(Copy Receipt) (Clerk’s Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: CASE NO. ORDER APPOINTING SUCCESSOR: LIMITED FULL GUARDIAN OF PERSON AND/OR LIMITED FULL GUARDIAN OF ESTATE An Incapacitated Person (ORAPGD) (CLERK’S ACTION REQUIRED) CLERK’S INFORMATION SUMMARY Due Date for Initial Personal Care Plan and Inventory: Due Date for Receipt(s) of Funds in Blocked Account(s): Due Date for Report and Accounting: The Clerk Shall Notify the Auditor of Loss of Voting Rights Yes Certified Professional Guardian No Non Professional Guardian (training required) THIS MATTER came on regularly for hearing on a Petition for Appointment of Successor Guardian or Limited Guardian of , an Incapacitated Person. The Court makes the following: #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 1 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com I. FINDINGS OF FACT 1. There is a need to appoint a successor guardian in that the previous guardian: is deceased, has resigned, has been discharged. 2. Guardian: The proposed Guardian is qualified to act as Guardian of the Person and/or Estate of the Incapacitated Person. Proposed Guardian’s address, phone numbers and email address are as follows: Address: *Telephone #(s): Business Personal E-mail address: 3. Guardian ad Litem Fees and Costs: Not Applicable The Guardian ad Litem was appointed at county state expense and shall submit a motion for payment of fees and costs pursuant to the local rules. The Guardian ad Litem has requested a fee of $ reimbursement of $ the amount of $ for services rendered and for costs incurred while acting as Guardian ad Litem. Fees in and costs in the amount of $ are reasonable and should be paid as follows: $ by the Guardian from the guardianship estate and/or $ by for the following reason(s): . 4. Bond: The assets of the Incapacitated Person: Total less than three thousand dollars ($3,000) and no bond is required. Exceed three thousand dollars ($3,000) and should be placed in a blocked account with an insured financial institution or bonded, unless the guardian is a bank or trust company. Are to be held by a nonprofit corporation authorized to act as Guardian, and the Court waives any bond requirement. 5. Right to Vote: The Incapacitated Person is is not capable of exercising the right to vote. II. #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 2 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com CONCLUSIONS OF LAW 1. That is an Incapacitated Person within the meaning of RCW Chapter 11.88, and a Full Limited Guardian of the Person and/or Full Limited Guardian of the Estate should be appointed; and that is a fit and proper person as required by RCW 11.88.020 to be appointed. 2. That any special powers of the Guardian or limitations and restrictions placed on the Incapacitated Person should be as follows: Not Applicable The Right to Vote is Revoked Other: III. ORDER It is hereby ordered: 1. Appointment of Guardian: is appointed as Full Limited Guardian of the Person and/or Full Limited Guardian of the Estate of , and the powers of the Guardian and the limitation and restrictions placed on the Incapacitated Person shall be as set forth in Conclusion of Law 2. 2. Letters of Guardianship/Limited Guardianship: The Clerk of the Court shall issue letters of Full Limited Guardianship of the Person and/or Full Limited Guardianship of the Estate to , upon the filing of an oath, Verification of Completion of Mandatory Guardian Training or an order waiving training, Guardianship bond in the amount of $ or bond is waived. The following account(s) shall be blocked and a Receipt of Funds in Blocked Account (form #37) shall be filed with the court no later than 30 days from the date of this order. #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 3 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com .If bond is waived, the Guardian is required to report to the Court if the total assets of the Incapacitated Person reaches or exceeds Three Thousand Dollars. Pursuant to RCW 11.88.100, the Guardian of the Estate shall file a yearly statement showing the monthly income of the Incapacitated Person if said monthly income, excluding moneys from state or federal benefits, is over the sum of Five Hundred Dollars per month for any three consecutive months. 3. Report of Substantial Change in Income of Assets: Within 30 days of any substantial change in the Estate’s income or assets, the Guardian of the Estate shall report to the Court and schedule a hearing. The purpose of the hearing will be for the Court to consider changing the bond or making other provision in accordance with RCW 11.88.100. 