IN THE CHANCERY COURT OF MADISON COUNTY, MISSISSIPPI

IN RE:______________________________	CAUSE NO.: ___________

LETTERS OF GUARDIANSHIP (AND CONSERVATORSHIP IF APPLICABLE)

WHEREAS, ________________, has been appointed by the Court as Guardian of the person (and Conservator of the estate, if applicable) of _______________, (a minor, if applicable).

I, THEREFORE, BY THESE LETTERS, authorize ______________, as Guardian (and Conservator, if applicable) aforesaid, to discharge the duties required of (him/her) by law or by the order of this Court: the Guardian (and Conservator, if applicable) is empowered with the powers enumerated in Section(s) (Section 209 if minor; Section 313 if Adult; and Section 421 if also Conservator) of the Mississippi Guardianship and Conservatorship Act, with the following exception(s): __(list exceptions as indicated in order of appointment, if any)_____.

WITNESS, Honorable ___(Judge's Name)____, Judge of the Chancery Court of Madison County, Mississippi, on the ____ day of _________, 20___, the seal of said Court hereunto affixed.

ISSUED, this the _______ day of ___________________, 20_____.

Ronny Lott, Chancery Clerk

By:_____________________________

Deputy Clerk (seal)

I, Ronny Lott,, Clerk of the Chancery Court in and for the County of Madison and the State of Mississippi, certify that the above is a true copy of the Letters of Guardianship upon the person (and Conservatorship of Estate, if applicable) of _____________, (a minor, if applicable), granted, and issued to _______________, Guardian (and Conservator, if applicable), on the _____ day of ____________, 20____, as same appears on file and of record in my office in the City of Canton in said County and State.

Given under my hand and seal of said Court at Canton, Mississippi, in Madison County and said State, this the _____ day of ______________, 20_____.