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DISTRICT COURT (Family Law Self Help Center)

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© 2018 Nevada Supreme Court
Page 1 of 7 – Order Appointing Guardian(s) (Adult)
COURT CODE: _____________________
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
DISTRICT COURT
_________________ COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
_
___________________________________
(name of adult who has a guardian)
A Protected Person.
CASE NO.: ____________________
DEPT: ____________________
ORDER APPOINTING GUARDIAN(S) OVER ADULT
This matter came before the Court for hearing on (date of hearing) ________________.
Petitioner (first guardian’s name) ________________________________________,
was present representing HIMSELF/HERSELF –OR– WITH COUNSEL, (attorney’s
name; or “n/a” if none) ________________________________________.
Petitioner (second guardian’s name) ________________________________________,
was present representing HIMSELF/HERSELF –OR– WITH COUNSEL, (attorney’s
name; or “n/a” if none) ________________________________________.
Proposed Protected Person (adult’s name) ____________________________________,
WAS PRESENT –OR– WAS NOT PRESENT and is represented by counsel,
(attorney’s name) ________________________________________.
It appearing to the satisfaction of the Court that notice is sufficient; and
It appearing by clear and convincing evidence that it is necessary to appoint a guardian
for the proposed protected person;
CLARK
Page 2 of 7 – Order Appointing Guardian(s) (Adult)
IT IS HEREBY ORDERED AND DETERMINED BY THE COURT as follows:
1. (Adult protected person’s name) ______________________________________, date of
birth (date) __________________, is a resident of the State of ___________________.
2. The Proposed Protected Person is an adult who needs the appointment of a guardian.
This request is supported by recent documentation demonstrating the need for a
guardianship.
3. Notice has been served upon the adult, the spouse and/or any living relative, or the
public guardian, if necessary, and/or any other persons or agency having the care,
custody and control of the adult.
4. It is necessary and in the best interest of the Protected Person that Petitioner(s) be
appointed as Guardian(s). The following is/are appointed to act as Guardian(s) of the
PERSON –OR– ESTATE –OR– PERSON AND ESTATE and shall have the
power and authority as may be necessary for the benefit of the above named Protected
Person until further order of this Court:
a. First Guardian: __________________________________________________
Street Address ___________________________________________________
City, State, Zip: __________________________________________________
Telephone: ______________________________________________________
b. Second Guardian: __________________________________________ N/A
Street Address ___________________________________________________
City, State, Zip: __________________________________________________
Telephone: ______________________________________________________
5. The Guardian(s) shall participate in the guardianship training class, if offered, through
_________________________________________________ –OR–
N/A.
6. Pursuant to NRS 159.081, the Guardian(s) shall file a written report on the condition of
the Protected Person every year between the anniversary date of
_______________________________ and _______________________________ for
the first report and each year thereafter. This obligation continues until the guardianship
of the person ends –OR– N/A
Page 3 of 7 – Order Appointing Guardian(s) (Adult)
7. Bond is:
Not applicable.
Reserved pending the filing of the inventory.
Ordered in the amount of $__________________.
Waived.
A blocked account is ordered in lieu of bond.
8. Inventory:
This is a person only guardianship; no estate is involved.
The Guardian(s) shall file an inventory of all of the property of the Protected
Person which comes to the possession, or knowledge of the Guardian(s) by (date)
______________________.
9. Accounting:
This is a person only guardianship; no estate is involved.
Summary administration of the estate is granted. An annual accounting is not
required until assets exceed the statutory threshold for summary administration.
A verified account of the estate of the Protected Person shall be made and filed
annually by (date) ___________________________, and must be filed within
60 days of this date and each year thereafter. This obligation continues until the
guardianship of the estate ends.
10. Pursuant to NRS 159.0593:
There is clear and convincing evidence that the Protected Person is a person with a
mental defect who is prohibited from possessing a firearm pursuant to 18 U.S.C.
§922 (d)(4) or (g) or (4). A Record of the Order containing this filing shall be
transmitted to the central repository for Nevada Records of Criminal History,
along with a statement that the record is being transmitted for inclusion in each
appropriate database of the National Instant Criminal Background Track System.
The Protected Person’s right to possess a firearm is not affected.
11. Pursuant to NRS 159.0594:
The Protected Person lacks the requisite understanding to vote or otherwise
participate in the election process and shall be removed from the voting records.
The Protected Person’s right to vote is not affected.
Page 4 of 7 – Order Appointing Guardian(s) (Adult)
12. All powers are reserved to the Protected Person except for the following powers, which
are granted to the Guardian(s):
Powers over Person (Court to check applicable powers granted to Guardian(s))
To oversee, maintain and/or approve the placement of the Protected Person in the
appropriate, least restrictive, and financially feasible care facility.
Only in the event that provisions of NRS Chapter 433A DO NOT apply, to approve
placement of the Protected Person in a secured facility, with the assistance law
enforcement and/or REMSA if needed.
To hire or discharge care givers as deemed necessary in the discretion of the
Guardian.
