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 and In Re: Conservatorship of ______________________________, Ward and Protected Person

Letters of Guardianship and Conservatorship (MINOR)

Guardian: _______________________________________, is qualified and is hereby authorized to act as Guardian of_____________________________________, 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. § 524.5-207, as follows: all powers therein, 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) all powers therein, or only those under paragraphs 1, 2, 3, 4, 5 and 6; and each guardian and conservator 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: _______________ Conservator of the Estate ____________________________ ____________________________ ____________________________ ____________________________ Phone Number: _______________

GAC 4-UM State

ENG

Rev 4/04

www.courts.state.mn.us/forms

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