Adult Guardianship and Co-decision-making Regulations, A-5.3 Reg 1

1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 The Adult Guardianship and Co-decision-making Regulations being Chapter A-5.3 Reg 1 (effective June 27, 2001) as amended by Saskatchewan Regulations 49/2002, 96/2005, 66/2011 and 30/2024. NOTE: This consolidation is not official. Amendments have been incorporated for convenience of reference and the original statutes and regulations should be consulted for all purposes of interpretation and application of the law. In order to preserve the integrity of the original statutes and regulations, errors that may have appeared are reproduced in this consolidation. 2 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Table of Contents 1 Title Appendix 2 Interpretation Form A 3 Forms prescribed Form B 3.1 Fees for decision-makers Form B.1 4 Notification of hearing Form C 5 Assessment Form D 6 Advocacy groups Form E 6.1 Exemption Form F 7 Dispensing with filing of bond Form G 7.1 Limitations on gifts Form H 8 R.R.S. c.D-25.1 Reg 1 repealed Form I 9 Coming into force Form J Form K Form L Form L.1 Form M Form M.1 Form N Form O Form P Form Q Form Q.1 Form R Form S Form T Form U 3 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 CHAPTER A-5.3 REG 1 The Adult Guardianship and Co-decision-making Act Title 1 These regulations may be cited as The Adult Guardianship and Co-decision-making Regulations. Interpretation 2 In these regulations: (a) “Act” means The Adult Guardianship and Co-decision-making Act; (b) “form” means the appropriate form set out in the Appendix. 13 Jly 2001 cA-5.3 Reg 1 s2. Forms prescribed 3 For the purposes of the Act: (a) Form A is the form for the application for: (i) appointment as a personal co-decision-maker or personal guardian pursuant to section 14 of the Act; or (ii) appointment as a property co-decision-maker or property guardian pursuant to section 40 of the Act; (b) Form B is the form for the affidavit of an applicant for an appointment mentioned in clause (a); (b.1) Form B.1 is the form for the affidavit of a person nominated to be an alternate decision-maker; (c) Form C is the form for the application for confirmation of a testamentary nomination of a personal co-decision-maker, personal guardian, property co-decision-maker or property guardian pursuant to section 64 of the Act; (d) Form D is the form for the affidavit of an applicant for a confirmation mentioned in clause (c); (e) Form E is the form for consent by a nearest relative to the appointment or confirmation mentioned in clauses (a) and (c); (f) Form F is the form for the affidavit of execution to be used in connection with Form E; (g) Form G is the form for the statement of objection pursuant to section 8 or 32 of the Act; (h) Form H is the form for the application for: (i) appointment as a temporary personal guardian pursuant to section 19 of the Act; or (ii) appointment as a temporary property guardian pursuant to section 44 of the Act; (i) Form I is the form for the affidavit of an applicant for an appointment mentioned in clause (h); 4 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING (j) Form J is the form for the assessment of the adult’s capacity pursuant to section 12 or 38 of the Act; (k) Form K is the form for the statement of inventory with respect to an application for appointment of a property co-decision-maker or property guardian or for resealing a foreign order pursuant to subsection 53(1) or 65.1(3) of the Act; (l) Form L is the form for the annual accounting required pursuant to subsection 54(1) of the Act where an order is made for the appointment of a property co-decision-maker or property guardian; (l.1) Form L.1 is the form for the final accounting required pursuant to subsection 54.1(1) of the Act; (m) Form M is the form for the bond respecting an undertaking to properly act as a property co-decision-maker, property guardian, alternate property co-decision-maker or alternate property guardian pursuant to section 55, 64.1 or 65.1 of the Act; (m.1) Form M.1 is the form for the bond respecting an undertaking to properly act as a temporary property guardian; (n) Form N is the form for an order appointing a personal co-decision-maker, personal guardian, property co-decision-maker, property guardian, temporary personal guardian, temporary property guardian or alternate decision-maker pursuant to the Act; (o) Form O is the form for the notice of authority to act as property co-decision-maker, property guardian or temporary property guardian filed pursuant to subsection 57(1) of the Act; (p) Form P is the form for the withdrawal of notice pursuant to section 58 of the Act; (q) Form Q is the form for the amended notice pursuant to section 58 of the Act; (q.1) Form Q.1 is the form for the affidavit that must be filed by an alternate decision-maker who assumes the position of decision-maker pursuant to subsection 64.1(9) of the Act; (r) Form R is the form for the application to review, pursuant to section 66 of the Act, the appointment or testamentary nomination of a personal co-decision- maker, personal guardian, property co-decision-maker, property guardian, temporary personal guardian or temporary property guardian pursuant to the Act; (s) Form S is the form for an application to reseal a foreign order pursuant to section 65.1 of the Act; (t) Form T is the form for an affidavit in support of an application to reseal a foreign order; (u) Form U is the form for an order resealing a foreign order. 13 Jly 2001 cA-5.3 Reg 1 s3; 23 Sep 2011 SR 66/2011 s3. 5 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 Fees for decision-makers 3.1(1) If the court has not made an order setting a fee for service, a person appointed pursuant to the Act to act as a property guardian for an adult may charge the following fees: (a) 2.5% of the money received by the property guardian on behalf of the adult per month; (b) 2.5% of the payments made by the property guardian on behalf of the adult per month. (2) If there is more than one property guardian, the amount determined pursuant to subsection (1) must be divided among the property guardians: (a) equally; (b) as agreed by the property guardians; or (c) as determined by the court. (3) If the court has not made an order setting a fee for service, a person appointed pursuant to the Act to act as a personal decision-maker for an adult may charge a fee of $15 for each hour that he or she was engaged in management of the adult’s personal affairs. (4) If the court has not made an order setting a fee for service, a person appointed pursuant to the Act to act as a property co-decision-maker or a temporary property guardian may charge a fee of $15 for each hour that he or she was engaged in management of the adult’s property. 23 Sep 2011 SR 66/2011 s4. Notification of hearing 4 For the purposes of sections 9 and 33 of the Act, notification of a hearing is to be provided by registered mail sent to the address included in the application, consents or statements of objection filed with the court. 13 Jly 2001 cA-5.3 Reg 1 s4. Assessment 5(1) An applicant pursuant to section 6 or 30 of the Act shall provide at least two assessments in Form J of the adult’s capacity for the purposes of section 12 or 38 of the Act. (2) At least two of the assessments provided pursuant to subsection (1) shall be performed by one or more of the following: (a) a duly qualified medical practitioner; (b) a practising member as defined in The Psychologists Act, 1997; (b.1) a registered psychiatric nurse as defined in The Registered Psychiatric Nurses Act. (c) a registered nurse as defined in The Registered Nurses Act, 1988; (d) a practising member as defined in The Occupational Therapists Act, 1997; 6 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING (e) a practising member as defined in The Social Workers Act; (f) a speech-language pathologist as defined in The Speech-Language Pathologists and Audiologists Act. (3) Every assessment provided pursuant to section 12 or 38 of the Act must include the following: (a) the name, address and telephone number of the assessor; (b) the qualifications of the assessor; (b.1) the reasons provided to the assessor for making the assessment; (c) the assessor’s personal relationship to and professional involvement with the adult; (d) the process used in carrying out the assessment, including reference to the assessment tools or methods used, the number of visits with the adult, the results of interviews with caregivers and other professional reports relied on; (e) the assessor’s opinion respecting the adult’s decision-making ability; (e.1) the factors on which the assessor has based his or her opinion respecting the adult’s decision-making ability; (f) the assessor’s opinion respecting the likelihood of change in the adult’s decision-making ability; (g) the assessor’s opinion and recommendation respecting the adult’s need for a co-decision-maker or guardian with respect to specific areas of decision- making. (4) Notwithstanding The Health Information Protection Act, personal health information as defined in that Act may be disclosed by a trustee as defined in that Act without the consent of the subject individual for the purpose of completing an assessment mentioned in subsection (3). 13 Jly 2001 cA-5.3 Reg 1 s5; 28 Jun 2002 SR 49/2002 s3; 16 Sep 2005 SR 96/2005 s3; 3 May 2024 SR 30/2024 s3. Advocacy groups 6(1) With respect to an application relating to an adult with an intellectual disability, the following are prescribed as advocacy groups for the purposes of clause (36(b) of the Act: (a) Family and Friends of Cosmo and Elmwood, Inc. with respect to adults who are residents in a home operated by Elmwood Residences, Inc. of Saskatoon or who are participants in a day program operated by Cosmopolitan Industries in Saskatoon; (b) the Saskatchewan Association for Community Living. (2) With respect to an application relating to an adult over the age of 55, Senior Power, Inc. is prescribed as an advocacy group for the purposes of clause 36(b) of the Act. 13 Jly 2001 cA-5.3 Reg 1 s6. 7 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 Exemption 6.1 The public guardian and trustee is exempted from the requirement to provide an annual accounting mentioned in subsection 54(1) of the Act or a final accounting mentioned in subsection 54.1(1) of the Act. 28 Jun 2002 SR 49/2002 s4; 23 Sep 2011 SR 66/2011 s5. Dispensing with filing of bond 7 For the purposes of clause 55(4)(a) of the Act, the court may dispense with the filing of a bond where the value of the estate does not exceed $10,000. 13 Jly 2001 cA-5.3 Reg 1 s7. Limitations on gifts 7.1(1) Pursuant to clause 63.1(2)(c) of the Act, the total value of all gifts made in an annual accounting period must not exceed $1,000. (2) A property guardian shall not make a gift to himself or herself without the authorization of the court. 23 Sep 2011 SR 66/2011 s6. R.R.S. c.D-25.1 Reg 1 repealed 8 The Dependent Adults Forms Regulations are repealed. 13 Jly 2001 cA-5.3 Reg 1 s8. Coming into force 9(1) Subject to subsection (2), these regulations come into force on the day on which section 1 of The Adult Guardianship and Co-decision-making Act comes into force. 8 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM A [Clause 3(a)] In the King’s Bench Judicial Centre of ________________________________________ Application for Appointment of a Decision-maker other than a Temporary Personal Guardian or Temporary Property Guardian NOTE: The Adult Guardianship and Co-decision-making Act provides that a person served with a copy of this application may file a statement of objection with the court setting out the reasons he or she objects to the application. 1. I, ______________________, of ________________________, __________________________ , apply to be appointed as: (check as appropriate)  personal co-decision-maker for ___________________________________ pursuant to section 14 of The Adult Guardianship and Co-decision-making Act  personal guardian for ___________________________________________ pursuant to section 14 of The Adult Guardianship and Co-decision-making Act  property co-decision-maker for ___________________________________ pursuant to section 40 of The Adult Guardianship and Co-decision-making Act:  with a bond for $ ________________________  without a bond  property guardian for ___________________________________________ pursuant to section 40 of The Adult Guardianship and Co-decision-making Act:  with a bond for $ ________________________  without a bond 1.1 I also apply to have _________________________________________appointed as alternate guardian (if applicable). 