To authorize any medical care the Protected Person may require.
To change the mailing address of the Protected Person.
To make informed decisions regarding the Protected Person’s health care, to include
consultations on treatment plans, consents and admissions, consents for residential
placements, consents for medications, and treatments recommended by medical providers,
and the authority to make related decisions for the benefit of the Protected Person.
The Guardian(s) is/are the Protected Person’s personal representative for purposes of
the Health Insurance Portability and Accountability Act of 1996, Public Law 104-
191, and any applicable regulations. The Guardian(s) of the person has/have authority
to obtain information from any government agency, medical provider, business,
creditor or third party who may have information pertaining to the Protected Person’s
health care or health insurance.
To ensure that housing and care arrangements provide the Protected Person with an
appropriate level of safety, well-being, health and maintenance.
To ensure that the Protected Person has access to family members and persons of
natural affection, and those persons and family members have access to the Protected
Person in a manner that ensures an appropriate level of safety and well-being for the
Protected Person.
To obtain neuropsychological examination to determine areas of defects and
capacities.
Other: _____________________________________________________________
Page 5 of 7 – Order Appointing Guardian(s) (Adult)
Powers over Estate (Court to check applicable powers granted to Guardian(s))
Permission to sell, donate, distribute, dispose of and/or abandon personal property to
maintain the integrity of the Protected Person’s estate.
Permission to freeze, access, utilize funds from, transfer and/or close any and all of
the Protected Person’s bank accounts and any and all other accounts at any financial
institution, whether solely or jointly held, for the benefit of the Protected Person.
Permission to redirect and/or become the representative payee for Social Security
income, and similar income, if any, for the benefit of the Protected Person.
Permission to obtain credit reports from any credit-reporting bureau to ascertain the
status of any credit card accounts and/or lines of credit and activity on any such
accounts.
Permission to obtain tax information, tax returns and/or any necessary documents
from the Internal Revenue Service for the benefit of the Protected Person.
Permission to investigate, apply for and/or consent to services for which the Protected
Person may be eligible.
Permission to access, drill, open, inventory, remove the contents of, and/or close any
safe deposit box, whether solely or jointly held by the Protected Person.
Other: _____________________________________________________________
13. Pursuant to NRS 159.074, a copy of this order must be served personally or by mail upon
the Protected Person no later than 5 days after the date of the appointment of the
Guardian. A notice of entry of the order must be filed with the Court.
14. The relatives required to be served and identified by petitioner as having been served
pursuant to NRS 159.047(2) et seq. must be served with notice of this order pursuant to
NRS 159.055(2)(d)(1) and are as follows:
Name and address: ________________________________________________
________________________________________________
Name and address: ________________________________________________
________________________________________________
Page 6 of 7 – Order Appointing Guardian(s) (Adult)
Name and address: ________________________________________________
________________________________________________
Name and address: ________________________________________________
________________________________________________
Name and address: ________________________________________________
________________________________________________
Name and address: ________________________________________________
________________________________________________
15. A notice of entry of order must be provided to the relatives identified above pursuant to
NRS 159.055(3)(a).
16. The interested persons/entities required to be served and identified by the Petitioners as
having been served pursuant to NRS 159.047(2) et seq. must be served with notice of this
order pursuant to NRS 159.055(2)(d)(2).
Name and address: ________________________________________________
________________________________________________
Name and address: ________________________________________________
________________________________________________
Name and address: ________________________________________________
________________________________________________
17. A notice of entry of the order must be provided to the interested persons/entities
identified above pursuant to NRS 159.055(3)(b).
18. Guardian(s) must file verified acknowledgements of the duties and responsibilities of a
guardian pursuant to NRS 159.073(1)(c).
19. Guardian(s) must immediately have the Letters of Guardianship and Oath issued. The
Letters of Guardianship may be revoked for failure to file the annual reports pursuant to
NRS Chapter 159.
Page 7 of 7 – Order Appointing Guardian(s) (Adult)
20. Other:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Pursuant to the Nevada Revised Statutes, the following information is provided:
Protected Person’s Attorney: ________________________________________
Street Address ___________________________________________________
City, State, Zip: __________________________________________________
Telephone: ______________________________________________________
IT IS SO ORDERED.
Dated this _____ day of _________________________, 20___.
____________________________________
DISTRICT COURT JUDGE
Respectfully Submitted by:
(Your Signature)
(Printed Name)
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DISTRICT COURT (Family Law Self Help Center)

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Completed 15 January 2021

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