Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward

There are all sorts of forms executors, beneficiaries, and probate court clerks have to fill out and correspond with during probate and estate settlement, including affidavits, letters, petitions, summons, orders, and notices.

Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward is a commonly used form within Georgia. Here’s an overview of what the form is and means, including a breakdown of the situations when (or why) you may need to use it:

Atticus Fast Facts About Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward

Sometimes it’s tough to find a quick summary— here’s the important details you should know about Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward:

• This form pertains to the State of Georgia

Government forms are not typically updated often, though when they are, it often happens rather quietly. While Atticus works hard to keep this information about Georgia’s Form GPCSF 11 - Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward up to date, certain details can change from time-to-time with little or no communication.

Step 1 - Download the correct Georgia form based on the name and ID if applicable

Double check that you have both the correct form name and the correct form ID. Some Georgia probate forms can look remarkably similar, so it’s best to double, even triple-check that you’re using the right one! Keep in mind that not all States have a standardized Form ID system for their probate forms.

Step 2 - Complete the Document

Fill out all relevant fields in Form GPCSF 11, take a break, and then review. Probate and estate settlement processes in GA are long enough to begin with, and making a silly error can push your timeline even farther back. No thank you!

Note: If you don’t currently know all of the answers and are accessing Form GPCSF 11 online, be sure to avoid closing the browser tab and potentially losing all your progress (or use a platform like Atticus to help avoid making mistakes).

Step 3 - Have Form GPCSF 11 witnessed or notarized (if required)

Some States and situations require particular forms to be notarized. If you have been instructed to get the document notarized or see it in writing on the document, then make sure to hire a local notary. There are max notary fees in the United States that are defined and set by local law. Take a look at our full guide to notary fees to make sure you aren’t overpaying or getting ripped off.

Step 4 - Submit Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward to the relevant office

This is most often the local probate court where the decedent (person who passed away) is domiciled (permanently resides) or the institution involved with this particular form (e.g. a bank). Some offices allow you to submit forms online, other’s don’t, and we while we generally recommend going in-person to expedite the process, sometimes that simply isn’t an option.

It’s also a generally good idea to establish a positive working relationship with any probate clerk (unfortunately there’s enough people & process out there making things more difficult and unnecessarily confusing for them), so a best practice is to simply ask the probate clerk proactively exactly how and where they’d prefer you to submit all forms.

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Different probate forms or processes can require different deadlines or response times for completing the appropriate form.

While some steps in the process are bound to specific deadlines (like petitioning for probate, having to submit an inventory of assets, or filing applicable notices to creditors and beneficiaries), many probate forms or processes are not tied to a specific deadline since the scope of work can vary based on situational factors or requirements involved.

Either way, there are a bunch of practical reasons why personal representatives should work to complete each step as thoroughly and quickly as possible when completing probate in Georgia.

5 reasons you should submit GPCSF 11 as quickly as possible:

1. The sooner you begin, the faster Georgia can allow heirs and beneficiaries to get their share of assets subject to probate. Acting promptly can also decrease the costs & overall mental fatigue through an otherwise burdensome process.
   
   Helpful Context: What’s the Difference Between Probate and Non-Probate Assets?

2. In general, creditors of an estate usually have around 3-6 months from the time you file notice to creditors to file any claims for debt against the deceased’s assets. If they don’t, then that debt is forfeited (and more importantly, the executor won’t be held personally responsible). So doing this sooner means you have a better idea of who is owed what and ensures you won’t get a surprise collector months later.

3. Not filing a will within 30 days (on average) could mean that the probate process proceeds according to intestate laws (laws that govern what happens to someone's stuff without a will) or is subject to unnecessary supervision by the probate court. And if you aren't directly related to the deceased (a.k.a. next of kin), this could also mean you lose your inheritance.

4. It’s important to file any necessary state tax returns on behalf of the deceased or estate by the following tax season in Georgia. If you don’t, you could owe penalties and interest. This also includes any necessary federal tax returns such as Forms 1040, 1041, or even a Form 706 estate tax return.

5. If a house in the State of Georgia is left empty (or abandoned) for a while, insurance can get dicey. For example, if the house burns down and no one has been there for a year, an insurance company may get out of paying your claim.

If you’re not using Atticus to get specific forms, deadlines, and timelines for Georgia probate, then try and stay as organized as possible, pay close attention to the dates mentioned in any correspondence you have with the State’s government officials, call the local Georgia probate clerk or court for exact answers regarding Form GPCSF 11, and when in doubt— consult a qualified trust & estates lawyer for that area.

Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward is one of the many probate court forms available for download through Atticus.

It may also be available through some Georgia probate court sites, such as . In order to access the latest version, be updated with any revisions, and get full instructions on how to complete each form, check out the Atticus Probate & Estate Settlement software or consider hiring a qualified legal expert locally within Georgia.

While Atticus automatically provides the latest forms, be sure to choose the correct version of Form GPCSF 11 - Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward f using any other site or resource in order to avoid having to re-complete the form process and/or make another trip to the Georgia probate court office.

Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward is a .pdf, so opening it should be as simple as clicking “View Form” from within the Atticus app or by clicking the appropriate link found on any Georgia-provided government platform. Once you’ve opened the form, you should be able to directly edit the form before saving or printing.

Here’s the text, verbatim, that is found on Georgia Form GPCSF 11 - Petition For The Appointment Of An Emergency Guardian And/or Conservator For A Proposed Ward. You can use this to get an idea of the context of the form and what type of information is needed.