2. Personal Decision-Making Authority: (where application is for the appointment of a personal co-decision-maker or personal guardian) (a) I seek the authority to assist the adult with the following: (where application is for the appointment of a personal co-decision-maker - check as appropriate) – or – (a) I seek the authority to make the following decisions for the adult: (where application is for the appointment of a personal guardian - check as appropriate) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall not give the personal co-decision-maker or personal guardian the authority to act with respect to all the matters mentioned below if an order providing particular powers would be sufficient to meet the needs of the adult.  decisions respecting the adult’s living arrangements  decisions respecting access to the adult  decisions respecting the adult’s social activities  decisions respecting the adult’s employment  decisions respecting the adult’s educational, vocational or other training  decisions respecting whether the adult should apply for any licence, permit, approval or other consent or authorization required by law that does not relate to the estate of the adult 9 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1  decisions respecting legal proceedings that do not relate to the estate of the adult  decisions respecting the adult’s health care, including decisions respecting admission to a health care facility or respecting treatment of the adult  decisions respecting the restraint of the adult  normal day-to-day decisions respecting the adult  other: (specify) ____________________________________________________________________________________ __________________________________________________________________________________________________ (b) I request that the following limitations, conditions or requirements apply to the authority requested: (optional) __________________________________________________________________________________________________ __________________________________________________________________________________________________ 3. Property Decision-Making Authority: (where application is for the appointment of a property co-decision-maker or property guardian) (a) I seek the authority to:  assist the adult in making decisions with respect to matters relating to his or her estate (where application is for the appointment of a property co-decision-maker) – or –  make decisions with respect to matters relating to the adult’s estate (where application is for the appointment of a property guardian) (b) I request that the following limitations, conditions or requirements apply to the authority requested: (optional) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall consider whether an order appointing a property co-decision-maker or property guardian should be made subject to limitations, conditions or requirements, including limiting the authority of the property co-decision-maker or property guardian to decisions involving more than a certain dollar amount. _______________________________________________________________________________________________ _______________________________________________________________________________________________ (c) With respect to the requirement of a bond: (check as appropriate) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court may dispense with the requirement to file a bond if the value of the estate does not exceed $10,000 or if the nearest relative and public guardian and trustee consent in writing or in any other situation the court considers appropriate.  I undertake to file a bond in the amount of $ _______________pursuant to section 55 of The Adult Guardianship and Co-decision-making Act (see Form M)  I request an order dispensing with the requirement to file a bond 10 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING 4. Service NOTE: You must include the addresses of the persons listed below that have been served other than the Minister of Social Services and the public guardian and trustee. (a) I have served the following persons with all of the documents filed as part of this application: (check as appropriate)  the adult with respect to whom the application is made  the public guardian and trustee (where application is for the appointment of a property co-decision-maker or property guardian)  the nearest relatives: Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the Minister of Social Services (where the adult is receiving services pursuant to section 10 or 56 of The Child and Family Services Act)  the personal co-decision-maker, personal guardian or temporary personal guardian of the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the property co-decision-maker, property guardian or temporary property guardian of the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the attorney under a power of attorney given by the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the proxy under a health care directive made by the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the supporter nominated by the adult pursuant to section 9 of The Personal Care Homes Regulations, 1996 Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ 11 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1  the person(s) who act(s) as trustee for the purpose of administering financial benefits on behalf of the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  other: (specify) ____________________________________________________________________________________ __________________________________________________________________________________________________ (b) (If applicable) I seek an order stating that I am not required to serve the following persons: NOTE:The Adult Guardianship and Co-decision-making Act provides that the court shall not dispense with service on the adult unless it is satisfied, on the basis of sufficient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ 5. Review I request that the order include the following terms: (check as appropriate)  that the order be reviewed by the court in ________________months  that the order not be reviewed by the court NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall determine whether it is in the best interests of the adult to require a review of the order, and if a review is required, shall specify the period within which the review is to take place. 5.1.Fees I plan to charge a fee and seek:  to receive the following fee for services: $ ________________________ or  to charge fees as set out in the Regulations or  I will not charge a fee 6. Documents Attached The following documents are filed with the court as part of this application: (check as appropriate)  proof of service of application on all persons required to be served  affidavit of proposed co-decision-maker or guardian (Form B)  affidavit of proposed alternate decision-maker (Form B.1) 12 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING  consent(s) of nearest relative(s) to appointment, if applicable without bond, of the proposed co-decision- maker or guardian and affi davit(s) of execution with respect to the consent(s) (Forms E and F)  two or more assessments of the adult’s capacity (Form J)  inventory of the estate of the adult (where application is for the appointment of a property co-decision- maker or property guardian) (Form K)  bond undertaking to properly act as a co-decision-maker or guardian (where application is for the appointment of a property co-decision-maker or property guardian) (Form M)  other: (describe) ___________________________________________________________________________________ __________________________________________________________________________________________________ Dated at _________________________, ____________, this _________ day of ___________________ , 20 __________. ________________________________________________ (Signature of Applicant) Address for service: ___________________________________________________ Phone: _________________________ Fax: ______________________________ E-mail: _______________________________________________________________ Permanent address (if different from address for service): ________________________________________________________________________ Phone: _____________________________ Fax: _____________________________ E-mail: _________________________________________________________________ 28 Jun 2002 SR 49/2002 s5; 16 Sep 2005 SR 96/2005 s4; 23 Sep 2011 SR 66/2011 s7; 3 May 2024 SR 30/2024 s4. 13 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM B [Clause 3(b)] In the King’s Bench Judicial Centre of ________________________________________ Affidavit in Support of an Application for Appointment of a Decision-maker other than a Temporary Personal Guardian or Temporary Property Guardian I, _________________________, of ________________________, _______________________, MAKE OATH AND SAY: 1. THAT I am the applicant and have personal knowledge of the matters deposed to in this affidavit, except where stated to be on information and belief, and where so stated I believe them to be true. 2. THAT I am _______________years of age. 3. THAT I am the _____________________(state relationship) of the adult named in the application (the “adult”). 4. THAT the nearest relative(s) of the adult, other than myself, is (are): Name Address Relationship _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 5. THAT the adult was born on _________________________________ , and is now ________________years of age. 6. THAT the adult currently resides at: Address: ________________________________________________________________________ Phone: __________________________________________________________________________ 7. THAT the current living arrangements of the adult, including the name, address and telephone number of any person, institution or agency providing ongoing support or primary care and assistance to the adult are: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 8. THAT I believe the adult is in need of a _______________________________________for the following reasons: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 9. THAT the adult needs or is likely to need to make the following types of decisions respecting his or her   (check as appropriate) personal/ property needs: (describe why you need the authority requested in your application) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 10. THAT the following resources, including less intrusive forms of support or assistance in decision-making, are available to assist the adult in making the decisions mentioned in paragraph 9: (describe type and frequency of support or assistance) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 14 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING 11. THAT the following alternative ways to assist the adult have been tried or carefully considered: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 12. THAT I believe the wishes of the adult are as follows: (attach written statement of adult’s wishes, if available, including the adult’s wishes with respect to whether the authority requested should be granted and whether the proposed co-decision-maker or guardian is acceptable to him or her; indicate date signed, if possible) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 13. THAT I believe I would be a suitable __________________________________________for the following reasons: (where the deponent is not the public guardian and trustee) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   14. THAT I (check as appropriate) have/ have not been appointed as a decision-maker for another person pursuant to The Dependent Adults Act or The Adult Guardianship and Co-decision-making Act (where the deponent is not the public guardian and trustee). Details, including name and address of adult, date of order, authority granted and fees for services received: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   15. THAT I (check as appropriate) have/ have not been in a relationship of financial trust with another person, including under a power of attorney. Details: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   16. THAT I (check as appropriate) have/ have not been convicted of, or received a pardon for, a criminal offence relating to assault, sexual assault or other acts of violence, intimidation, criminal harassment, uttering threats, theft or fraud. (attach criminal record check completed by your local police service). Details: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   17. THAT I (check as appropriate) have/ have not been a respondent pursuant to The Victims of Domestic Violence Act or a defendant pursuant to a section of the Criminal Code relating to securing a peace bond. Details: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 15 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1   18. THAT I (check as appropriate) have/ have not applied for or been petitioned into bankruptcy. Details, including the status or outcome of that application or petition: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 19. Repealed. 