Free STATE OF MINNESOTA - Minnesota

M.S. § 524.5-110

State of Minnesota
Select County County of _________________

District Court Probate Division Judicial District: _______________ Court File No. _________________ Case Type: 14, Conservatorship

Guardianship In Re: Conservatorship of __________________________

Letters of: Guardianship Conservatorship

Guardian: ______________________________________, is qualified and is hereby authorized to act as Guardian of the Ward, after being appointed as guardian by the Court; the ward's spouse; or the ward's parent, with all of the powers and authority prescribed by statute as shown on the order appointing guardian the terms of which order are incorporated herein by reference including the powers under M.S. § 524.5-313 subd. (c), as follows: all powers therein, or only those under paragraphs 1, 2, 3, 4, 5, 6 and 7; and Conservator: _______________________________________, is qualified and is hereby authorized to act as Conservator of the protected person, with all of the powers and authority prescribed by statute as shown on the order appointing conservator, the terms of which order are incorporated herein by reference including the powers under M.S.§524.5-417 subd.(c) as follows: all powers therein, or only those under paragraphs 1, 2, 3, 4, 5 and 6; and each has such other powers and duties granted under applicable law. Dated:______________, 20____
PRESENT ADDRESS AND TELEPHONE NUMBER OF WARD / PROTECTED PERSON

____________________________ Judge of District Court
PRESENT ADDRESS AND TELEPHONE NUMBER OF GUARDIAN / CONSERVATOR

_____________________________ _____________________________ _____________________________ _____________________________ Phone Number: ________________

__________________________________ __________________________________ __________________________________ __________________________________ Phone Number: _____________________ __________________________________ __________________________________ __________________________________ __________________________________ Phone Number: _____________________

GAC 4-U

State

ENG

Rev 12/03

www.courts.state.mn.us/forms

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