaryStateCountyOn day of , 20the petitioner, known to me or proved through satisfactory evidence, signed the Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary SealPetitioner requests:Name of NomineeRelationship to WardStreet AddressCity/TownStateZipCodeE-mailPhoneNumberName ofCo-NomineeRelationship to WardStreet AddressCity/TownStateZipCodeE-mailPhoneNumberor some suitable person be appointed to that trust.Attach form PC-9.1 Waiver, if applicable.PC-2.2 (Rev. 07/17) Page 2 of 3 SIGN HERE SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com DECREEUpon hearing, it is hereby ordered and decreed:For good cause shown:GuardianStreet AddressCity/TownStateZip CodeEmailPhone NumberCo-GuardianStreetAddressCity/TownStateZip CodeEmailPhone Numberis/are hereby appointed guardian and/or co-guardians of the minor respondent.Bond Fixed at: $ With SuretyWithout Surety Appointed APPRAISER(S) Check box if Appraiser(s) is/are the same as above OR Complete Appraiser(s) information below.Appraiser NameStreet AddressCity/TownStateZip CodeEmailPhone NumberCo-Appraiser NameStreet AddressCity/TownStateZip CodeEmailPhone NumberEntered as an order and decree of the court on:Probate JudgeDateSignature of Probate JudgePC-2.2 (Rev. 07/17) Page 3 of 3 SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com