3 May 2024 SR 30/2024 s4. 20. THAT my general plan with respect to the adult or the adult’s estate is as follows: (a) I plan to take the following actions: _______________________________________________________________ ____________________________________________________________________________________________________; (b) I plan to make the following decisions with respect to the adult’s estate: _____________________________ _____________________________________________________________________________________________________ 21. THAT the estimated value of the adult’s estate is as follows: (where application is for the appointment of a property co-decision-maker or property guardian) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 22. THAT the adult’s property is currently managed as follows: (where application is for the appointment of a property co-decision-maker or property guardian) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 23. (If applicable) THAT I request an order dispensing with the requirement to file a bond pursuant to section 55 of The Adult Guardianship and Co-decision-making Act for the following reasons: (where application is for the appointment of a property co-decision-maker or property guardian) (attach consent of nearest relative or public guardian and trustee, if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 24. (If applicable) THAT the reasons I seek an order stating that I am not required to serve the following persons are: NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall not dispense with service on the adult unless it is satisfied, on the basis of sufficient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Reason for dispensing with service: ________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 16 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Reason for dispensing with service: ________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 25. THAT attached are the following exhibits, marked A to _________ , all of which I believe to be true copies of the originals: (check as appropriate)  power of attorney given by the adult (where order appointing property co-decision-maker or property guardian is requested)  health care directive made by the adult (where order appointing personal co-decision-maker or personal guardian with authority respecting health care decisions is requested)  last will and testament made by the adult (where order appointing property co-decision-maker or property guardian is requested)  written statement of the adult’s wishes  other: (describe) ___________________________________________________________________________________ __________________________________________________________________________________________________ 26. THAT no other application, other than the following, has been made to this court for the appointment of a personal co-decision-maker, personal guardian, property co-decision-maker or property guardian for the adult, to the best of my information and belief: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 27. THAT I am not aware of any conflict of interest that presently exists or will exist if I should be so appointed. 27.1. THAT I understand that I must account annually to the court and the public guardian and trustee (if application is for the appointment of a property co-decision-maker or property guardian) 28. THAT I will undertake, on my appointment as co-decision-maker or guardian, to exercise the duties and powers assigned to me by the court diligently, in good faith and in the best interests of the adult. I will exercise my powers and duties in a way that encourages the adult to participate as fully as possible in decision-making and to act independently in all matters where he or she is able. I will protect the adult’s civil and human rights and limit my interference in his or her life to the greatest extent possible. 29. THAT I make this affidavit in support of an application pursuant to The Adult Guardianship and Co-decision-making Act for an Order appointing me as the ______________________________________________ for _________________________________________________________________________________________________. NOTE: If there is more than one applicant, each needs to complete Form B. SWORN before me at _________________________) Saskatchewan, this _______________________ day) of ________________________________, 20 ________) ________________________________________________ (Signature of Applicant) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires _______________________ 28 Jun 2002 SR 49/2002 s6; 23 Sep 2011 SR 66/2011 s8; 3 May 2024 SR 30/2024 s4. 17 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM B.1 [Clause 3(b.1)] In the King’s Bench Judicial Centre of ________________________________________ Affidavit in Support of an Application for Appointment of an Alternate Decision-Maker I, ___________________________________ , of ________________, ________ , MAKE OATH AND SAY (OR DECLARE): 1. THAT I am the applicant and have personal knowledge of the matters deposed to in this affidavit, except where stated to be on information and belief, and where so stated I believe them to be true. 2. THAT I am ________________ years of age. 3. THAT I am the _____________________________________ of the adult named in the application (the ‘adult’). (state relationship) 4. THAT I believe I would be a suitable alternate ____________________________________________________________ (type of decision-maker) for the following reasons (if the deponent is not the public guardian and trustee): 5. THAT I (check as appropriate)  have /  have not been appointed as a decision-maker for another person pursuant to The Dependent Adults Act or The Adult Guardianship and Co-decision-making Act (if the deponent is not the public guardian and trustee). Details, including name and address of adult, date of order, authority granted and fees for services received: (if applicable) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 6. THAT I (check as appropriate)  have /  have not been in a relationship of financial trust with another person, including under a power of attorney. Details: (if applicable) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 7. THAT I (check as appropriate)  have /  have not been convicted of, or received a pardon for, a criminal offence relating to assault, sexual assault or other acts of violence, intimidation, criminal harassment, uttering threats, theft or fraud. Details: (if applicable) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ NOTE: Attach a copy of a criminal record check completed by your local police service. 8. THAT I (check as appropriate)  have /  have not been a respondent pursuant to The Victims of Domestic Violence Act or a defendant pursuant to a section of the Criminal Code relating to securing a peace bond. Details: (if applicable) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 18 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING 9. THAT I (check as appropriate)  have /  have not applied for or been petitioned into bankruptcy. Details, including the status or outcome of that application or petition: (if applicable) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 10. Repealed. 3 May 2024 SR 30/2024 s4. 11. THAT I am not aware of any conflict of interest that presently exists or will exist if I should be so appointed. 12. THAT I will undertake, on my appointment as alternate _______________________________, to exercise the duties and powers assigned to me by the court diligently, in good faith and in the best interests of the adult. If called upon to act as a decision-maker, I will exercise my powers and duties in a way that encourages the adult to participate as fully as possible in decision-making and to act independently in all matters where he or she is able. I will protect the adult’s civil and human rights and limit my interference in his or her life to the greatest extent possible. 13. THAT I make this affidavit in support of an application pursuant to The Adult Guardianship and Co-decision-making Act for an Order appointing me as the alternate ____________ for ________________________. SWORN (OR DECLARED) before me at __________________________________) Saskatchewan, this _______________________ day) of ________________________________, 20 ________) ________________________________________________ (Signature of Applicant) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires ______________________ 23 Sep 2011 SR 66/2011 s9; 3 May 2024 SR 30/2024 s4. 19 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM C [Clause 3(c)] In the King’s Bench Judicial Centre of ________________________________________ Application for Confirmation of a Testamentary Nomination (Appointment by Will) 1. I, _____________________________________________ , of _____________________________, _____________ , apply for confirmation of a testamentary nomination as: (check as appropriate)  personal co-decision-maker for ________________________________________________  personal guardian for ________________________________________________________  property co-decision-maker for ________________________________________________  property guardian for ________________________________________________________ 2. Property Decision-Making Authority: (where application is for the confirmation of a testamentary nomination as a property co-decision-maker or property guardian) With respect to the requirement of a bond: (check as appropriate) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court may dispense with the requirement to file a bond if the value of the estate does not exceed $10,000 or if the nearest relative and public guardian and trustee consent in writing or in any other situation the court considers appropriate.  I undertake to file a bond in the amount of $ _____________________ pursuant to section 55 of The Adult Guardianship and Co-decision-making Act (see Form M)  I request an order dispensing with the requirement to file a bond 3. Service NOTE: You must include the addresses of the persons listed below that have been served other than the Minister of Social Services and the public guardian and trustee. (a) I have served the following persons with all of the documents filed as part of this application: (check as appropriate)  the adult with respect to whom the application is made  the public guardian and trustee (where application is for the appointment of a property co-decision-maker or property guardian)  the nearest relatives Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the Minister of Social Services (where the adult is receiving services under section 10 or 56 of The Child and Family Services Act) 20 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING  the personal co-decision-maker, personal guardian or temporary personal guardian of the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the property co-decision-maker, property guardian or temporary property guardian of the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the attorney under a power of attorney given by the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the proxy under a health care directive made by the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  the supporter nominated by the adult pursuant to section 9 of The Personal Care Homes Regulations, 1996 Name: ___________________________________________________________________________________________ Relationship:

