Or Appoint Gdn of Person/Estate (ORAPLGP, ORAPGDP, ORAPLGE, ORAPGDE, ORAPGD) - Page 1 of 9 WPF GDN 04.0100 (07/2017) RCW 11.88.020, 11.88.095 Superior Court of Washington County of In the Guardianship of: , Incapacitated Person No . Order Appointing Limited Guardian of Person (ORAPLGP) Full Guardian of Person (ORAPGDP) and/or Limited Guardian of Estate (ORAPLGE) Full Guardian of Estate (ORAPGDE) Full Guardian of Person and Estate (ORAPGD) Guardianship Summary (GDSM) Clerk222s Action R equired, Para 3.3 Guardianship Summary Date guardian appointed: Due date for inventory (no later than 3 months from appointment): Due date for care plan (no later than 3 months from appointment): The clerk shall notify the auditor of loss of voting rights: Yes No Due date for report and accounting: Date of next review: Letters expire on: Bond amount: $ Restricted account agreements required: yes No Due date for receipt(s) of funds in blocked account(s): Certified professional guardian (CPG) Public professional guardian (PUG) Lay (family) guardian (LGD) Training completed Training required Incapacitated Person (IP) Guardian of : Estate Person Name Address Phone* Facsimile Guardian of : Estate Person Standby Guardian Name Address Ph one* Facsimile American LegalNet, Inc. www.FormsWorkFlow.com Or Appoint Gdn of Person/Estate (ORAPLGP, ORAPGDP, ORAPLGE, ORAPGDE, ORAPGD) - Page 2 of 9 WPF GDN 04.0100 (07/2017) RCW 11.88.020, 11.88.095 Standby Guardian Interested Parties Name Address Phone* Relation to IP Interested Parties Interested Parties Name Address Phone* Relation to IP This matter came on regularly for hearing on a petition for appointment of guardian or limited guardian of , the alleged incapacitated person (AIP). The AIP was present in court; The hearing was conducted outside of the courtroom at the location of the AIP; The AIP222s presence was waived for good cause shown other than mere inconvenience, as set forth in the file and reports in this matter; The guardian ad litem was present. The following other persons were also present at the hearing: . The court considered the written report of the Guardian ad Litem and the medical/psychological/ARNP report, the testimony of witnesses, remarks of counsel, and the documents filed herein. Based on the above, the court makes the following: I. Findings of Fact 1.1 Notices All notices required by law have been given and proof of service as required by statute is on file. Notice, if required, was provided to the Regional Administrator of DSHS pursuant to RCW 11.92.150, but DSHS neither appeared at this hearing nor responded to the petition. 1.2 Jurisdiction The jurisdictional facts set forth in the petition are true and correct, and the court has jurisdiction over the person and/or estate of the AIP. 1.3 Guardian ad Litem The Guardian ad Litem appointed by the court has filed a report with the court. The report is complete and complies with all requirements of RCW 11.88.090. 1.4 Alternative arrangements made by the AIP The AIP did not make alternative arrangements for assistance, such as a power of attorney, prior to become incapacitated. American LegalNet, Inc. www.FormsWorkFlow.com Or Appoint Gdn of Person/Estate (ORAPLGP, ORAPGDP, ORAPLGE, ORAPGDE, ORAPGD) - Page 3 of 9 WPF GDN 04.0100 (07/2017) RCW 11.88.020, 11.88.095 The AIP made alternative arrangements for assistance, but such arrangements are inadequate in the following respects: . (Name) has been acting in a fiduciary capacity for the AIP and should not continue to do so for the following reasons: . 1.5 Capacity The AIP, , is: incapable of managing his or her personal affairs. incapable of managing his or her financial affairs. The AIP is in need of a full guardianship over the person estate. The AIP is capable of managing some personal and/or financial affairs, but is in need of the protection and assistance of a limited guardian of the person estate in the following areas: . 1.6 Guardian The proposed guardian is qualified to act as guardian of the person and/or estate of the AIP. Proposed guardian222s address, phone numbers and email address are as follows: Address: Phone No(s): Business Personal Email: . 1.7 Guardian ad Litem fees and costs The Guardian ad Llitem was appointed at county expense estate 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 $ for services rendered and reimbursement of $ for costs incurred while acting as Guardian ad Litem. Fees in the amount of $ and costs in the amount of $ are reasonable and should be paid as follows: $ by the guardian from the guardianship estate and/or American LegalNet, Inc. www.FormsWorkFlow.com Or Appoint Gdn of Person/Estate (ORAPLGP, ORAPGDP, ORAPLGE, ORAPGDE, ORAPGD) - Page 4 of 9 WPF GDN 04.0100 (07/2017) RCW 11.88.020, 11.88.095 $ by for the following reason(s): . 1.8 Bond The assets of the AIP: are unknown, and Bond shall be reviewed at review of inventory. total less than three thousand dollars ($3,000) and no bond is required. exceed three thousand dollars ($3,000), and a 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. 1.9 Restrictions on AIP222s right to communicate, visit, and interact with others The following facts support restricting the AIP222s right to communicate, visit, and interact with others: 1.10 Right to Vote The AIP: is capable of exercising the right to vote. is not capable of exercising the right to vote. The AIP is incompetent for purposes of rationally exercising the right to vote in that the AIP lacks the capacity to understand the nature and effect of voting such that she or he cannot make an individual choice. II. Conclusions of Law Based upon the above findings and fact, the court makes the following conclusions of law: 2.1. Incapacitated Person (Name) 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. 2.2 Guardian (Name) is a fit and proper person as required by RCW 11.88.020 to be appointed as a guardian. American LegalNet, Inc. www.FormsWorkFlow.com Or Appoint Gdn of Person/Estate (ORAPLGP, ORAPGDP, ORAPLGE, ORAPGDE, ORAPGD) - Page 5 of 9 WPF GDN 04.0100 (07/2017) RCW 11.88.020, 11.88.095 2.3 Powers and limitations of the guardian The powers and limitations of the guardian should be as follows: All of the powers of a guardian pursuant to the provisions of RCW 11.88 et. seq. and RCW 11.92 et seq. that are not expressly limited. Other: . The guardian does not have power to consent to sterilization on behalf of the incapacitated person. 2.4 Restrictions on Incapacitated Person222s right to communicate, visit, and interact with others The guardian is authorized to restrict the incapacitated person222s right to communicate, visit, and interact, or otherwise associate with the following persons: Name of Person Nature of Restriction 1. 2. 3. 4. 2.5 Limitations and restrictions placed on the Incapacitated Person The limitations and restrictions placed on the Incapacitated Person are as follows: The following rights are revoked: To vote or hold an elected office. To marry, divorce, or enter into or end a state registered domestic partnership. To make or revoke a will. To enter into a contract. To appoint someone to act on his or her behalf. To sue and be sued other than through a guardian. To possess a license to drive. To buy, sell, own, mortgage, or lease property. To consent to or refuse medical treatment. To decide who shall provide care and assistance. To make decisions regarding social aspects of his or her life. American LegalNet, Inc. www.FormsWorkFlow.com Or Appoint Gdn of Person/Estate (ORAPLGP, ORAPGDP, ORAPLGE, ORAPGDE, ORAPGD) - Page 6 of 9 WPF GDN 04.0100 (07/2017) RCW 11.88.020, 11.88.095 Other limitations and restrictions: . III. Order The court orders: 3.1 Prior Power of Attorney Any pow