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: Emergency Agency/Conservatorship __________________________, Ward and Protected Person

Emergency Letters of Guardianship Agency/Conservatorship (Letters Terminate on_______________)

Guardian: _____________________________, is qualified and is hereby authorized to act as Guardian of ______________________________, after being appointed as guardian by the Court with all of the powers and authority prescribed by statute as shown on the order appointing emergency 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 Agent/Conservator: _____________________________, is qualified and is hereby authorized to act as Agent/Conservator of the protected person, with all of the powers and authority prescribed by statute as shown on the order appointing emergency agent/conservator, the terms of which order are incorporated herein by reference including the powers under M.S. § 524.5-418 subd. (c) as follows: 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.

The powers and duties under these Letters of Guardianship and Agency/Conservatorship expire and terminate on _____________________________. Dated:
PRESENT ADDRESS AND TELEPHONE NUMBER OF WARD / PROTECTED PERSON ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Phone Number: _________________

____________________________ Judge of District Court
PRESENT ADDRESS AND TELEPHONE NUMBER OF GUARDIAN / CONSERVATOR _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ Phone Number: ________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ Phone Number: ________________________

GAC 20-U State

ENG

Rev 12/03

www.courts.state.mn.us/forms

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