_____________________________________________________________________________________  the person(s) who act(s) as trustee for the purpose of administering financial benefits on behalf of the adult Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________  other: (specify) ____________________________________________________________________________________ __________________________________________________________________________________________________ (b) (If applicable) I seek an order stating that I am not required to serve the following persons: NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall not dispense with service on the adult unless it is satisfied, on the basis of sufficient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ Name: ___________________________________________________________________________________________ Relationship: _____________________________________________________________________________________ 21 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 4. Review I request that the order include the following terms: (check as appropriate)  that the order be reviewed by the court in ___________months  that the order not be reviewed by the court NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall determine whether it is in the best interests of the adult to require a review of the order, and if a review is required, shall specify the period within which the review is to take place. 4.1.Fees I plan to charge a fee and seek:  to receive the following fee for services: $ ________________________ or  to charge fees as set out in the Regulations or  I will not charge a fee 5. Documents Attached The following documents are filed with the court as part of this application: (check as appropriate)  court-certified or notarial copy of the last will and testament of the previous co-decision-maker or guardian of the adult  court-certified copy of the order appointing a co-decision-maker or guardian for the adult  proof of service of application on all persons required to be served  affidavit of proposed co-decision-maker or guardian (Form D)  consent(s) of nearest relative(s) to confirmation, if applicable without bond, of the testamentary nomination of the proposed co-decision-maker or guardian and affidavit(s) of execution with respect to the consent(s) (Forms E and F)  bond undertaking to properly act as a co-decision-maker or guardian, if applicable (where application is for the confirmation of a testamentary nomination as a property co-decision-maker or property guardian) (Form M)  other: (describe) ___________________________________________________________________________________ __________________________________________________________________________________________________ Dated at _________________________, ____________, this _________ day of ___________________ , 20 __________. ________________________________________________ (Signature of Applicant) Address for service: ___________________________________________________ Phone: _________________________ Fax: ______________________________ E-mail: _______________________________________________________________ Permanent address (if different from address for service): ________________________________________________________________________ Phone: _____________________________ Fax: _____________________________ E-mail: _________________________________________________________________ 28 Jun 2002 SR 49/2002 s7; 16 Sep 2005 SR 96/2005 s4; 23 Sep 2011 SR 66/2011 s10; 3 May 2024 SR 30/2024 s4. 22 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM D [Clause 3(d)] In the King’s Bench Judicial Centre of ________________________________________ Affidavit in Support of an Application for Confirmation of a Testamentary Nomination (Appointment by Will) I, ______________________________________________, of _______________________________, ____________, MAKE OATH AND SAY: 1. THAT I am the applicant and have personal knowledge of the matters deposed to in this affidavit, except where stated to be on information and belief, and where so stated I believe them to be true. 2. THAT I have been nominated in the will of _______________________________, who died on _______________, to act in that person’s place as the ____________________ for _________________________________(the “adult”), and have been so acting since that person’s death. 3. THAT I notified the public guardian and trustee of the above on ______________ (where application is for the confirmation of a property co-decision-maker or property guardian). 4. THAT I am _______________years of age. 5. THAT I am the ____________________________________(state relationship) of the adult. 6. THAT the nearest relative(s) of the adult, other than myself, is (are): Name Address Relationship _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 7. THAT the adult was born on ________________________, and is now __________________________years of age. 8. THAT the adult currently resides at: Address: ________________________________________________________________________ Phone: __________________________________________________________________________ 9. THAT the current living arrangements of the adult, including the name, address and telephone number of any person, institution or agency providing ongoing support or primary care and assistance to the adult are: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 10. THAT I believe the wishes of the adult are as follows: (attach written statement of adult’s wishes, if available, including the adult’s wishes with respect to whether the authority requested should be granted and whether the proposed co-decision-maker or guardian is acceptable to him or her; indicate date signed, if possible) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 11. THAT I believe I would be a suitable __________________________________________for the following reasons: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 23 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1   12. THAT I (check as appropriate) have/ have not been appointed as a decision-maker for another person pursuant to The Dependent Adults Act or The Adult Guardianship and Co-decision-making Act. Details, including name and address of adult, date of order, authority granted and fees for services received: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   13. THAT I (check as appropriate) have/ have not been in a relationship of financial trust with another person, including under a power of attorney. Details: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   14. THAT I (check as appropriate) have/ have not been convicted of, or received a pardon for, a criminal offence relating to assault, sexual assault or other acts of violence, intimidation, criminal harassment, uttering threats, theft or fraud (attach criminal record check completed by your local police service). Details: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   15. THAT I (check as appropriate) have/ have not been a respondent pursuant to The Victims of Domestic Violence Act or a defendant pursuant to a section of the Criminal Code relating to securing a peace bond. Details: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________   16. THAT I (check as appropriate) have/ have not applied for or been petitioned into bankruptcy. Details, including the status or outcome of that application or petition: (if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 17. THAT I am able to carry out my duties as __________________________________in a satisfactory manner, for the following reasons: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 18. THAT my general plan with respect to the adult or the adult’s estate is as follows: (a) I plan to take the following actions: _______________________________________________________________ _____________________________________________________________________________________________________ ____________________________________________________________________________________________________; 24 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING (b) I plan to make the following decisions with respect to the adult’s estate: _____________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 19. (If applicable) THAT I request an order dispensing with the requirement to file a bond pursuant to section 55 of The Adult Guardianship and Co-decision-making Act for the following reasons: (where application is for the appointment of a property co-decision-maker or property guardian) (attach consent of nearest relative or public guardian and trustee, if applicable) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 20. (If applicable) THAT the reasons I seek an order stating that I am not required to serve the following persons are: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Name: _______________________________________________________________________________________________ Relationship: _________________________________________________________________________________________ Reason for dispensing with service: ____________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Name: _______________________________________________________________________________________________ Relationship: _________________________________________________________________________________________ Reason for dispensing with service: ____________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 21. THAT attached are the following exhibits, marked A to _________ , all of which I believe to be true copies of the originals: (check as appropriate)  written statement of the adult’s wishes  other: (describe) __________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 22. THAT no other application, other than the following, has been made to this court for the appointment or confirmation of a personal co-decision-maker, personal guardian, property co-decision-maker or property guardian for the adult, to the best of my information and belief: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 23. THAT I am not aware of any conflict of interest that presently exists or will exist if I should be so confirmed. 23.1. THAT I understand that I must account annually to the court and the public guardian and trustee (where application for the appointment of a property co-decision-maker or property guardian) 25 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 24. THAT I will undertake, on my appointment as co-decision-maker or guardian, to exercise the duties and powers assigned to me by the court diligently, in good faith and in the best interests of the adult. I will exercise my powers and duties in a way that encourages the adult to participate as fully as possible in decision-making and to act independently in all matters where he or she is able. I will protect the adult’s civil and human rights and limit my interference in his or her life to the greatest extent possible. 25. THAT I make this affidavit in support of an application pursuant to The Adult Guardianship and Co-decision-making Act for an Order confirming me as the _____________ for ____________________________ . SWORN before me at _________________________) Saskatchewan, this _______________________ day) of ________________________________, 20 ________) ________________________________________________ (Signature of Applicant) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires _______________________ 28 Jun 2002 SR 49/2002 s8; 23 Sep 2011 SR 66/2011 s11; 3 May 2024 SR 30/2024 s4. 26 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM E [Clause 3(e)] In the King’s Bench Judicial Centre of ________________________________________ Consent by Nearest Relative to Appointment of a Co-decision-maker or Guardian or to Confirmation of a Testamentary Nomination (Appointment by Will) I, _____________________________________, of _________________________________________, ___________________, the__________________________________(state relationship) of the adult named in the application, consent to the appointment or confirmation of ________________________________________________________________________as:  personal co-decision-maker for ____________________  personal guardian for ____________________________  property co-decision-maker for ___________________:  with a bond for $ _____________________________  without a bond  property guardian for ___________________________:  with a bond for $ _____________________________  without a bond Dated at _________________________, ____________, this _________ day of ___________________ , 20 __________. ___________________________________________________ ________________________________________________ (Witness) (Signature of Consenting Nearest Relative) Address for service: ___________________________________________________ Phone: _________________________ Fax: ______________________________ E-mail: _______________________________________________________________ Permanent address (if different from address for service): ________________________________________________________________________ Phone: _____________________________ Fax: _____________________________ E-mail: _________________________________________________________________ 28 Jun 2002 SR 49/2002 s9; 16 Sep 2005 SR 96/2005 s4; 3 May 2024 SR 30/2024 s4. 