DATE FILEDFORCOURT USE ONLY Name of RespondentStreet AddressCity/TownStateZipCodePhoneNumberPetitioner:NameRelationship to RespondentStreet AddressCity/TownStateZipCodePhoneNumberRespectfully requests:There is occasion for the appointment of a TEMPORARY GUARDIAN of the above respondent; that a petition for the appointment of a guardian of this person and estate is now pending. He/she requests that:Name of NomineeRelationship toRespondentStreet AddressCity/TownStateZip CodeName of Co-Nominee (if any)Relationship toRespondentStreet AddressCity/TownStateZip Codeor some suitable person be appointed to said trust.Form PC-9.1, Waiver, if applicable. Petitioner: To the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.TEMPORARY GUARDIANSHIPRIGL 33-15-10PC-2.1 (Rev. 07/17) State of Rhode Island and Providence PlantationsSTATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town ofNo. SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com DECREEFor good cause shown:NameStreet AddressCity/TownStateZip CodeEmailPhone NumberNameStreet AddressCity/TownStateZip CodeEmailPhone Numberis/are hereby appointed temporary guardian and/or temporary co-guardians of the respondent for the purpose of:Said appointment will expire onunless further extended by the court.(date)Bond Fixed at: $ With Surety Without Surety Appointed : 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 NumberAppointed RESIDENT Resident Agent NameStreet AddressCity/TownStateZip CodeEmailPhoneNumberProbate JudgeDateSignature of Probate JudgePC-2.1 (Rev. 07/17) Page 2 of 2 SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com