Decree and Order of Appointment of Guardian of Minor

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					                                                                  Docket No.                         Commonwealth of Massachusetts
       DECREE AND ORDER OF                                                                                  The Trial Court
    APPOINTMENT OF GUARDIAN of a                                                                        Probate and Family Court
              MINOR
 In the Interests of:
                                                                                                                                 Division



 A MINOR




 Upon the Petition for Appointment of Guardian of                                                                filed
                                      , after hearing on                                                 , the Court FINDS THAT:
               (date)                                                              (date)


                                                     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:




    Parent Two, after hearing, is found to be currently          unfit         unavailable to parent said Minor for the following reasons:




 IT IS THEREFORE ORDERED AND DECREED that the following person(s) is/are appointed as Guardian of said Minor
 1. Name:
                                     First Name                                     M.I.                       Last Name


                          (Address Line 1)                 (Apt, Unit, No. etc.)               (City/Town)           (State)        (Zip)

     Primary Phone #:
MPC 740 (06/09)                                                                                                           page       of
     Name:
                                       First Name                                 M.I.                         Last Name


                            (Address Line 1)              (Apt, Unit, No. etc.)                (City/Town)               (State)        (Zip)

   Primary Phone #:
                                                                                                                                   click to add
 The Court directs the issuance of Letters of Appointment of Guardianship as follows:

         The Letters shall expire on                                                            , the Minor's 18th birthday, unless
                                                             (date)
         otherwise ordered by the Court.
         The powers and duties of the Guardian are unrestricted, except the Guardian may not consent to extraordinary
         medical treatment pursuant to G.L. c. 190B, §5-306A
         The powers and duties of the Guardian are limited by the following restrictions:




 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.

         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.

         Parent One shall have the following rights to contact with the minor child:




         Parent Two shall have the following rights to contact with the minor child:




         Parent One shall pay child support in the amount of     $                       beginning
                                                                                                                (date)
         by wage/suspended wage assignment.
         Parent Two shall pay child support in the amount of     $                       beginning
                                                                                                                (date)
         by wage/suspended wage assignment.
         Other:




  Date




MPC 740 (06/09)                                                                                                             page         of