27 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM F [Clause 3(f)] In the King’s Bench Judicial Centre of ________________________________________ Affidavit of Execution I, ________________________________, (print full name of witness) of ____________________________ , __________, MAKE OATH AND SAY: 1. THAT I was present and saw__________________________________________________________________ , who is personally known to me to be the person named in the “Consent by Nearest Relative to Appointment of a Co- decision-maker or Guardian or to Confirmation of a Testamentary Nomination” (Form E), duly sign and execute the same for the purposes named in that document. 2. THAT the same was executed at ________________________________________, ____________________________, and that I am the subscribing witness. 3. THAT I know the said ________________________________and he/she is in my belief 18 years of age or more. SWORN before me at _________________________) Saskatchewan, this _______________________ day) of ________________________________, 20 ________) ________________________________________________ (Signature of Witness) _________________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires __________________________ 28 Jun 2002 SR 49/2002 s9; 3 May 2024 SR 30/2024 s4. 28 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM G [Clause 3(g)] In the King’s Bench Judicial Centre of ________________________________________ Statement of Objection NOTE: The Adult Guardianship and Co-decision-making Act requires the filing of this statement of objection within 10 days after the last person is served with an application for the appointment of a co-decision-maker or guardian. I, ______________________________________________, of _______________________________, _____________, object to the application for an Order for the appointment of _________________________________ as _______________for (the “adult”) pursuant to The Adult Guardianship and Co-decision-making Act. My relationship to the adult is that of _______________________________________________. The reasons for my objection are as follows: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ Dated at _________________________, ____________, this _________ day of ___________________ , 20 __________. ________________________________________________ (Signature of Objector) Address for service: ___________________________________________________ Phone: _________________________ Fax: ______________________________ E-mail: _______________________________________________________________ Permanent address (if different from address for service): ________________________________________________________________________ Phone: _____________________________ Fax: _____________________________ E-mail: _________________________________________________________________ 16 Sep 2005 SR 96/2005 s4; 3 May 2024 SR 30/2024 s4. 29 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM H [Clause 3(h)] In the King’s Bench Judicial Centre of ________________________________________ Application for Appointment of a Temporary Personal Guardian or Temporary Property Guardian 1. I, ___________________________________________, of _______________________________, ___________________, apply to be appointed as: (check as appropriate)  temporary personal guardian for _________________________________________ for a period of ___________ (not to exceed six months), pursuant to section 19 of The Adult Guardianship and Co-decision-making Act  temporary property guardian for _________________________________________ or a period of ____________ (not to exceed six months), pursuant to section 44 of The Adult Guardianship and Co-decision-making Act 2. Personal Decision-Making Authority: (where application is for the appointment of a temporary personal guardian) (a) I seek the authority to make the following decisions for the adult: (check as appropriate) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall restrict the authority of a temporary personal guardian to those matters mentioned in section 15 of the Act that are necessary to protect the adult from serious physical or mental harm.  decisions respecting the adult’s living arrangements  decisions respecting access to the adult  decisions respecting the adult’s social activities  decisions respecting the adult’s employment  decisions respecting the adult’s educational, vocational or other training  decisions respecting whether the adult should apply for any licence, permit, approval or other consent or authorization required by law that does not relate to the estate of the adult  decisions respecting legal proceedings that do not relate to the estate of the adult  decisions respecting the adult’s health care, including decisions respecting admission to a health care facility or respecting treatment of the adult  decisions respecting the restraint of the adult  normal day-to-day decisions respecting the adult  other: (specify) ____________________________________________________________________________________ __________________________________________________________________________________________________ (b) I request that the following limitations, conditions or requirements apply to the authority requested: (optional) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 30 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING 3. Property Decision-Making Authority: (where application is for the appointment of a temporary property guardian) (a) I seek the authority to do only those things relating to the adult’s estate that are necessary to protect the adult’s estate from serious damage or loss and to provide the adult with the necessaries of life. (b) I specifically request the authority: (check as appropriate)  to instruct any financial institution where the adult has an account that no funds are to be withdrawn from the account until further notice  to direct any source of the adult’s income to send the income to an account that is the subject of an instruction pursuant to the above item  to stop any disposition of the adult’s estate or direct that the proceeds of a disposition be paid into court  other: (specify) ____________________________________________________________________________________ __________________________________________________________________________________________________ (c) I request that the following limitations, conditions or requirements apply to the authority requested: (optional) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ (d) with respect to the requirement for a bond (if the application is for appointment of a temporary property guardian) (check as appropriate):  I undertake to file a bond in the amount of $ __________________pursuant to section 44 of the Act; or  I will not file a bond because ___________________________________________________________________ NOTE: A bond is not required if the estate is valued below $10,000. 4. Service I have served the following persons with all of the documents filed as part of this application: (check as appropriate)  the adult with respect to whom the application is made  the public guardian and trustee (where application is for the appointment of a temporary property guardian)  other: (specify) ____________________________________________________________________________________ __________________________________________________________________________________________________ 5. Review I request that the order include the following terms: (check as appropriate)  that the order be reviewed by the court in ________________months  that the order not be reviewed by the court NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall determine whether it is in the best interest of the adult to require a review of the order, and if a review is required, shall specify the period within which the review is to take place. 5.1. Fees I plan to charge a fee and seek:  to receive the following fee for services: $ ________________________ or  to charge fees as set out in the Regulations or  I will not charge a fee 31 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 6. Documents Attached The following documents are fi led with the court as part of this application: (check as appropriate)  proof of service of application on all persons required to be served  affi davit of proposed temporary guardian (Form I)  other: (describe) ___________________________________________________________________________________ __________________________________________________________________________________________________ Dated at _________________________, ____________, this _________ day of ___________________ , 20 __________. ________________________________________________ (Signature of Applicant) Address for service: ___________________________________________________ Phone: _________________________ Fax: ______________________________ E-mail: _______________________________________________________________ Permanent address (if different from address for service): ________________________________________________________________________ Phone: _____________________________ Fax: _____________________________ E-mail: _________________________________________________________________ 28 Jun 2002 SR 49/2002 s10; 16 Sep 2005 SR 96/2005 s4; 23 Sep 2011 SR 66/2011 s12; 3 May 2024 SR 30/2024 s4. 32 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM I [Clause 3(i)] In the King’s Bench Judicial Centre of ________________________________________ Affidavit in Support of an Application for the Appointment of a Temporary Personal Guardian or Temporary Property Guardian I, _____________________________________, of __________________________________, ___________________, MAKE OATH AND SAY: 1. THAT I am the applicant and have personal knowledge of the matters deposed to in this affidavit, except where stated to be on information and belief, and where so stated I believe them to be true. 2. THAT I am _______________years of age. 3. THAT I am the _____________________(state relationship) of the adult named in the application (the “adult”). 4. THAT the nearest relative(s) of the adult, other than myself, is (are): Name Address Relationship _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 5. THAT the adult was born on _________________________________ , and is now ________________years of age. 6. THAT the adult currently resides at: Address: _____________________________________________________________________________________________ Phone: _______________________________________________________________________________________________ 7. THAT the current living arrangements of the adult, including the name, address and telephone number of any person, institution or agency providing ongoing support or primary care and assistance to the adult are: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 8. THAT I believe the adult is in need of a temporary ____________________guardian for the following reasons: (describe adult’s difficulty with decision-making and why an immediate appointment is necessary) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 9. THAT I believe I would be a suitable _________________________________guardian for the following reasons: (where the deponent is not the public guardian and trustee) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 10. THAT the adult’s property that is at risk is as follows: (where application is for the appointment of a temporary property guardian) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 33 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 11. THAT the adult’s property is currently managed as follows: (where application is for the appointment of a temporary property guardian) _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 12. THAT no other application, other than the following, has been made to this court for the appointment of a temporary personal guardian or temporary property guardian for the adult, to the best of my information and belief: _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________ 13. THAT I am not aware of any confl ict of interest that presently exists or will exist if I should be so appointed. 13.1. THAT I undertake to fi le a bond as required by the court. 14. THAT I will undertake, on my appointment as temporary guardian, to exercise the duties and powers assigned to me by the court diligently, in good faith and in the best interests of the adult. I will exercise my powers and duties in a way that encourages the adult to participate as fully as possible in decision-making and to act independently in all matters where he or she is able. I will protect the adult’s civil and human rights and limit my interference in his or her life to the greatest extent possible. 