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District Court Denver Probate Court ___________________ County, Colorado Court Address: ______________________________________________ In the Interest of: In the Matter of the Estate of: _________________________________________________ Division________ Courtroom ________ COURT USE ONLY Case Number:_______________

ORDER APPOINTING GUARDIAN AD LITEM
1. Upon the Court's own motion; stipulation of the parties; motion of __________________ (appointee

name) at the following address:

Phone number:

Attorney Registration #: .

is appointed as Guardian ad Litem for the following person

2. This Order is entered pursuant to Section: 15-10-403(5) in a trust, estate, or judicially supervised settlement matter - appointment of a Guardian ad Litem to represent the interests of a minor, an incapacitated, protected, unborn, or unascertained person, or a person whose identity or address is unknown. The reason for the appointment and the Guardian ad Litem's duties are as follows:

15-14-115 in a matter regarding a person under disability - appointment of a Guardian ad Litem to represent the interests of a respondent or an incapacitated or protected person. The reason for the appointment is as follows:

3. The Guardian ad Litem's duty is/are: to investigate and prepare specific written recommendations regarding: the allegations of incapacity or of the need for financial protection. the appropriateness of limitations to the Guardianship/Conservatorship. the appropriateness/qualifications of the nominee. issues raised in the Visitor's Report. issues raised in the Guardian's/Conservator's Report. issues raised by

.

JDF 742

7/09

ORDER APPOINTING GUARDIAN AD LITEM

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the appropriateness of termination of the Guardianship/Conservatorship. other to advocate for and represent the best interests of the above named person regarding the following issues:

Other:

4. The appointee shall have access to all relevant information regarding the Respondent in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other privacy laws, without further order, authorization or release. Relevant information includes, but is not limited to the following records, reports, and evaluations: medical, psychiatric, psychological, drug, alcohol, law enforcement, social services, school, financial, and estate planning. This Order provides the authority to release such information to the appointee regardless of the original source of information. The appointee shall not disclose this information inappropriately. 5. The Guardian ad Litem shall prepare a written report, including recommendations. The report shall be filed and served upon interested persons at least 10 calendar days before the hearing for which the report was prepared If no hearing is currently set, the report must be filed within 30 calendar days from the date of appointment. The report shall be filed and served upon interested persons by (date). 6. Unless otherwise ordered by the Court, the Guardian ad Litem or Visitor appointment is automatically terminated 30 days after the hearing at which the report is considered. If the hearing is waived, appointment is terminated 30 days after the report is filed. Other (explain)

7. The appointee shall be compensated by: The captioned estate. The maximum hourly rate is set at $_____________. The State of Colorado because all responsible parties are indigent (JDF 208 completed). (See CJD 04-05) Person to be determined by the Court at a later date. Other (explain)

8. Acceptance of this appointment requires the appointee to comply with Chief Justice Directive 04-05. Failure to comply may result in termination of the appointment and/or removal from the appointment list.

Next appearance is on Date: __________________________

(date), at

(time), in

(division).

___________________________________________ Judge Magistrate Registrar

JDF 742

7/09

ORDER APPOINTING GUARDIAN AD LITEM

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