GPCSF 11 [i] Eff. July 2017 PETITION FOR THE APPOINTMENT OF AN EMERGENCY GUARDIAN AND/OR CONSERVATOR FOR A PROPOSED WARD INSTRUCTIONS I. Specific Instructions 1. This form is to be used for filing a Petition for the Appointment of an Emergency Guardian and/or Conservator for a Proposed Ward pursuant to O.C.G.A. §§ 29-4-14 and/or 29-5-14. 2. In determining if this Court is the proper place to bring this action, Petitioner(s) should consult Georgia law, including but not limited to, Chapters 4, 5 and 11 of Title 29, as applicable. 3. Regarding the need for the pre-hearing appointment of an Emergency Guardian/Emergency Conservator, O.C.G.A. §§ 29-4-15 (c) (5) and 29-5-15 (c) (5) provide as follows: If the court determines that there is probable cause to believe that the Proposed Ward is in immediate need of an emergency guardian, the court shall appoint a pre-hearing emergency guardian to serve until the emergency hearing, with or without prior notice to the Proposed Ward, but only if the threatened risk is so immediate and the potential harm so irreparable that any delay is unreasonable and the existence of the threatened risk and potential for irreparable harm is certified by the affidavit of a physician licensed to practice medicine under Chapter 34 of Title 43, a psychologist licensed to practice under Chapter 39 of Title 43, or a licensed clinical social worker. However, pending the emergency hearing, the court shall order that no withdrawals may be made from any account on the authority of the Proposed Ward’s signature without the court’s prior approval and that the emergency conservator shall not expend any funds of the Proposed Ward without prior court approval. 4. Further, if a pre-hearing emergency guardian/emergency conservator is appointed to serve until the emergency hearing, then such guardian and/or conservator shall, prior to the issuance of Letters of Emergency Guardianship/Emergency Conservatorship, take an oath and post such bond as the court may require. 5. In any case involving the creation of a Conservatorship when the Proposed Ward owns real property in Georgia, a certificate of creation of conservatorship will be completed by the Clerk of the Probate Court and filed with the Clerk of the Superior Court of each county in which the Proposed Ward owns real property within thirty (30) days of the date of such order. GPCSF 11 [ii] Eff. July 2017 6. The burden of proof is on the Petitioner to present clear and convincing evidence that the Proposed Ward lacks sufficient capacity to make or communicate significant responsible decisions concerning his or her health or safety and is in need of a guardianship AND/OR that there is an immediate, clear, and substantial risk of death or serious physical injury, illness, or disease unless an emergency guardian is appointed and/or that the Proposed Ward lacks sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her property and is in need of a conservatorship AND that there is an immediate, substantial risk of irreparable waste or dissipation of the estate unless an emergency conservator is appointed. 7. The Certificate to the Secretary of State page is to be used only when a determinative finding has been made that the Proposed Ward’s voting rights should be removed due to the lack of capacity of the ward. The order of the Court must be modified to reflect that this right was removed. The certificate must be mailed to the Secretary of State. 8. The Certificate to the GBI page shall be used in all cases where a Guardianship and/or Conservatorship is/are established. Individuals so listed in this database will be prohibited from obtaining a Georgia Weapons Carry License. In the event the ward’s rights are restored, such restoration of rights shall be sent to the GBI, so the database can be updated. Only the Certificate needs to be sent to the GBI and not the Guardianship Order. 9. According to Probate Court Rule 5.6 (A) unless the court specifically assumes the responsibility, it is the responsibility of the moving party to prepare the proper citation and deliver it properly so that it can be served according to law. All pages after the Notice regarding Uniform Probate Court Rule 5.6 (A) are to be completed by the moving party, unless otherwise directed by the court. 10. An oath must be administered by a Probate Judge or Clerk (the oath cannot be administered by a notary public). Use Georgia Probate Court Supplement 4 for the oath. The oath is not included in this form. Georgia Probate Court Standard Form 53, Commission to Administer Oath, can be used if the oath is to be administered by a court outside the State of Georgia. II. General Instructions General instructions applicable to all Georgia Probate Court Standard Forms are available in each Probate Court or at www.gaprobate.gov, labeled GPCSF 1. GPCSF 11 [1] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) PETITION FOR APPOINTMENT OF AN EMERGENCY GUARDIAN AND/OR EMERGENCY CONSERVATOR FOR A PROPOSED WARD [NOTE: Unless there are two or more Petitioners, the affidavit beginning on page 11 must be completed by a physician, psychologist, or licensed clinical social worker and based on an examination within fifteen (15) days prior to the filing of this Petition.] The Petition of ___________________________________________________________, whose relationship to the above-named Proposed Ward is__________________________, whose domicile is ____________________________________________________________________, Street City County State Zip Code and mailing address is ___________________________________________________________, Street City County State Zip Code AND [initial either (a) or (b) below] ______ (a) The Petition of ______________________________________________________, whose relationship to the above Proposed Ward is ___________________________, whose domicile is_____________________________________________________, Street City County State Zip Code and mailing address is _________________________________________________. Street City County State Zip Code OR ______ (b) Attached hereto as pages 11 and 12 and made a part of this Petition is the completed affidavit of ____________, a physician, psychologist licensed to practice in Georgia or licensed clinical social worker, who has examined the Proposed Ward within fifteen (15) days prior to the filing of this Petition, and shows to the Court the following: GPCSF 11 [2] Eff. July 2017 1. The Proposed Ward ______________________________________________________________________________ [Full name of Proposed Ward] First Middle Last whose age is ___________, date of birth is ___________________________________________, Social Security Number is ____________________________, domicile is ______________________________________________________________________________ Street City County State Zip Code presently located at _____________________________________________________________, Street City County State Zip Code which is a __________________________________________________ and can be contacted at [type of facility, if applicable] telephone number: ______________________. 2. (a) Will the Proposed Ward be moved within the [Select One] □ Yes □ No next three (3) days? (b) Is the Proposed Ward a citizen of a foreign country? [Select One] □ Yes □ No If you answer “Yes” to (a) and/or (b), provide the necessary information below: (a) The following is the address where the Proposed Ward is anticipated to be moved: ___________________________________________________________________ Street City County State Zip Code Telephone Number (b) The Proposed Ward is a citizen of a foreign country, said country being: __________________ (if an emergency guardianship or conservatorship is granted, pursuant to The Vienna Convention, the Probate Court must notify the consul). 