4. Inventory: Within three months of appointment, the Guardian of the Estate shall file a verified Inventory of all the property of the Incapacitated Person, which shall come into the Guardian’s possession or knowledge, including a statement of all encumbrances, liens and other secured charges on any item. A review hearing upon filing of the inventory is required is not required. 5. Disbursements: On or before the date the Inventory is due, the Guardian of the Estate shall also apply to the Court for an Order Authorizing Disbursements on behalf of the Incapacitated Person as required by RCW 11.92.040. 6. Personal Care Plan: The Guardian of the Person shall complete and file within three (3) months after appointment a Personal Care Plan which shall comply with the requirements of RCW 11.92.043(1). 7. Status of Incapacitated Person: Unless otherwise ordered, the Guardian of the Person shall file an annual report on the status of the Incapacitated Person that shall comply with the requirements of RCW 11.92.043(2). 8. Substantial Change in Condition or Residence: The Guardian of the Person shall report to the Court within thirty (30) days any substantial change in the Incapacitated Person’s condition, or any change in residence of the Incapacitated Person. #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 4 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com 9. Designation of Standby Guardian: The Guardian shall file a written designation of a standby Guardian that complies with the requirements of RCW 11.88.125. 10. Authority for Investment and Expenditure: The authority of the Guardian of the Estate for investment and expenditure of the ward’s estate is as follows: 11. Duration of Guardianship: This Guardianship shall continue in effect: until [date]; OR until terminated pursuant to RCW 11.88.140; the necessity for the Guardianship to continue shall be periodically reviewed. 12. Discharge/Retention of Guardian ad Litem: The Guardian ad Litem is discharged; or The Guardian ad Litem shall continue performing further duties or obligations as follows: 13. Notice of Right to Receive Pleadings: The following persons are described in RCW 11.88.090(5)(d), and the Guardian shall notify them of their right to file with the Court and serve upon the Guardian, or the Guardian’s attorney, a request to receive copies of pleadings filed by the Guardian with respect to the Guardianship: Name Address 14. Guardian Fees: DSHS cases: The Guardian is allowed such fees and costs as permitted by the Washington Administrative Code in the amount of $ per month as a deduction from the incapacitated person’s participation in the DSHS cost of care. Such fees are subject to court review and approval. This deduction is approved for the initial twelve month reporting period and ninety days thereafter, from the date of this order to . The Guardian may petition for fees in excess of the above amount only on notice to the appropriate DSHS Regional Administrator per WAC 388.71; OR #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 5 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com Non-DSHS cases: The Guardian shall petition the Court for approval of fees. The Guardian may advance itself $ per month subject to Court review and approval. 15. Guardian ad Litem Fee: Not Applicable Fees and costs are approved as reasonable; OR The Guardian ad Litem fees and costs are approved as reasonable in the total amount of $ . They shall be paid from Spokane County, OR the Guardianship estate assets, other source(s) as follows: are approved as reasonable in the 16. Legal Fees: The legal fees and costs of amount of $ . , and shall be paid from the Guardianship estate assets OR other source(s) as follows: 17. Guardian’s Report: The Guardian’s report shall cover the 12 (twelve) month 24 (twenty-four) month or 36 (thirty-six) month period following the appointment. The Guardian’s report is due within 90 days of the end of the reporting period and shall comply with the requirements of RCW 11.92.040(2). DATED AND SIGNED IN OPEN COURT THIS DAY OF , 20 . __________________________________________________ Judge/Court Commissioner Presented by: Signature of Petitioner/Attorney Printed Name of Petitioner/Attorney, WSBA/CPG # Address City, State, Zip Code #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 6 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com *Telephone/Fax Number Email Address *Under GR 22 (b) (6), parties’ personal telephone number(s) are confidential information. If you do not want your personal phone number(s) on this public form, complete form #S2-Sealed Confidential Information and file in the confidential file. Copy received and approved by: ____________________________________ Guardian ad Litem #10A-ORDER APPOINTING SUCCESSOR GUARDIAN OF PERSON AND/OR ESTATE PAGE 7 OF 7 Revised 2/08 American LegalNet, Inc. www.FormsWorkflow.com