FORM FOR PETITION AND ORDER OF GUARDIAN

(a) Petition. In the Circuit Court of the Judicial Circuit, in and for County, Florida Probate Division Case No. In Re: Guardianship of Respondent’s Name PETITION FOR APPOINTMENT OF GUARDIAN Petitioner, , files this petition pursuant to section 744.1097, Florida Statutes, and alleges that: 1. The petitioner, proposed guardian .....(name)....., who is years of age, whose residential address is and post office address is . The relationship of the petitioner to the respondent is . 2. Venue is proper in .....(county)....., pursuant to section 744.1097(2), Florida Statutes, (choose one): ( ) a. the incapacitated person resides in .....(county)....., Florida; ( ) b. the incapacitated person is not a Florida resident but owns property in .....(county)....., Florida; or ( ) c. a debtor of the incapacitated person resides in .....(county)...., Florida and the incapacitated person is not a Florida resident and does not own property in Florida. 3. The nature of the incapacity of the respondent: 4. The extent of the guardianship requested for the respondent: ( ) a. plenary; or ( ) b. limited. 5. The guardianship requested for the respondent is (choose one): ( ) a. of the person; ( ) b. of the property; or ( ) c. of the person and property. 6. The nature and value of the property subject to guardianship: 7. The names and addresses of the living next of kin of the respondent are: Name Address Relationship 8. Choose one: ( ) a. the petitioner proposes that .....(name)..... be appointed as guardian and that .....(name)..... is qualified to serve; ( ) b. a willing and qualified guardian has not been located; or ( ) c. the proposed guardian is a professional guardian and has complied with the registration requirements of section 744.2002, Florida Statutes. 9. The proposed guardian should be appointed because: 10. There are or are not alternatives to the appointment of a guardian, such as trust agreements, powers of attorney, designation of health care surrogate, or other advanced directive, known to petitioner. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Signed .....(date)...... Signature: Petitioner Name: Address: Phone Number: E-mail Address:

(b) Order. In the Circuit Court of the Judicial Circuit, in and for County, Florida Probate Division Case No. In Re: Guardianship of Respondent’s Name ORDER FOR APPOINTMENT OF GUARDIAN 1. By order of this court on .....(date)....., the respondent .....(name)..... was adjudicated incapacitated and is now a ward as defined in section 744.102(22), Florida Statutes. The extent of the incapacity is .....(plenary or limited)...... The ward retains the rights listed in section 744.3215(a), Florida Statutes. 2. No alternative to guardianship exists that sufficiently addresses the respondent’s needs. 3. A .....(plenary or limited)..... guardianship of the: ( ) a. person; ( ) b. property; or ( ) c. person and property is consistent with the respondent’s welfare and safety, is the least restrictive alternative, and reserves to the respondent the right to make decisions in all matters commensurate with the ward’s ability to do so. 4. .....(Name of guardian)..... is qualified to serve as .....(plenary or limited)..... guardian of the: ( ) a. person; ( ) b. property; or ( ) c. person and property of the ward 5. ( ) a. .....(Name of guardian)..... is the standby guardian or preneed guardian; ( ) b. there is no standby guardian or preneed guardian; ( ) c. there is a standby guardian or preneed guardian, but such person is not qualified to serve pursuant to section 744.309, Florida Statutes; or ( ) d. there is a standby guardian or preneed guardian, but appointment of such person is contrary to the best interests of the ward because: 6. Any additional facts that support the selection of guardian: 7. ( ) a. No advance directive exists; ( ) b. the following advance directive exists and is entitled .....(name of advance directive)..... and is dated .....(date of advance directive).....; ( ) c. the advance directive is being revoked or modified and the surrogate under the advance directive entitled .....(name of advance directive)..... and is dated .....(date of advance directive)..... was given notice of this proceeding and any motion to revoke or modify the advance directive; or ( ) d. if the advance directive is being revoked or modified the facts supporting the revocation or modification: ORDERED and ADJUDGED as follows: 8. The court hereby appoints .....(name of guardian)..... as the.....(plenary or limited)..... guardian of the: ( ) a. person; ( ) b. property; or ( ) c. person and property of the ward. 9. The guardian may exercise only those delegable rights that have been removed from the ward and specifically delegated to the guardian, which are: ( ) a. to contract; ( ) b. to sue and defend lawsuits; ( ) c. to apply for government benefits; ( ) d. to manage property or to make any gift or disposition of property; ( ) e. to determine the ward’s residence; ( ) f. to consent to medical and mental health treatment; and ( ) g. to make decisions about the ward’s social environment or other social aspects of the ward’s life. 10. The guardian may not exercise the following rights, even if such rights were removed from the ward: a. to marry; b. to vote; c. to personally apply for government benefits; d. to have a driver license; e. to travel; and f. to seek or retain employment. 11. The amount of the bond to be given by the guardian is: 12. The guardian: ( ) a. must; or ( ) b. is not required to place all, or part, of the property of the ward in a restricted account in a financial institution designated pursuant to section 69.031, Florida Statutes. 13. ( ) a. No known advance directive exists; ( ) b. the advance directive entitled .....(name of advance directive)..... and is dated .....(date of advance directive)..... is being modified or revoked as follows: ( ) i. the surrogate shall not continue to exercise any authority over the ward with regard to health care decisions; ( ) ii. the surrogate shall continue to exercise authority over the respondent with regard to health care decisions; ( ) iii. the surrogate shall exercise the following authority over the ward with regard to: ; or ( ) iv. The guardian shall exercise the following authority over the ward with regard to health care decisions: 14. The respondent .....(may or may not)..... have a license to carry a firearm or possess a weapon or firearm. ORDERED this .....(date)...... Judge