3. a. Is an emergency guardianship necessary because the [Select One] □ Yes □ No Proposed Ward lacks sufficient capacity to make or communicate significant responsible decisions concerning his or her health or safety and there is an immediate and substantial risk of death or serious physical injury, illness, or disease unless an emergency guardian is appointed? b. Is an emergency conservatorship necessary because the [Select One] □ Yes □ No Proposed Ward lacks sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her property and there is an immediate substantial risk of irreparable waste or dissipation of the estate unless an emergency conservator is appointed? If you answer “Yes” to (a) and/or (b), provide the facts that support the claim of the need for an emergency guardian/emergency conservator (continued on next page): GPCSF 11 [3] Eff. July 2017 [NOTE: Pursuant to O.C.G.A. §§ 29-4-15(b) and 29-5-14(b), the Court shall dismiss the Petition if the Petitioner(s) does/do not allege facts that cause the Court to believe that the Proposed Ward is in need of an emergency guardian/emergency conservator as stated above. The Petition cannot be granted unless sufficient facts are presented that support the claim for the need for the appointment of an emergency guardian/emergency conservator. While an attached physician’s, psychologist’s, or social worker’s affidavit is permissible, the Petitioner(s) MUST specifically allege sufficient facts to support the granting of this Petition.] ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 4. (a) It is in the best interest of the Proposed Ward for the following individual to be appointed emergency guardian: ______________________________ (b) It is in the best interest of the Proposed Ward for the following individual to be appointed emergency conservator: ____________________________ 5. (a) Is it necessary, in addition to the appointment of an [Select One] □ Yes □ No emergency guardian, after notice and hearing, for the Court to immediately appoint a pre-hearing emergency guardian? (b) Is it necessary, in addition to the appointment of an [Select One] □ Yes □ No emergency conservator, after notice and hearing, for the Court to immediately appoint a pre-hearing emergency conservator? If you answer “Yes” to (a) and/or (b), provide the following on a separate page: 1. The reasons why a pre-hearing emergency guardian/emergency conservator is necessary; 2. Who should be appointed as a pre-hearing emergency guardian/emergency conservator; 3. The specific powers that should be granted to the pre-hearing emergency guardian and/or emergency conservator; and 4. Why such powers are necessary to prevent irreparable harm to the Proposed Ward. 6. The reason(s) why the procedures for the appointment of a non-emergency (permanent) guardianship and/or conservatorship are inadequate to protect the Proposed Ward and/or his or her property is/are: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 7. Will a petition for permanent guardianship/conservatorship be filed? [Select One] □ Yes □ No If you answer “Yes,” provide the details of such filing, including the Petitioner’s name, county of filing, expected date of filing, etc.: ______________________________________________________________________________________________ ______________________________________________________________________________________________ GPCSF 11 [4] Eff. July 2017 8. The foreseeable duration of the Proposed Ward’s incapacity is ____________________________ _________________________ and the Court should grant the emergency guardian/conservator the following powers and duties that do not exceed those absolutely necessary to respond to the immediate threatened risk(s) described above: ______________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 9. (a) Has a Power of Attorney been created by anyone for the [Select One] □ Yes □ No Proposed Ward? (b) Has a trust been created by anyone for the Proposed [Select One] □ Yes □ No Ward? (c) Has another document been created by anyone that gives [Select One] □ Yes □ No another person authority to act on the Proposed Ward’s behalf? (d) Does anyone else have the authority to act on behalf of [Select One] □ Yes □ No the Proposed Ward? If you answer “Yes” to (a), (b), (c) and/or (d), provide the following information: 1. The full name of each individual with the authority to act under a power of attorney, trust, or otherwise. A name should be listed for each affirmative answer in this paragraph; 2. The complete address of each individual with the authority to act under a power of attorney, trust, or otherwise. An address should be listed for each affirmative answer in this paragraph; 3. The telephone number of each individual with the authority to act under a power of attorney, trust, or otherwise. A telephone number should be listed for each affirmative answer in this paragraph; 4. Attach a copy of each document that creates such authority; and For each of the individuals named in this paragraph, state whether or not it appears he or she is willing and able to act on behalf of the Proposed Ward and include the facts that give rise to that appearance. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ GPCSF 11 [5] Eff. July 2017 10. [NOTE: If the appointment of an emergency conservator is sought and no petition for permanent conservatorship is being filed simultaneously, this form must be completed.] ASSETS, INCOME, OTHER SOURCES OF FUNDS, LIABILITIES, AND EXPENSES OF PROPOSED WARD REAL PROPERTY [Indicate if property is jointly owned and, if so, with whom] Description County State Joint Owner, Approximate Equity: if any Parcel 1: __________________________________________________ $_________________ Parcel 2: __________________________________________________ $_________________ Parcel 3: __________________________________________________ $_________________ INCOME FROM ALL SOURCES Yearly Total: Social Security per year: $_________________ SSI [Supplemental Security Income] per year: $_________________ Retirement benefits per year: $_________________ VA benefits per year: $_________________ Other income per year (e.g., alimony, annuity, or trust distributions): $_________________ Interest, dividend, or investment income: $_________________ Yearly Total of All Income: $_________________ Total of Income Covered by Conservatorship Period: $_________________ PERSONAL AND INTANGIBLE PROPERTY [Indicate if property is jointly owned and, if so, with whom] (1) Checking/Savings/Money Market/Certificates of Deposit/ Liquid Accounts: Bank/Financial Institution/Broker Account Number Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ (2) Stocks/Bonds/Investments (including retirement and profit- sharing accounts): (a) Held by Brokers: Brokerage Firm/Institution Account Number Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ GPCSF 11 [6] Eff. July 2017 (b) Privately Held: Company/Issuer Number of Shares Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ (3) Automobiles Year/Make/Model V.I.N. Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ (4) Other assets of significant value: Description Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ Total Value of Personal and Intangible Property: $_________________ DEBTS AND OTHER LIABILITIES PERSONAL AND INTANGIBLE PROPERTY The Proposed Ward has the following debts and/or liabilities: Approximate Balance: (1) Secured Debts Obligor/Payee Collateral Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ (2) Unsecured Debts Obligor/Payee Account Number Joint Owner, if any _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ _____________________________________________________________________ $_________________ Total Debts and Other Liabilities of Proposed Ward: $_________________ GPCSF 11 [7] Eff. July 2017 AVERAGE MONTHLY LIABILITIES AND EXPENSES Household: Care Facility/Rent/Mortgage Payments: $_________________ Property Taxes/Insurance: $_________________ Utilities/Lawn Care/Pest Control: $_________________ Miscellaneous Household Food: $_________________ Total Credit Account and Other Debt Payments: $_________________ Other [specify] ______________________________________: $_________________ Automotive/Transportation: Fuel and Repairs: $_________________ Tags, License Fees, Insurance: $_________________ Bus/Train/Taxi Fares: $_________________ Minors or Other Dependents of Proposed Ward: Childcare: $_________________ School Tuition/Supplies/Expenses/Lunches: $_________________ Clothing/Diapers/Grooming/Hygiene: $_________________ Medical/Dental/Prescription: $_________________ Other Insurance: Health: $_________________ Life/Disability: $_________________ Other [specify] ______________________________________: $_________________ Proposed Ward’s Other Expenses: Laundry/Clothing/Grooming/Hygiene: $_________________ Medical/Dental/Prescriptions/Medications: $_________________ Entertainment/Vacations/Subscriptions/Dues: $_________________ Personal Caretakers/Cleaning Personnel: $_________________ Total Expenses: $_________________ PAYMENTS TO CREDITORS Is the Proposed Ward behind on any debt payments? [Select One] □ Yes □ No If so, payee and amount: _______________________________ $_________________ SUMMARY (1) Average Monthly Income: $_________________ (2) Average Monthly Expenses: $_________________ GPCSF 11 [8] Eff. July 2017 11. This Court has jurisdiction to hear this action under Georgia law, and particularly under Chapters 4, 5, and 11 of Title 29 because: ____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 12. Additional Data: [Where full particulars are lacking, state here the reasons for any such omission.] ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ WHEREFORE, Petitioner(s) pray(s): 1. that service be perfected as required by law; 2. that the Court appoint legal counsel and an evaluator for the Proposed Ward and order an evaluation as required by law; 3. that the Court order an emergency hearing to be conducted not sooner than three (3) days nor later than five (5) days after the filing of this Petition; 4. that an emergency guardian/emergency conservator be appointed for the Proposed Ward; and 5. that, if requested, the Court immediately appoint a pre-hearing emergency guardian/emergency conservator with such powers and duties as the Court shall direct. ____________________________________ ____________________________________ Signature of First Petitioner Signature of Second Petitioner, if any ____________________________________ ____________________________________ Printed Name Printed Name ____________________________________ ____________________________________ ____________________________________ ____________________________________ Mailing Address Mailing Address ____________________________________ ____________________________________ Telephone Number Telephone Number Signature of Attorney ______________________________________________________ Printed Name of Attorney ______________________________________________________ Address ______________________________________________________ ______________________________________________________ Telephone Number __________________ State Bar #________________________ GPCSF 11 [9] Eff. July 2017 VERIFICATION GEORGIA, __________________________ COUNTY Personally appeared before me the undersigned Petitioner(s) who, after being duly sworn, state(s) that the facts set forth in the foregoing Petition for the Appointment of an Emergency Guardian and/or Emergency Conservator for a Proposed Ward (and the attached Exhibit(s)) are true and correct. Sworn to and subscribed before me this ______ day of ________________, 20____. ____________________________________ Signature of First Petitioner ___________________________________ ____________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name of First Petitioner My Commission Expires _______________ --------------------------------------------------------------------------------------------------------------------- Sworn to and subscribed before me this ______ day of ________________, 20____. ____________________________________ Signature of Second Petitioner ___________________________________ ____________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name of Second Petitioner My Commission Expires _______________ GPCSF 11 [10] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) CONSENT TO SERVE AS EMERGENCY GUARDIAN/EMERGENCY CONSERVATOR RE: Petition for the Appointment of an Emergency Guardian and/or Emergency Conservator for the above-named Proposed Ward I, ____________________________, having been nominated as emergency guardian, and I, ____________________________________________________, having been nominated as emergency conservator of the above-named Proposed Ward, do hereby consent to serve as emergency guardian and/or emergency conservator and pre-hearing emergency guardian and/or pre-hearing emergency conservator if so appointed. _____________________________________ _____________________________________ Signature Proposed Emergency Guardian Signature Proposed Emergency Conservator _____________________________________ _____________________________________ Printed Name Printed Name _____________________________________ _____________________________________ _____________________________________ _____________________________________ Mailing Address Mailing Address _____________________________________ _____________________________________ Telephone Number Telephone Number GPCSF 11 [11] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) RE: Petition for Appointment of an Emergency Guardian and/or Emergency Conservator for the above-named Proposed Ward AFFIDAVIT OF PHYSICIAN, PSYCHOLOGIST, OR CLINICAL SOCIAL WORKER FOR EMERGENCY GUARDIANSHIP AND/OR EMERGENCY CONSERVATORSHIP I, being first duly sworn, depose and say that I am a physician licensed to practice under Chapter 34 of Title 43 of the Official Code of Georgia Annotated, a psychologist licensed to practice under Chapter 39 of Title 43 of the Official Code of Georgia Annotated, or a licensed clinical social worker; that my office address is __________________________________________________ and that I have examined the above-named Proposed Ward on the ______ day of _________________________, 20____. [NOTE: The examination on which this affidavit is based must occur WITHIN FIFTEEN (15) DAYS prior to the filing of the Petition.] I found him/her to be incapacitated by reason of: ______________________________________________________________________________ ______________________________________________________________________________ to the extent that said Proposed Ward: [initial all that apply] ______ (a) [for emergency guardianship:] lacks sufficient capacity to make or communicate significant responsible decisions concerning his or her health or safety and there is an immediate and substantial risk of death or serious physical injury, illness, or disease unless an emergency guardian is appointed, and [if applicable] ______ (i) the threatened risk is so immediate and the potential harm so irreparable that any delay is unreasonable and a pre-hearing guardian should be appointed. ______ (b) [for emergency conservatorship:] lacks sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her property and there is an immediate, substantial risk of irreparable waste or dissipation of the estate unless an emergency conservator is appointed, and [if applicable] ______ (ii) the threatened risk is so immediate and the potential harm so irreparable that any delay is unreasonable and a pre-hearing conservator should be appointed. GPCSF 11 [12] Eff. July 2017 The following facts support my opinion of incapacity and the existence of (an) immediate threat(s) or risk(s) to the Proposed Ward: _____________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. The foreseeable limits on the duration of such incapacity are: ______________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. Optional: Affiant’s opinions as to any other limitations on the emergency guardianship and/or emergency conservatorship are: _______________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. WITNESS MY HAND AND SEAL this ______ day of _________________________, 20____. _______________________________________________ Signature of Physician/Psychologist/LCSW ___________________________________________________ Printed Name of Evaluator Sworn to and subscribed before me this ______ day of _________________, 20___. ___________________________________ NOTARY/CLERK OF PROBATE COURT My Commission Expires ________________ GPCSF 11 [13] Eff. July 2017 NOTICE: 1. As to the Certificate to the Secretary of State, this page is to be used only when a determinative finding has been made that voting rights should be removed due to the lack of capacity of the Proposed Ward. The Order must be modified to reflect that this right was removed. The certificate must be mailed to the Secretary of State. 