FORM MH-103 GC letters & acceptance temp

• Legal Form Number: FORM MH-103
• Date: 01 January 2014
• 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 and Temporary CONSERVATOR AND ACCEPTANCE OF APPOINTMENT WITH MENTAL HEALTH POWERS

LETTERS OF TEMPORARY GUARDIAN

AND TEMPORARY CONSERVATOR

1. [Appointee’s name] is appointed temporary guardian of [ward’s name] and granted the general powers of a guardian pursuant to A.R.S. §§ 14-5312, -5312.01 and -5312.01(B), including but not limited to the power to consent for [ward’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. [Appointee’s name] is appointed temporary conservator for [protected 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...