Order Appointing Special Guardian Of An Incapacitated Person {MPC 622}

ORDER APPOINTING SPECIAL GUARDIAN OF AN INCAPACITATED PERSON In the Interests of: First Name Middle Name Docket No. Commonwealth of Massachusetts The Trial Court Probate and Family Court Division Last Name Incapacitated Person After hearing the Court finds that: The appointed Guardian First Name M.I. Last Name is not effectively performing the duties of a Guardian and the appointment as Guardian has been suspended or terminated by separate Order. It is necessary to appoint a Special Guardian because the welfare of the Incapacitated Person requires immediate action. The Court appoints the following person as Special Guardian: First Name M.I. (Apt, Unit, No. etc.) (City/Town) Last Name (Address) (State) (Zip) Primary Phone #: The Special Guardian may exercise only the powers specified in this Order. The powers of the Special Guardian are: All and only those powers granted to the Guardian in the most recent Decree and Order of the Court dated except as may be limited by the following: As follows: The Court orders the following: 1. The Court has appointed counsel for the Incapacitated Person. (See Separate Order Appointing Counsel.) 2. The Special Guardian shall serve: without surety on his, her or their bond because: it is in the best interest of the Incapacitated Person as there are minimal assets under management by the guardian or because: MPC 622 (5/30/11) page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Docket No. In the Interests of: First Name Middle Name Last Name language in a Durable Power of Attorney or Health Care Proxy waives the Guardian's bond or requests a waiver of any necessity of sureties on a bond. with personal or corporate sureties on his/her/their bond in the amount of $ pursuant to G.L. c. 190B, § 5-307. NO LETTERS OF SPECIAL GUARDIANSHIP FOR A PROTECTED PERSON SHALL ISSUE UNTIL THE BOND IS FILED AND APPROVED. 3. The Special Guardian's appointment shall expire 90 days from today's date or on (date) . If this date is more than 90 days from the date of appointment, the Court finds the following circumstances warrant the longer period of appointment: 4. The parties shall comply with a stipulation or agreement dated which is filed with the Court and expressly made a part of this order. 5. A at a.m. hearing shall be held on this matter on p.m. at the Probate and Family Court. 6. Other: Date JUSTICE OF THE PROBATE AND FAMILY COURT MPC 622 (5/30/11) page 2 of 2 www.FormsWorkFlow.com