2. As to the Certificate to the GBI, this page shall be used in all cases where a Guardianship and/or Conservatorship is established. Individuals so listed in this database will be prohibited from obtaining a firearm permit. In the event the Proposed Ward’s rights are restored, such restoration of rights shall be sent to the GBI so the database can be updated. Only the Certificate needs to be sent to the GBI and not the Guardianship Order. NOTICE THE FOLLOWING PAGES ARE TO BE COMPLETED BY THE PETITIONER (MOVING PARTY) UNLESS OTHERWISE DIRECTED BY THE COURT. SEE PROBATE COURT RULE 5.6 (A). GPCSF 11 [14] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) ORDER FOR EVALUATION, APPOINTMENT OF COUNSEL, AND NOTICE OF HEARING The above and foregoing Petition for the Appointment of an Emergency Guardian and/or Emergency Conservator for a Proposed Ward having been read and considered, and it appearing that there is sufficient evidence to believe that the Proposed Ward is in need of an emergency guardian and/or emergency conservator within the meaning of O.C.G.A. §§ 29-4-14 and/or 29-5- 14, IT IS HEREBY ORDERED that _____________________________________________ (physician) (psychologist) (licensed clinical social worker), telephone number ______________________________, is appointed to evaluate the above-named Proposed Ward at ___:________ _______m., on __________________________, 20____ at [location name and address] _____________________________________________________. In compliance with Georgia law and federal law, including HIPAA, healthcare providers shall permit the above evaluator to have access to the Proposed Ward’s medical records; IT IS FURTHER ORDERED that the Clerk shall immediately notify the Proposed Ward of these proceedings by having all pleadings, as well as this order, personally served on the Proposed Ward; and IT IS FURTHER ORDERED that the above-named Proposed Ward shall submit to an evaluation at the time and place stated above and that a written report shall be furnished to the Court and made available to the parties within seventy-two (72) hours after this order being issued. IT IS FURTHER ORDERED that the evaluator shall explain the purpose of the evaluation to the Proposed Ward. IT IS FURTHER ORDERED that ________________________________, attorney at law, telephone number ______________________ is hereby appointed to represent the Proposed Ward. IT IS FURTHER ORDERED that an emergency hearing shall be conducted in the Probate Court of _______________________ County, courtroom _______________________, [address] ______________________________________________________________________________, Georgia OR at the following address: _______________________________________________ _____________________________ at ____:_______ _______m., on _______________, 20___, which is not sooner than three (3) days nor later than five (5) days after the filing of the Petition. GPCSF 11 [15] Eff. July 2017 [initial all that apply] _____ (a) IT IS FURTHER ORDERED that, based on the affidavit filed with the Petition, it appears that the threatened risk of death or serious physical injury, illness, or disease of the Proposed Ward is so immediate and the potential harm so irreparable that any delay is unreasonable, and _________________________________________ is named as pre-hearing emergency guardian of the Proposed Ward, to serve pending the hearing as scheduled above. Emergency Letters of Guardianship shall be issued upon said pre- hearing emergency guardian taking the oath. _____ (b) IT IS FURTHER ORDERED that, based on the affidavit filed with the Petition, it appears that the threatened risk of waste or dissipation of the Proposed Ward’s property is so immediate and the potential harm so irreparable that any delay is unreasonable, and _________________________________________________________ is named as pre-hearing emergency conservator of the Proposed Ward, to serve pending the hearing as scheduled above. Emergency Letters of Conservatorship shall be issued upon said pre-hearing emergency conservator posting a surety bond in the amount of $___________________ and taking the oath. [initial all that apply] ______ (i) IT IS FURTHER ORDERED that, pending the emergency hearing, the Court hereby orders that no withdrawals may be made from any account on the authority of the Proposed Ward’s signature without the Court’s prior approval and that the pre-hearing emergency conservator shall not expend any funds of the Proposed Ward without prior Court approval. GPCSF 11 [16] Eff. July 2017 NOTICE TO PROPOSED WARD: This is to notify you of a proceeding initiated in this Court by ______________________ __________________________________________________________ seeking to appoint: [initial all that apply] _____ (a) an emergency guardian for your person; and/or _____ (b) an emergency conservator for your property. BY THIS ORDER, THE COURT HAS APPOINTED AN ATTORNEY TO REPRESENT YOU AND HAS SCHEDULED A HEARING. YOU AND YOUR ATTORNEY HAVE THE RIGHT TO ATTEND ANY HEARING HELD ON THIS MATTER. IF AN EMERGENCY GUARDIAN IS APPOINTED FOR YOU, YOU MAY LOSE IMPORTANT RIGHTS TO CONTROL AND MANAGE YOUR PERSON. IF AN EMERGENCY CONSERVATOR IS APPOINTED FOR YOU, YOU MAY LOSE IMPORTANT RIGHTS TO CONTROL AND MANAGE YOUR PROPERTY. ALTHOUGH YOU MUST ATTEND THE EVALUATION, YOU DO NOT HAVE TO RESPOND TO QUESTIONS. SO ORDERED this _________day of ________________________________, 20____. _______________________________________ Judge of the Probate Court GPCSF 11 [17] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) CERTIFICATE OF SERVICE OF ORDER FOR EVALUATION; APPOINTMENT OF COUNSEL; AND NOTICE OF HEARING [NOTE: Notice is required to be mailed to the Proposed Ward’s guardian ad litem (if any) and attorney.] I certify that I have this date mailed (unless otherwise noted) in an envelope with proper postage affixed thereto for first-class delivery a copy of the foregoing Petition for the Appointment of an Emergency Guardian and/or Emergency Conservator for a Proposed Ward and order to the following parties at the address listed below: This _______ day of ____________________________, 20____. ___________________________________ Clerk of the Probate Court ___________________________________ ___________________________________ Address ___________________________________ Telephone Number GPCSF 11 [18] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) ORDER FOR DISMISSAL The above and foregoing Petition for the Appointment of an Emergency Guardian and/or Emergency Conservator for a Proposed Ward having been read and considered pursuant to O.C.G.A. §§ 29-4-15 and/or 29-5-15, and based on the Petition and prior to the court-ordered evaluation, it appears that there is not probable cause to believe that the Proposed Ward is in need of an emergency guardian and/or emergency conservator; therefore, IT IS HEREBY ORDERED that the Petition is dismissed. IT IS FURTHER ORDERED that a copy of the Petition, the medical affidavit, if any, and this order be served on the Proposed Ward by first-class