MPC 740 (5/30/11)
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A MINOR
DECREE AND ORDER OF
APPOINTMENT OF GUARDIAN of a
MINOR
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
In the Interests of:
Last Name
Middle Name
Division
(date)
, after hearing on
Upon the Petition for Appointment of Guardian of
filed
(date)
, the Court FINDS THAT:
is a minor whose date of birth is
(date)
.
is the Minor's
mother
father
(hereinafter referred to as "Parent One")
is the Minor's
mother
father
(hereinafter referred to as "Parent Two")
Venue is proper.
The minor child, who is over age 14, nominated said guardian.
Parent One consented to said petition.
Parent Two consented to said petition.
Parent One, after proper notice, did not object to said petition.
Parent Two, after proper notice, did not object to said petition.
Parent One's parental rights have been terminated.
Parent Two's parental rights have been terminated.
Parent One is deceased.
Parent Two is deceased.
Parent One, after hearing, is found to be currently
unfit
unavailable to parent said Minor for the following reasons:
unavailable to parent said Minor for the following reasons:
unfit
Parent Two, after hearing, is found to be currently
IT IS THEREFORE ORDERED AND DECREED that the following person(s) is/are appointed as Guardian of said Minor
Last Name
Name:
First Name
M.I.
(Address)
(State)
(Zip)
Primary Phone #:
(Apt, Unit, No. etc.)
MPC 740 (5/30/11)
In the Interests of:
of
page
Last Name
Middle Name
Docket No.
Last Name
Name:
First Name
M.I.
(Address)
(State)
(Zip)
Primary Phone #:
(Apt, Unit, No. etc.)
The Court directs the issuance of Letters of Appointment of Guardianship as follows:
The Letters shall expire on:
The powers and duties of the Guardian are unrestricted, except the Guardian may not consent to extraordinary
The powers and duties of the Guardian are limited by the following restrictions:
medical treatment pursuant to G.L. c. 190B, §5-306A
the Minor's 18
th
birthday
or
(date)
IT IS FURTHER ORDERED THAT:
The Guardian(s) shall, on or before one year from the date of this decree, and annually thereafter, file an
Annual Report of Guardian. Failure of the Guardian(s) to do so may result in the revocation of this Decree.
The Guardian(s) is/are prohibited from permanently removing the child from the Commonwealth without an order of
the Court.
Parent One shall have the following rights to contact with the minor child:
The Guardian(s) shall notify the Court in writing within 30 days of any changes to his/her home address, or
telephone number or of that of the Minor.
1.
2.
3.
4.
The Guardian shall serve:
without surety on his,her, or their bond:
because the minor has no estate
for the following good cause
personal sureties
with
corporate surety on his/her/their bond in the amount of
pursuant to G.L. c. 190B, §5-410
5.
Parent Two shall have the following rights to contact with the minor child:
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MPC 740 (5/30/11)
In the Interests of:
of
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Last Name
Middle Name
Docket No.
Parent One shall pay child support in the amount of
$
beginning
by wage/suspended wage assignment.
Parent Two shall pay child support in the amount of
$
beginning
by wage/suspended wage assignment.
6.
The parties shall comply with a stipulation or agreement dated
7.
(date)
which is filed with the Court and expressly made part of this Order.
,
Other:
8.
Date
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