Address
City, State, Zip
Phone
I am the[ ] Petitioner
[ ] Attorney for the [ ] Petitioner [ ] Protected Person and my Utah Bar number is ______
In the District Court of ______County,Utah
Court Address ______
In the Matter of Protection for
______,
Respondent / Order Appointing Guardian for an Adult
______
Case Number
______
Judge
The matter before the court is a petition to appoint a guardian for the respondent named above. This matter is being resolved by: (Choose all that apply.)
[ ] The stipulation of the parties.
[ ] The pleadings and other papers of the parties.
[ ] A hearing held on ______(date),notice of which was served on all parties.
Petitioner
[ ] was present.
[ ] was not present.
[ ] was represented by ______(name).
[ ] was not represented.
Respondent
[ ] was present.
[ ] was excused from attending.
[ ] was represented by ______(name).
Having considered the documents filed with the court, the evidence and the arguments, and now being fully informed,
The Court Orders That:
(1)______(name) is appointed as guardian of the above-named respondent, who is now a protected person, to serve:
without bond.
with bond in the amount of $______.
Choose (2) or (3), but not both.
(2)[ ]Limited guardianship. The guardianhas authority to: (Choose all that apply.)
[ ] make decisions about the protected person’s custody and residence;
[ ] make decisions about the protected person’s training and education;
[ ] provide for the protected person’s care, comfort, and maintenance;
[ ] take reasonable care of the protected person’s clothing, furniture, vehicles, and other personal effects;
[ ] commence protective proceedings if the protected person’s property needsprotection;
[ ] give consent necessary to enable the protected person to receive medical or other professional care, counsel, treatment, or service;
[ ] institute proceedings to compel a person to perform their duty to support the protected person;
[ ] receive money and tangible property deliverable to the protected person and apply the money and property for the protected person’s support, care, and education;
[ ] other (Describe additional authority that the guardian should have.)
(3)[ ] Fullguardianship. The guardianhas plenary or full authority.
(4)Upon qualification of and acceptanceby the guardian, the clerk of court shall issuean appropriate letter of guardianship.
Approved as to form.
Sign here ►Date / Petitioner or Attorney
Sign here ►
Date / Protected Person’s Attorney
Sign here ►
Date / Judge
Certificate of Service
I certify that I served a copy of this document on the following people.
Person’s Name / Method of Service / Served at this Address / Served on this Date
(Petitioner or Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge or in receptacle for deliveries.)
[ ] Left at home (With person of suitable age and discretion residing there.)
(Protected Person’s Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge or in receptacle for deliveries.)
[ ] Left at home (With person of suitable age and discretion residing there.)
(Clerk of Court) / [ ] Mail
[ ] Hand Delivery
[ ] Electronic File
(Interested Person or Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge or in receptacle for deliveries.)
[ ] Left at home (With person of suitable age and discretion residing there.)
(Interested Person or Attorney) / [ ] Mail
[ ] Hand Delivery
[ ] Fax (Person agreed to service by fax.)
[ ] Email (Person agreed to service by email.)
[ ] Left at business (With person in charge or in receptacle for deliveries.)
[ ] Left at home (With person of suitable age and discretion residing there.)
Sign here ►
Date / Typed or Printed Name
Order Appointing Guardianfor an Adult / Approved Board of District Court Judges September 12, 2012
Revised April 3, 2015 / Page 1 of 4