mail, and a copy of this order be served in the same manner upon the Petitioner(s) or his/her/their attorney, if any. SO ORDERED this _________ day of ________________________________, 20____. ____________________________________ Judge of the Probate Court GPCSF 11 [19] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) CERTIFICATE OF SERVICE OF ORDER OF DISMISSAL [NOTE: Notice is required to be mailed to the Proposed Ward’s guardian ad litem (if any) and attorney.] I certify that I have this day mailed (unless otherwise noted) in an envelope with proper postage affixed thereto for first class delivery a copy of the Petition, the medical affidavit, and* order for dismissal to the Proposed Ward and other persons listed below as required by law, and to the following parties at the address listed below: This _______ day of ____________________________, 20____. ___________________________________ Clerk of the Probate Court ___________________________________ ___________________________________ Address ___________________________________ Telephone Number * not necessary if dismissal is after evaluation. GPCSF 11 [20] Eff. July 2017 IN THE PROBATE COURT OF __________________________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) COURT APPOINTED EVALUATOR’S REPORT EMERGENCY GUARDIANSHIP AND/OR EMERGENCY CONSERVATORSHIP PROCEEDINGS PETITIONER(S): _________________________________________________ PROPOSED WARD: _________________________________________________ In compliance with the Order of the Probate Court of ______________ County, dated ____________________________, 20_____, I performed an evaluation of the above-named Proposed Ward on ________________________, 20_____. This evaluation took place at: _____________________________________________________________________________. The evaluation continued for __________ (minutes)(hours). I explained the purpose of the evaluation to the Proposed Ward. The following questions and tests were utilized in the evaluation: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Below is a list of all persons and other sources of information consulted in evaluating the Proposed Ward: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The following is a description of the Proposed Ward’s mental and physical state and condition, including all observed facts considered: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________. GPCSF 11 [21] Eff. July 2017 The following is a description of the overall social condition of the Proposed Ward, including support, care, education, well-being, and the functional capabilities of the Proposed Ward, determined by the evaluator: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The following are my findings as to the needs of the Proposed Ward and their foreseeable duration: [initial all that apply] ________ (a) I find the Proposed Ward to be incapacitated by reason of ___________________ __________________________________________________________________ __________________________________________________________________ ___________________________________ to the extent that said Proposed Ward: ____ (i) [for emergency guardianship] lacks sufficient capacity to make or communicate significant responsible decisions concerning his or her health or safety and there is an immediate, clear, and substantial risk of death or serious physical injury, illness, or disease unless an emergency guardian is appointed; and/or ____ (ii) [for emergency conservatorship] lacks sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her property and there is an immediate, substantial risk of irreparable waste or dissipation of the Proposed Ward’s estate unless an emergency conservator is appointed, ________ (b) I do not find that the Proposed Ward meets the standards for emergency guardianship set out in (a) (i) above. ________ (c) I do not find that the Proposed Ward meets the standards for emergency conservatorship set out in (a) (ii) above. ________________________________________________ Physician licensed under Chapter 34 of Title 43 of the Official Code of Georgia Annotated/ Psychologist licensed under Chapter 39 of Title 43 of the Official Code of Georgia Annotated/ Licensed Clinical Social Worker ________________________________________________ Printed Name GPCSF 11 [22] Eff. July 2017 Sworn to and subscribed before me this _____day of _______________, 20_____. _____________________________________ NOTARY/CLERK OF PROBATE COURT My Commission Expires _________________ [NOTE: This report must be filed with the Probate Court no later than seventy-two (72) hours after the Order for Evaluation being issued.] GPCSF 11 [23] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) STIPULATION AND WAIVER BY PROPOSED WARD’S ATTORNEY IN RE: PETITION FOR THE APPOINTMENT OF AN EMERGENCY GUARDIAN AND/OR EMERGENCY CONSERVATOR FOR THE ABOVE-NAMED PROPOSED WARD The undersigned, as the attorney representing the above-named Proposed Ward in these proceedings [initial all that apply] ________ (a) does hereby stipulate into evidence the affidavit prepared by _____________________________________________, [name of affiant evaluator] being the evaluation report ordered by the Court in this matter, and hereby waives the appearance of such affiant at any hearing concerning the said Petition; ________ (b) does hereby stipulate into evidence the affidavit(s) prepared by _____________________________________________, [name of affiant evaluator] which is the affidavit referred to in the introductory paragraph (b) of the Petition, and hereby waives the appearance of such affiant at any hearing concerning the said Petition; and/or ________ (c) does further waive the appearance of my client, the Proposed Ward, at said hearing. This _________ day of ________________________________, 20____. Signature of Attorney _____________________________________________________ Printed name of Attorney _____________________________________________________ Address _____________________________________________________ _____________________________________________________ Telephone Number _____________________ State Bar # ______________________ GPCSF 11 [24] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) FINAL ORDER A hearing was held on the above-referenced Petition for the Appointment of an Emergency Guardian and/or Emergency Conservator for a Proposed Ward on ________________________, 20_____, and after considering the pleadings, the evaluation report, and the evidence taken at the hearing, the Court makes the following: FINDINGS OF FACT 1. All procedural requirements of O.C.G.A. §§ 29-4-14 and/or 29-5-15 have been met. 2. The above-named ward (does) (does not) lack sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her health and safety and there is an immediate and substantial risk of death or serious physical injury, illness, or disease due to [state how or why lacks capacity]:________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________. The above-named ward (does) (does not) lack sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her property and there is an immediate, substantial risk of irreparable waste or dissipation of the ward’s property due to [state how or why lacks capacity]: _______________________________________________________ ______________________________________________________________________________ Such need appears to be limited to the following number of days: ____________. 