15. THAT I make this affi davit in support of an application pursuant to The Adult Guardianship and Co-decision-making Act for an Order appointing me as temporary ________________________________________ guardian for ________________________________________________________________________________________. SWORN before me at _________________________) Saskatchewan, this _______________________ day) of ________________________________, 20 ________) ________________________________________________ (Signature of Applicant) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires _______________________ 28 Jun 2002 SR 49/2002 s11; 23 Sep 2011 SR 66/2011 s13; 3 May 2024 SR 30/2024 s4. 34 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM J [Clause 3(j) and Section 5] In the King’s Bench Judicial Centre of ______________________________________________________ Affidavit re Assessment of Adult’s Capacity I, ______________________________________________________________, of _____________________, _______________, MAKE OATH AND SAY: 1. THAT I am a _______________________________________________________________and have assessed the capacity (occupation) of ______________________________________________________________________ to make decisions with respect to:  personal matters  property matters (“Capacity” is defined in The Adult Guardianship and Co-decision-making Act as the ability: (i) to understand information relevant to making a decision; and (ii) to appreciate the reasonably foreseeable consequences of making or not making a decision.) 2. THAT the information contained in this assessment form is, to the best of my ability, true and accurate. NOTE: The disclosure of personal health information is in accordance with subsection 5(4) of these regulations and may be disclosed by a trustee, in accordance with clause 27(4)(l) of The Health Information Protection Act, without the consent of the subject individual for the purpose of completing the assessment. 3. THAT my address and telephone number are as follows: Address: ________________________________________________________________________________________________ Phone: __________________________________________________________________________________________________ 4. THAT my qualifications are as follows: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 5. THAT the reasons provided by the applicant to me for making this assessment are as follows: (Describe the issues that have led to the assessment, e.g., financial mismanagement by the adult; medical or nutritional neglect; disorientation or wandering.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 6. THAT my personal relationship to and/or professional involvement with the adult is as follows: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 35 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 7. THAT in making this capacity assessment, I have followed the following process: (Describe assessment tools or methods used, number of visits with adult, results of interviews with caregivers, other professional reports relied on, etc. You may attach copies of any reports or other documents supporting the assessment.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 8. THAT in my opinion the adult’s decision-making ability is as follows: (Describe the adult’s decision-making ability and support required.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 9. THAT I base my opinion on the following factors: (Describe the evidence relating to the adult’s decision-making ability on which you have based your decision.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 10. THAT in my opinion the likelihood of change in the adult’s decision-making ability is as follows: (Include reasons.) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 11. THAT in my opinion the adult requires a personal co-decision-maker: (If the application is for the appointment of a personal co-decision-maker or personal guardian, check as appropriate.) NOTE: A person requiring a personal co-decision-maker is a person whose capacity is impaired to the extent that he or she requires assistance in decision-making in order to make reasonable decisions with respect to the matters listed below.  to assist in making decisions respecting the adult’s living arrangements  to assist in making decisions respecting access to the adult  to assist in making decisions respecting the adult’s social activities  to assist in making decisions respecting the adult’s employment  to assist in making decisions respecting the adult’s educational, vocational or other training  to assist in making decisions respecting whether the adult should apply for any licence, permit, approval or  other consent or authorization required by law that does not relate to the estate of the adult  to assist in making decisions respecting legal proceedings that do not relate to the estate of the adult  to assist in making decisions respecting the adult’s health care, including decisions respecting admission to a  health care facility or respecting treatment of the adult  to assist in making decisions respecting the restraint of the adult  to assist in making normal day-to-day decisions respecting the adult  other: (specify) _______________________________________________________________________________________ ________________________________________________________________________________________________________ 36 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING 12. THAT in my opinion the adult requires a personal guardian: (If the application is for the appointment of a personal co-decision-maker or personal guardian, check as appropriate.) NOTE: A person requiring a personal guardian is a person whose capacity is impaired to the extent that he or she is unable to make reasonable decisions with respect to the matters listed below.  to make decisions respecting the adult’s living arrangements  to make decisions respecting access to the adult  to make decisions respecting the adult’s social activities  to make decisions respecting the adult’s employment  to make decisions respecting the adult’s educational, vocational or other training  to make decisions respecting whether the adult should apply for any licence, permit, approval or other consent  or authorization required by law that does not relate to the estate of the adult  to make decisions respecting legal proceedings that do not relate to the estate of the adult  to make decisions respecting the adult’s health care, including decisions respecting admission to a health care  facility or respecting treatment of the adult NOTE: A clear direction set out in a health care directive will take precedence over the decision of a personal guardian. As well, unless a court decides otherwise, the decision of a proxy appointed in a health care directive will take precedence over the decision of a personal guardian.  to make decisions respecting the restraint of the adult  to make normal day-to-day decisions respecting the adult  other: (specify) _______________________________________________________________________________________ ________________________________________________________________________________________________________ 13. THAT I make the following recommendation respecting the adult’s need for a personal co-decision-maker or personal guardian: (Complete this section if the application is for the appointment of a personal co-decision-maker or personal guardian.) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall not give the personal co-decision-maker or personal guardian the authority to act with respect to all the matters mentioned above if an order providing particular powers would be sufficient to meet the needs of the adult. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 14. That in my opinion the adult: (If the application is for the appointment of a property co-decision-maker or property guardian, check as appropriate.) NOTE: A person requiring a property co-decision-maker is a person whose capacity is impaired to the extent that he or she requires assistance in decision-making in order to make reasonable decisions with respect to matters relating to his or her estate. A person requiring a property guardian is a person whose capacity is impaired to the extent that he or she is unable to make reasonable decisions with respect to matters relating to his or her estate.  requires a property co-decision-maker to assist in making decisions with respect to matters relating to his or  her estate  requires a property guardian to make decisions with respect to matters relating to his or her estate 37 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 15. THAT I make the following recommendation respecting the adult’s need for a property co-decision-maker or property guardian: (Complete this section if the application is for the appointment of a property co-decision-maker or property guardian.) NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall consider whether an order appointing a property co-decision-maker or property guardian should be made subject to limitations, conditions or requirements, including limiting the authority of the property co-decision-maker or property guardian to decisions involving more than a certain dollar amount. _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 16. (Optional) THAT in my opinion, without the appointment I have recommended, the following consequences are likely to occur: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ SWORN before me at _____________________ , } Saskatchewan, this ___________________ day } of _________________________, 20 _________ } __________________________________________________ (Signature of Assessor) _________________________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires __________________________________ 16 Sep 2005 SR 96/2005 s4; 3 May 2024 SR 30/2024 s4. 38 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM K [Clause 3(k)] In the King’s Bench Judicial Centre of ___________________________________ Statement of Inventory re Application for Appointment of a Property Co-decision-maker Or Property Guardian I, ______________________________________________________, of ____________________________ , ______________, MAKE OATH AND SAY THAT the information in this Statement of Inventory is true and complete to the best of my knowledge and belief, and sets out all of the assets and debts of _____________________________________________________ (name of adult) as of ____________________________________ (date). SWORN before me at _________________________ ) Saskatchewan, this _________________day ______ ) of ________________________________, 20 _______) _______________________________ (Signature of Applicant) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires ______________________ NOTE: The inventory must be filed with the court and the Public Guardian and Trustee. ASSETS OF THE ADULT A. Financial Institution Accounts Financial Institution Account Number Jointly Owned With Value (if applicable) ___________________________________________________________________________________________ 1. 2. 3.

Total Value: B. Term Deposits Financial Institution Interest Rate Maturity Date Jointly Owned With Face Value (if applicable) __________________________________________________________________________________________ 1. 2. 3. Total Value: 39 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 C. Uncashed Cheques Issuer Jointly Payable to Value (if applicable) __________________________________________________________________________________________ 1. 2. 3. Total Value: D. Cash on Hand Total Value: E. Real Estate Legal description Jointly Owned With: Value (if applicable) __________________________________________________________________________________________ 1. 2. 3. Total Value: F. Stocks and Investment Funds Company Number of Shares or Units Jointly Owned With Value (if applicable) __________________________________________________________________________________________ 1. 2. 3. Total Value: G. Bonds Issuer Interest Rate Maturity Date Jointly Owned With FaceValue (if applicable) __________________________________________________________________________________________ 1. 2. 3. Total Value: H. RRSP, RRIF Company Description/Policy Number Value ___________________________________________________________________________ 1. 2. 3. Total Value: 40 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING I. Life Insurance (owned by the adult or where the adult is beneficiary) Company Description/Policy Number Value ___________________________________________________________________________ 1. 2. 