Superior Court of Washington County of ___________________ No. _____________________ In the Guardianship of: Provisional Order Granting (ORGMT) Denying (ORDYMT) Transfer of Guardianship or Conservatorship To Washington (RCW 11.90.410) Clerk's action required: para 2.1 _______________________________, Incapacitated Person I. Findings 1.1 The guardian or conservator petitioned to transfer the guardianship or conservatorship from _______________________________ (county and state) to Washington. The petitioner filed a certified copy of the other state's provisional order of transfer. This court held a hearing on ____________________ (date). Notice of this petition was given to those persons who would be entitled to notice if the petition were a petition for the appointment of a guardian or issuance of a protective order in both the transferring state and this state. The notice was given in a manner that complies with Washington requirements. RCW 11.90.410(2). There has not been an objection to the transfer. There has been an objection to the transfer. The objector: has not established that the transfer would be contrary to the interests of the incapacitated or protected person. has established that the transfer would be contrary to the interests of the incapacitated or protected person. Provisional. Order Granting/Denying Transfer (ORGMT, ORDYMT) - Page 1 of 3 of Guardianship/Conservatorship to Washington WPF GDN 02.0150 (07/2015) RCW 11.90.410 American LegalNet, Inc. www.FormsWorkFlow.com 1.2 1.3 1.4 1.5 1.6 The proposed guardian is State. is not eligible to be appointed guardian in Washington 1.7 The proposed guardian has has not filed proof of successful completion of Washington's lay guardian training program. This court recognizes the guardianship or conservatorship order from the other state. This court recognizes the determination of the incapacitated or protected person's incapacity and the appointment of the guardian or conservator. RCW 11.90.410. II. Order 1.8 1.9 2.1 A. Denied: The petition to transfer the guardianship or conservatorship is denied. This order does not affect the ability of the guardian or conservator to seek appointment as guardian in this state if this court has jurisdiction to make an appointment other than by reason of the provisional order of transfer. B. Granted: The petition to transfer the guardianship or conservatorship is provisionally granted. The petitioner shall seek a final order to transfer the guardianship or conservatorship from the other state. Not later than 90 days after issuance of a final order accepting transfer of a guardianship or conservatorship in Washington, the court shall determine whether the guardianship needs to be modified to conform to Washington law. 1. Provisional Letters: The court clerk shall issue provisional letters of guardianship: Full Full Limited guardian of the person, and/or Limited guardian of the estate valid until (date) ____________ to (name of guardian) _________________________ upon the filing of an oath, any bond required in paragraph 2.4, and form GDN 04.0300, Designation of and Consent by In-State (Resident) Agent, if the guardian or limited guardian resides outside the state. Letters of guardianship in Washington shall not issue until the Washington Court enters a final order appointing guardian in this State. 2 Guardian Bond and Security: Guardianship bond is set in the amount of $________________. Bond is waived. Bond shall be reviewed at review of inventory. The guardian shall have access to all accounts. Provisional. Order Granting/Denying Transfer (ORGMT, ORDYMT) - Page 2 of 3 of Guardianship/Conservatorship to Washington WPF GDN 02.0150 (07/2015) RCW 11.90.410 American LegalNet, Inc. www.FormsWorkFlow.com The following accounts are blocked, and no funds may be withdrawn without court order: . All other accounts shall be blocked and the guardian shall file a receipt of funds into blocked account, form WPF GDN 04.0600, with the Court no later than 30 days from the date of this order: . 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 ($3,000). 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 ($500) per month for any three consecutive months. 2.2 Other: . Dated ______________________________ Presented by: _________________________________ Judge/Court Commissioner Signature of Guardian/Attorney Printed Name of Guardian/Attorney, WSBA/CPG# Address City State, Zip Code *Telephone/Fax Number Email Address * Privacy notice: If you do not want your personal phone number on this public form, you may list your telephone number on a separate form which may be available to parties and the court, as well as its staff and volunteers, but will not be made available to the public. Use Form WPF GDN 03.0100, Guardianship Confidential Information form (Telephone Numbers), for this purpose. Provisional. Order Granting/Denying Transfer (ORGMT, ORDYMT) - Page 3 of 3 of Guardianship/Conservatorship to Washington WPF GDN 02.0150 (07/2015) RCW 11.90.410 American LegalNet, Inc. www.FormsWorkFlow.com