3. The current value of the personal property and income covering the emergency period of the ward, is approximately $____________. The ward has an interest in real property in the following locations: (a) ____________________________County, (state) ____________________________; (b) ____________________________County, (state) ____________________________; (c) ____________________________County, (state) ____________________________. The ward has outstanding debts of $ _____________________ and average expenditures of $________________________ per month. GPCSF 11 [25] Eff. July 2017 4. Petitioner(s) moved the Court to appoint _______________________________________ as emergency guardian and _______________________________________________________ as emergency conservator asserting those individual(s) should serve because:________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ [initial all that apply] ______ (a) Another individual, being ___________________________________, was nominated/designated by the ward to serve as guardian, _____ (i) and no good cause was shown to override such preference. _____ (ii) but good cause was shown not to appoint said individual, being: ___________________________________________ ________________________________________________. ______ (b) Another individual with higher preference, being ___________________, was nominated/designated to serve as guardian by someone other than the ward, and/but it (is) (is not) in the best interest of the ward to appoint him/her guardian because ______________________________________________ ____________________________________________________________. ______ (c) Another individual, being __________________________________, was nominated/designated by the ward to serve as conservator, _____ (i) and no good cause was shown to override such preference. _____ (ii) but good cause was shown not to appoint said individual, being: ___________________________________________ ________________________________________________. ______ (d) Another individual with higher preference, being ____________________, was nominated/designated to serve as conservator by someone other than the ward, and/but it (is) (is not) in the best interest of the ward to appoint him/her conservator because ____________________________________________ ____________________________________________________________. 5. The Petitioner(s) asserted that the following additional powers pursuant to O.C.G.A. §§ 29-4-23 (b) and 29-5-23 (c) were absolutely necessary to respond to the immediate and threatened risks alleged in the Petition: For the emergency guardian: ________________________________________________ _____________________________________________________________________________; For the emergency conservator: ______________________________________________ ______________________________________________________________________________. GPCSF 11 [26] Eff. July 2017 The Court finds, by clear and convincing evidence, that the above-named ward (hereinafter referred to as the “ward”) is in need of: [initial all that apply] _____ (a) an emergency guardian because the ward lacks sufficient capacity to make or communicate significant responsible decisions concerning his or her health or safety and there is an immediate and substantial risk of death or serious physical injury, illness, or disease unless an emergency guardian is appointed. _____ (b) an emergency conservator because the ward lacks sufficient capacity to make or communicate significant responsible decisions concerning the management of his or her property and there is an immediate, substantial risk of irreparable waste or dissipation of the ward’s property unless an emergency conservator is appointed. The duration of the emergency guardianship and/or emergency conservatorship is for [initial one] _____ (a) sixty (60) days, or until the effective date of the appointment of permanent guardianship and/or conservatorship, or until the emergency guardian(s) and/or conservator(s) are removed, or the dismissal of a Petition for the appointment of an emergency guardian/emergency conservator, whichever occurs first. _____ (b) a date certain prior to the time identified in (a) above, being __________________________, 20_____. IT IS ORDERED that _______________________________________should be, and hereby is/are, appointed emergency guardian(s) and ____________________________ should be, and hereby is/are, appointed emergency conservator(s) of the ward because: ______________________________________________________________________________ ________________________. Letters of emergency guardianship and/or emergency conservatorship shall issue to such emergency guardian(s) and/or emergency conservator(s) upon taking the required oath and upon the emergency conservator’s(s’) posting bond in the amount of $_______________________. The appointed emergency guardian(s) and/or emergency conservator(s) shall have no authority to act on behalf of the ward until Letters of Emergency Guardianship and/or Emergency Conservatorship have issued. IT IS FURTHER ORDERED that the emergency guardian(s) shall have only the following powers and duties determined by the Court to be absolutely necessary to respond to the immediate threatened risk: ________________________________________________________________ _____________________________________________________________________________. IT IS FURTHER ORDERED that the emergency conservator(s) shall have only the following powers and duties determined by the Court to be absolutely necessary to respond to the immediate threatened risk: _______________________________________________________ _____________________________________________________________________________. GPCSF 11 [27] Eff. July 2017 IT IS FURTHER ORDERED that the emergency guardian(s) shall file the following reports with the Court: __________________________________________________________________ ______________________________________________________________________________. IT IS FURTHER ORDERED that the emergency conservator(s) shall file the following reports with the Court: ____________________________________________________________ ______________________________________________________________________________. IT IS FURTHER ORDERED that a copy of this Order shall be hand delivered or mailed by first class mail to the ward, the ward’s attorney, the guardian ad litem, if any, the emergency guardian and/or emergency conservator, the Petitioner(s) and his/her/their attorney(s), if any. IT IS FURTHER ORDERED that the ward’s legal counsel shall make reasonable efforts to explain to the ward this Order and the ward’s rights under this Order. IT IS FURTHER ORDERED that, within thirty (30) days of the date hereof, the Clerk shall file the certificate of creation of conservatorship in accordance with O.C.G.A. § 29-5-13 (d) with the Clerk of Superior Court of each county in this state in which the ward owns real property. SO ORDERED this _________ day of ________________________________, 20____. __________________________________________ Judge of the Probate Court/Hearing Officer exercising the jurisdiction of the Probate Court pursuant to O.C.G.A. §§ 29-4-12 (d) (7) and/or 29-5-12 (d) (7) GPCSF 11 [28] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ PROPOSED WARD ) CERTIFICATE OF SERVICE OF FINAL ORDER [NOTE: Notice is required to be mailed to the ward’s guardian ad litem (if any) and attorney; and the interested parties as found in paragraph 9 of the Petition.] I certify that I have this date mailed (unless otherwise noted) in an envelope with proper postage affixed thereto for first-class delivery a copy of the Final Order Appointing Emergency Guardian and/or Emergency Conservator to the ward and other persons listed below as required by law, and to the following parties at the address listed below: This _______ day of ____________________________, 20____. _____________________________________ Clerk of the Probate Court _____________________________________ _____________________________________ Address _____________________________________ Telephone Number GPCSF 11 [29] Eff. July 2017 Probate Court Return Mailing Address: ________________________________ ________________________________ (Above space to be used for filing in Superior Court Clerk’s Office Deeds and Records) IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ WARD ) CERTIFICATE OF CREATION OF EMERGENCY CONSERVATORSHIP [Pursuant