3. Total Value: J. Vehicles Description Jointly Owned With Value (if applicable) ___________________________________________________________________________ 1. 2. 3. Total Value: K. Other Personal Property Description Jointly Owned With Value (if applicable) ___________________________________________________________________________ 1. 2. 3. Total Value: TOTAL VALUE OF ABOVE-LISTED ASSETS (A+B+C+D+E+F+G+H+I+J+K): L. Monthly Payments Received by the Adult (annuities, pensions, salary) Paid By Description Jointly Owned With Monthly Amount (if applicable) ___________________________________________________________________________________ 1. 2. 3. Total Monthly Amount: M. Funds Held in a Discretionary Trust for the Benefit of the Adult Estate of Trustee Amount ________________________________________________________________ 1. 2. 3. 41 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 DEBTS OF THE ADULT A. Financial Institution Loans Owing to Description Security Held, if any Amount Owing _________________________________________________________________________________ 1. 2. 3. Total Amount Owing: B. Credit Cards Owing to Description Amount Owing ________________________________________________________________________________ 1. 2. 3. Total Amount Owing: C. Mortgages Owing to Description Security Held, if any Amount Owing ___________________________________________________________________________ 1. 2. 3. Total Amount Owing: D. Other Debts Owing to Description Security Held, if any Amount Owing: ___________________________________________________________________________ 1. 2. 3. Total Amount Owing: TOTAL AMOUNT OF ABOVE-LISTED DEBTS (A+B+C+D): MONTHLY EXPENSES OF THE ADULT Food $ _________________”. Rent or mortgage payment $ _________________”. Utilities $ _________________”. Clothing $ _________________”. Medication $ _________________”. Transportation $ _________________”. Insurance $ _________________”. Incidentals $ _________________”. Other $ _________________”. Total $ _________________”. 42 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM L [Clause 3(l)] In the King’s Bench Judicial Centre of ____________________________________ Annual Accounting by Property Co-decision-maker or Property Guardian I, ________________________________________, of ________________________ , __________________________, MAKE OATH AND SAY: 1. THAT I am the _______________________________________(property co-decision-maker/property guardian) for __________________________________________(the “adult”). 2. THAT the information set out in this Annual Accounting of the adult’s property is true and complete to the best of my knowledge and belief, and is for the period from _______to ________(period of accounting). SWORN before me at _____________________) Saskatchewan, this ________________ day) of ____________________________ , 20 _____) ____________________________________________________ (Signature of Property Co-decision-maker or Property Guardian) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires ______________________ A. Funds Received: Date Received Received From Description Amount 1. 2. 3. 4. 5. 6. 7. 8. Total Funds Received: 43 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 B. Funds Spent: Date Spent Paid To Description Amount _____________________________________________________________________________ 1. 2. 3. 4. 5. 6. 7. 8. Total Funds Spent: Attach statement of inventory (Form K) updated to the end of the accounting period. 16 Sep 2005 SR 96/2005 s4; 23 Sep 2011 SR 66/2011 s14; 3 May 2024 SR 30/2024 s4. 44 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM L.1 [Clause 3(l)] In the King’s Bench Judicial Centre of ____________________________________ Final Accounting by Property Co-decision-maker or Property Guardian I, ________________________________________, of ________________________ , __________________________, MAKE OATH AND SAY: 1. THAT I was the __________________________________________________________________(type of guardian) for ________________________________between ________________________and ________________________ . (adult’s name) (dates) 2. THAT the information set out in this Final Accounting of the adult’s property is true and complete to the best of my knowledge and belief, and is for the period from _________________to __________________. (period of accounting). SWORN (OR DECLARED) before me at _____________________) Saskatchewan, this ________________ day) of ____________________________ , 20 _____) ____________________________________________________ (Signature of Property Co-decision-maker or Property Guardian) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires ______________________ A. Funds Received: Date Received Received From Description Amount 1. 2. 3. 4. 5. 6. 7. 8. Total Funds Received: 45 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 B. Funds Spent: Date Spent Paid To Description Amount _____________________________________________________________________________ 1. 2. 3. 4. 5. 6. 7. 8. Total Funds Spent: Attach statement of inventory (Form K) updated to the end of the accounting period. 23 Sep 2011 SR 66/2011 s15; 3 May 2024 SR 30/2024 s4. 46 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Form M [Clause 3(m)] In the King’s Bench Judicial Centre of _______________________________________ Bond We, ______________________________________________ (name of property co-decision-maker or property guardian) of ____________________ , ____________________ (address), and ____________________________ (name of surety) of ____________________ , _____________________ (address), are jointly and severally bound to a judge of the Court of King’s Bench for Saskatchewan at the Judicial Centre of _______________________________ in the amount of $ ________________________, to be paid to the judge at that judicial centre. The condition of this obligation is that if the above-named property co-decision-maker or property guardian of the property of _______________________________ (adult’s name) does all of the following, then this obligation shall be void, but otherwise shall be and remain in full force and effect: (a) make or cause to be made an accurate inventory of all the property of the adult that has or shall come into the possession or knowledge of the property co-decision-maker or property guardian, and provide the same to the local registrar of the Court of King’s Bench at the Judicial Centre of __________________ and to the public guardian and trustee whenever required by law to do so; (b) make or cause to be made an accurate annual accounting of all the property of the adult that has or shall come into the possession or knowledge of the property co-decision-maker or property guardian, and provide the same to the local registrar of the Court of King’s Bench at the Judicial Centre of __________ and to the public guardian and trustee whenever required by law to do so; (c) well and truly administer according to law all the property of the adult that has or shall come into the possession or knowledge of the property co-decision-maker or property guardian. Sealed with our seals and dated this _________day of _______________________ , 20 _________ . Name: _______________________________________ _____________________________________________ Address: _____________________________________ (Signature of Property Co-decision-maker or Property Guardian) Phone: ________________Fax: _________________ E-mail: _______________________________________ Name: _______________________________________ _____________________________________________ Address: ____________________________________ (Signature of Surety) Phone: ________________Fax: _________________ E-mail: _______________________________________ 28 Jne 2002 SR 49/2002 s12; 3 May 2024 SR 30/2024 s4. 47 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 Form M.1 [Clause 3(m.1)] In the King’s Bench Judicial Centre of _______________________________________ Bond We, ________________________________________________________________ (name of temporary property guardian) of ____________________ , ____________________ (address), and ____________________________ (name of surety) of ____________________ , _____________________ (address), are jointly and severally bound to a judge of the Court of King’s Bench for Saskatchewan at the Judicial Centre of _______________________________ in the amount of $ ________________________, to be paid to the judge at that judicial centre. The condition of this obligation is that if the above-named temporary property guardian of the property of _________________________________________________________________________________________________________ (adult’s name) well and truly administers according to all law all the property of the adult that has or shall come into the possession or knowledge of the temporary property guardian, then this obligation shall be void, but otherwise shall be and remain in full force and effect. Sealed with our seals and dated this _________day of _______________________ , 20 _________ . Name: _______________________________________ _____________________________________________ Address: _____________________________________ (Signature of Temporary Property Guardian) E-mail: _______________________________________ Name: _______________________________________ _____________________________________________ Address: ____________________________________ (Signature of Surety) Phone: ________________Fax: _________________ E-mail: _______________________________________ 23 Sep 2011 SR 66/2011 s15; 3 May 2024 SR 30/2024 s4. 48 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Form N [Clause 3(n)] In the King’s Bench Judicial Centre of _____________________________________ Order Appointing a Decision-maker On the application of ______________________ , and on hearing read the application and documents filed as part of and in support of the application, all filed: The Court finds that __________________________ (the “adult”):  (a) is a person whose capacity is impaired to the extent that the adult requires assistance in decision- making in order to make reasonable decisions with respect to some or all of the matters mentioned in section 15 of The Adult Guardianship and Co-decision-making Act (the “Act”), and is in need of a personal co-decision-maker;  (b) is a person whose capacity is impaired to the extent that the adult is unable to make reasonable decisions with respect to some or all of the matters mentioned in section 15 of the Act, and is in need of a personal guardian;  (c) is a person described in (a) or (b) above, and an immediate appointment of a temporary personal guardian is necessary to protect the adult from serious physical or mental harm;  (d) is a person whose capacity is impaired to the extent that the adult requires assistance in decision- making in order to make reasonable decisions with respect to matters relating to his or her estate, and is in need of a property co-decision-maker;  (e) is a person whose capacity is impaired to the extent that the adult is unable to make reasonable decisions with respect to matters relating to his or her estate, and is in need of a property guardian;  (f) is a person described in (d) or (e) above, and an immediate appointment of a temporary property guardian is necessary to protect the adult’s estate from serious damage or loss. It is therefore ordered that: (check as appropriate) 1. _________________be appointed as _______________________ for ______________________ pursuant to section _________of The Adult Guardianship and Co-decision-making Act, (in the case of the appointment of a temporary personal or property guardian) for a period of _______________ months. 2 (Where application is for the appointment of a personal co-decision-maker, personal guardian or temporary personal guardian) The _______________________ shall have authority with respect to the following matters: (check as appropriate)  decisions respecting the adult’s living arrangements  decisions respecting access to the adult  decisions respecting the adult’s social activities  decisions respecting the adult’s employment  decisions respecting the adult’s educational, vocational or other training  decisions respecting whether the adult should apply for any licence, permit, approval or other consent or authorization required by law that does not relate to the estate of the adult 49 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1  decisions respecting legal proceedings that do not relate to the estate of the adult  decisions respecting the adult’s health care, including decisions respecting admission to a health care facility or respecting treatment of the adult  decisions respecting the restraint of the adult  normal day-to-day decisions respecting the adult  other (specify) _______________________________________________________________________________ _____________________________________________________________________________________________ (If applicable) subject to the following limitations, conditions or requirements: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 3. (Where application is for the appointment of a property co-decision-maker, property guardian or temporary property guardian, and if applicable) The authority of the ______________________is subject to the following limitations, conditions or requirements: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 4. (If the application is for the appointment of a property co-decision-maker or property guardian) A bond in the amount of $ ___________ has been filed with the local registrar by _____________________ ; or No bond is to be filed. 