IN THE SUPERIOR COURT OF THE

STATE OF WASHINGTON IN AND FOR THE

COUNTY OF  . . . . . . . . .

IN THE MATTER OF THE

GUARDIANSHIP/

CONSERVATORSHIP OF

. . . . . . . . . . . . . . . . .

Cause No.  . . . . . . . .

LETTERS OF

GUARDIANSHIP/CONSERVATORSHIP

Date letters expire

. . . .

THESE LETTERS OF GUARDIANSHIP/CONSERVATORSHIP PROVIDE OFFICIAL VERIFICATION OF THE FOLLOWING:

On the . . . . . . . . . day of . . . . . . . ., (year) . . . . the Court appointed . . . . . . . . . . .to serve as:

□ Guardian of the Person □ Full □ Limited

□ Conservator of the Estate □ Full □ Limited

for . . . . . . . . . . . ., in the above referenced matter.

The Guardian/Conservator has fulfilled all legal requirements to serve including, but not limited to: Taking and filing the oath; filing any bond consistent with the court's order; filing any blocked account agreement consistent with the court's order; and appointing a resident agent for a nonresident guardian.

The Court, having found the Guardian/Conservator duly qualified, now makes it known . . . . . . . . . is authorized as the Guardian for . . . . . . . . . . . . . . designated in the Court's order as referenced above.

The next filing and reporting deadline in this matter is on the . . . day of . . . . . . ., . . . . . ..

THESE LETTERS ARE NO LONGER VALID ON . . . . . . . . . .

These letters can only be renewed by a new court order. If the court grants an extension, new letters will be issued.

This matter is before the Honorable . . . . . . . . of Superior Court, the seal of the Court being affixed

this . . . . day of . . . . . . . ..

State of Washington )

) ss.

County of . . . . . . . . .)

I, . . . . . . . ., Clerk of the Superior Court of said County and State, certify that this document represents true and correct Letters of Guardianship/Conservatorship in the above entitled case, entered upon the record on this . . . . . . . day of . . . . . ., . . . ..

These letters remain in full force and effect until the date of expiration set forth above.

The seal of Superior Court has been affixed and witnessed by my hand this . . . . . . . day of . . . . . . . . ., . . . ..

. . . . . . . . . ., Clerk of Superior Court

By . . . . . . . ., Deputy

. . . . . . . . . . . . . . . . . . . .

(Signature of Deputy)