to O.C.G.A. § 29-5-13 (d)] DATE ORDER ISSUED: _________________________________________________________ GRANTOR [NAME OF WARD]: ___________________________________________________ GRANTEE [NAME OF EMERGENCY CONSERVATOR(S) OF ABOVE WARD]: ____________ An emergency conservatorship has been created for the above-named ward. Said emergency conservatorship expires: [initial one] ______ (a) in sixty (60) days, or on the effective date of the appointment of a permanent conservator, or when the emergency conservator(s) is/are removed, or the dismissal of a Petition for the appointment of a conservator, whichever occurs first. ______ (b) on a date certain, being _________________________, 20______. Original Certificate delivered or mailed to Clerk of Superior Court of ________________ County on _________________________, 20______. I do hereby certify that the above information is based on the Order of the Probate Court issued on the date set out above and that the above information is true and correct. By: _____________________________________________ Clerk of the Probate Court GPCSF 11 [30] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ WARD ) CERTIFICATE OF FILING CERTIFICATE OF CREATION OF CONSERVATORSHIP I have this date hand-delivered and/or mailed for filing a Certificate of Creation of Conservatorship to the Clerk of the Superior Court of each of the following counties, together with payment of any recording costs: ______________________________________________________________________________ ______________________________________________________________________________ This _______ day of ____________________________, 20____. _____________________________________ Clerk of the Probate Court GPCSF 11 [31] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ WARD ) __________________________________, ) DATE OF BIRTH ) LETTERS OF EMERGENCY GUARDIANSHIP OF ADULT WARD FROM: the Judge of the Probate Court of said County TO: __________________________________, Guardian(s) The above-named adult ward was found by this Court to be in need of an emergency guardian, and this Court entered an order designating you as such emergency guardian. You have assented to this appointment by taking your oath. In general, your duties as emergency guardian were declared by the Court to be those absolutely necessary to respond to the immediate threatened risk, specifically _________________________________________________________________ ______________________________________________________________________________. These letters expire [initial one]: _____ (a) in sixty (60) days, or on the effective date of the appointment of a permanent guardian, or when the emergency guardian(s) is/are removed, or upon the dismissal of a petition for the appointment of a permanent guardian, whichever occurs first. _____ (b) on a date certain, being _________________________, 20______. Given under my hand and official seal, the _______ day of _________________, 20____. _______________________________________ Judge of the Probate Court [NOTE: The following must be signed if the judge does not sign the original of this document:] Issued by: __________________________________ (Seal) Clerk of the Probate Court GPCSF 11 [32] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ WARD ) __________________________________, ) DATE OF BIRTH ) LETTERS OF EMERGENCY CONSERVATORSHIP OF ADULT WARD FROM: the Judge of the Probate Court of said County. TO: __________________________________, Conservator(s) The above-named adult ward was found by this Court to be in need of an emergency conservator, and this Court entered an order designating you as such emergency conservator(s). You have assented to this appointment by taking your oath and posting a bond. In general, your duties as emergency conservator(s) were declared by the Court to be those absolutely necessary to respond to the immediate threatened risk, specifically, _________________________________ ______________________________________________________________________________. These letters expire [initial one]: _____ (a) in sixty (60) days, or on the effective date of the appointment of a permanent conservator, or when the emergency conservator(s) is/are removed, or upon the dismissal of a petition for the appointment of a permanent conservator, whichever occurs first. _____ (b) on a date certain, being _________________________, 20______. Given under my hand and official seal, the ______ day of __________________, 20____. _______________________________________ Judge of the Probate Court [NOTE: The following must be signed if the judge does not sign the original of this document:] Issued by: __________________________________ (Seal) Clerk of the Probate Court GPCSF 11 [33] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ WARD ) __________________________________, ) DATE OF BIRTH ) LETTERS OF EMERGENCY GUARDIANSHIP AND CONSERVATORSHIP OF ADULT WARD FROM: the Judge of the Probate Court of said County. TO: __________________________________, Guardian(s) and Conservator(s) The above-named adult ward was found by this Court to be in need of an emergency guardian and conservator and has designated you as such emergency guardian(s) and emergency conservator(s). You have assented to this appointment by taking your oath and posting a bond. In general, your duties as emergency guardian(s) and emergency conservator(s) were declared by the Court to be those absolutely necessary to respond to the immediate threatened risk, specifically, ______________________________________________________________________________ ______________________________________________________________________________. These letters expire [initial one]: _____ (a) in sixty (60) days, or on the effective date of the appointment of a permanent guardian and conservator, or when the emergency guardian(s) and emergency conservator(s) is/are removed, or upon the dismissal of a petition for the appointment of a permanent guardian and/or conservator, whichever occurs first. _____ (b) on a date certain, being _________________________, 20______. Given under my hand and official seal, the _______ day of _________________, 20____. _______________________________________ Judge of the Probate Court [NOTE: The following must be signed if the judge does not sign the original of this document:] Issued by: __________________________________ (Seal) Clerk of the Probate Court GPCSF 11 [34] Eff. July 2017 CERTIFICATE OF GUARDIANSHIP / CONSERVATORSHIP ESTABLISHED *Mandatory Field Make Electronic Submissions via the Georgia Criminal Justice Information System (CJIS) Network -OR- Mail Guardianship / Conservatorship forms to: Georgia Crime Information Center Attention: CJIS Operations Unit 3121 Panthersville Rd. Decatur, Georgia 30034 *DATE OF ORDER (mm/dd/yyyy) *JUDGE’S NAME *PROBATE COURT COUNTY/ORI NUMBER *ESTATE NUMBER THE FOLLOWING INDIVIDUAL HAS BEEN ADJUDICATED TO LACK SUFFICIENT MENTAL CAPACITY AND GUARDIANSHIP/CONSERVATORSHIP HAS BEEN ESTABLISHED. *NAME (Last, First, Middle) *SEX *RACE *DATE OF BIRTH (mm/dd/yyyy) SOCIAL SECURITY NUMBER (###-##-####) CURRENT ADDRESS (Street Address) CITY STATE ZIP CODE SIGNATURE (Court Official) DATE SIGNED *Court Official’s Title GPCSF 11 [35] Eff. July 2017 IN THE PROBATE COURT OF _______________________ COUNTY STATE OF GEORGIA IN RE: ) ) ___________________________________, ) ESTATE NO. ____________ WARD ) CERTIFICATE OF FILING OF CERTIFICATE OF GUARDIANSHIP/CONSERVATORSHIP ESTABLISHED I hereby certify that the above-stated information is true and correct and that I have this date mailed this Certificate of Guardianship/Conservatorship Established to the Georgia Bureau of Investigation by placing copies of same in an envelope addressed as set forth above and depositing same in the U.S. Mail, first-class, with adequate postage thereon. This ______ day of ___________________________, 20____. _______________________________________ Clerk of the Probate Court