FORM MH-103 Gc Letters & Acceptance Temp

• Legal Form Number: FORM MH-103
• Date: 01 January 2024
• Section: Az Mh Forms Annotated

FORM MH-103

(Attorney's name, State Bar No.)

(Attorney's law firm name)

(Law firm bar number)

(Address)

(Phone number)

(Attorney or firm's e-mail address)

Attorney for: __________

SUPERIOR COURT OF ARIZONA, __________ COUNTY

In the Matter of the Guardianship of and Conservatorship for: an Adult. No. __________ LETTERS OF Temporary Guardian WITH MENTAL HEALTH POWERS and CONSERVATOR AND
ACCEPTANCE OF APPOINTMENT

LETTERS OF TEMPORARY GUARDIAN

AND CONSERVATOR

1. __________ is appointed temporary guardian of (subject person's name) and granted the general powers of a guardian pursuant to A.R.S. §§ 14-5312 and -5312.01, including but not limited to the power to consent for (subject person's name) to receive inpatient mental health care and treatment and be placed in a level one behavioral health facility licensed by the Arizona Department of Health Services for medical, psychiatric, and psychological treatment, subject to the following restrictions: .

2. __________ is appointed temporary conservator for (subject person's name) and is granted the general powers of a conservator pursuant to A.R.S. §§ 14-5424 and -5425.

3. This temporary appointment and the authority to consent to inpatient treatment mental health care and treatment expire on __________ (not more than six months).

[4. Temporary conservator's powers are subject to the following restrictions:

a. (Identify the funds or accounts to be deposited into a newly created restricted account and the restrictions) shall be deposited into an interest bearing, federally insured restricted account at a financial institution engaged in business in Arizona. No withdrawals of principal or interest may be made without certified order of the superior...