5. (If applicable) Service of the application and/or order on the following persons is not required: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6. (If applicable) The __________________shall bring this order to be reviewed by the court in ____________ months. 7. (If applicable) __________________________________ shall receive payment of $ __________ as a fee for services as _____________________________________ . ISSUED at _________________________ , ________________________, this _______ day of ___________, 20 _____. 16 Sep 2005 SR 96/2005 s4; 23 Sep 2011 SR 66/2011 s18; 3 May 2024 SR 30/2024 s4. 50 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM O [Clause 3(o)] Notice of Authority of Property Decision-Maker To the Registrar ____________________________ To the Registrar of Titles Re: __________________________________________ (name of adult) Pursuant to the provisions of section 57 of The Adult Guardianship and Co-decision-making Act, take notice that I am the property co-decision-maker, property guardian or temporary property guardian of the above named adult. In my opinion, the adult has an interest in the following titles and interests: (description) You are required to register this notice against all titles to land described in this notice. Dated this ____________ day of _______________, 20 ________. ____________________________________________________ (Signature of Property Co-decision-maker, Property Guardian or Temporary Property Guardian) Name: _______________________________________ Address: ____________________________________ Phone: ________________Fax: _________________ E-mail: _______________________________________ 3 May 2024 SR 30/2024 s4. 51 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM P [Clause 3(p)] Withdrawal of Notice To the Registrar ____________________________ To the Registrar of Titles Re: __________________________________________ (name of adult) NOTE: Where Notice is being withdrawn because the adult has died please attach a notarial copy of the adult’s death certificate or a court-certified copy of letters probate or letters of administration. The Notice dated ____________________, 20 __________, and sent to you pursuant to section 57 of The Adult Guardianship and Co-decision-making Act with respect to the above named adult and registered in your office on the ________________ day of _______________ , 20 _____ , as No. __________ is withdrawn with respect to the following land: (description) Dated this ____________ day of _______________, 20 ________. ____________________________________________________ (Signature of Property Co-decision-maker, Property Guardian or Temporary Property Guardian) Name: _______________________________________ Address: ____________________________________ Phone: ________________Fax: _________________ E-mail: _______________________________________ 3 May 2024 SR 30/2024 s4. 52 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING FORM Q [Clause 3(q)] Amended Notice To the Registrar ____________________________ To the Registrar of Titles Re: __________________________________________ (name of adult) The Notice dated __________________, 20 ____ , and sent to you pursuant to section 57 of The Adult Guardianship and Co-decision-making Act with respect to the above-named adult and registered in your office on the __________ day of ___________________, 20 _______ , as No. ______ is amended as follows: Dated this ____________ day of _______________, 20 ________. ____________________________________________________ (Signature of Property Co-decision-maker, Property Guardian or Temporary Property Guardian) Name: _______________________________________ Address: ____________________________________ Phone: ________________Fax: _________________ E-mail: _______________________________________ 3 May 2024 SR 30/2024 s4. 53 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 FORM Q.1 [Clause 3(q.1)] Alternate Decision-Maker Assuming Role of Decision-Maker To: Local Registrar and Public Guardian and Trustee 1. I, _________________________________________ , of _____________________, in ____________________________, pursuant to section 64.1 of The Adult Guardianship and Co-decision-making Act, acknowledge that I am the alternate decision-maker for _______________________ pursuant to the order of _________________________. (adult’s name) (type of decision-maker) 2. That effective _____________________________________ I assumed the position of _________________________ (date) (type of decision-maker) from ___________________________________________________because I have only been advised and I do verily (fi rst decision-maker) believe it to be true that (choose one): the current decision-maker is dead; a decision-maker has been ordered for the current decision-maker; or the current decision-maker lacks capacity and an enduring power of attorney or health care directive has come into effect. 3. I have fi led a bond in the amount of __________ as required by the order of ___________________________ . (date of appointment order) Dated at ______________________ , __________________ , this _______ day of ______________________, 20 _____. ___________________________________________________ (Signature of Alternate Decision-maker) 23 Sep 2011 SR 66/2011 s17. 54 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Form R [Clause 3(r)] In the King’s Bench Judicial Centre of _______________________________________ Application for Review 1. I, _______________________, of __________________________ , ______________________ , request the following relief: (check as appropriate)  review of the appointment of _______________________________as _______________________________ for ____________________________ pursuant to The Dependent Adults Act or The Adult Guardianship and Co-decision-making Act  review of the authority of ____________________as _____________________________________________ for __________________________________________  review of the confi rmation of the testamentary nomination of ____________________________________ as ____________________________ for ____________________________ pursuant to The Dependent Adults Act or The Adult Guardianship and Co-decision-making Act  other: (specify) _______________________________________________________________________________ _____________________________________________________________________________________________ 2. An order was granted by this Court on _____________, _______ :  appointing _____________________as _________________________for _______________________________  confi rming the testamentary nomination of _________________________as ________________________ for ____________________________ 3. I ask this Court to make an order: (check as appropriate)  discharging ___________________________from offi ce and appointing _____________________________ as ___________________________________  changing the authority of ________________________ as follows: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 55 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1  changing the amount of the bond fi led as follows: ______________________________________________ _____________________________________________________________________________________________  changing the nature of the appointment from a _____________________to a ______________________ (e.g. from a personal co-decision-maker to a personal guardian)  other: (specify) _______________________________________________________________________________ _____________________________________________________________________________________________ 4. Service NOTE: You must include the addresses of the persons listed below that have been served other than the Minister of Social Services and the public guardian and trustee. (a) I have served the following persons with this petition: (check as appropriate)  the adult with respect to whom the application is made  the public guardian and trustee (where application is for the review of the appointment of a property co-decision-maker, property guardian or temporary property guardian)  the nearest relatives Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the Minister of Social Services (where the adult is receiving services pursuant to section 10 or 56 of The Child and Family Services Act)  the personal co-decision-maker, personal guardian or temporary personal guardian of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the property co-decision-maker, property guardian or temporary property guardian of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the attorney under a power of attorney given by the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the proxy under a health care directive made by the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ 56 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING  the supporter nominated by the adult pursuant to section 9 of The Personal Care Homes Regulations, 1996 Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the person(s) who act(s) as trustee for the purpose of administering fi nancial benefi ts on behalf of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  other: (specify) _______________________________________________________________________________ _____________________________________________________________________________________________ (b) (If applicable) I seek an order stating that I am not required to serve the following persons: NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall not dispense with service on the adult unless it is satisfi ed, on the basis of suffi cient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Reason for dispensing with service: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Reason for dispensing with service: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Reason for dispensing with service: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. Summary of Facts I request that the order be reviewed for the following reasons: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 57 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1  the supporter nominated by the adult pursuant to section 9 of The Personal Care Homes Regulations, 1996 Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the person(s) who act(s) as trustee for the purpose of administering financial benefits on behalf of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  other: (specify) _______________________________________________________________________________ _____________________________________________________________________________________________ (b) (If applicable) I seek an order stating that I am not required to serve the following persons: NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall not dispense with service on the adult unless it is satisfied, on the basis of sufficient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Reason for dispensing with service: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Reason for dispensing with service: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Reason for dispensing with service: ___________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 5. Summary of Facts 13 Jly 2001 cA-5.3 Reg 1; 28 Jun 2002 SR 49/2002 s13; 16 Sep 2005 SR 96/2005 s4; 23 Sep 2011 SR 66/2011 I request that the order be reviewed for the followsi2n0g; 3r eMaasyo n20s2:4 SR 30/2024 s4. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 58 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Form S [Clause 3(s)] In the King’s Bench Judicial Centre of _______________________________________ Application for Resealing a Foreign Order 1. I, _________________________________________________, of ________________________, __________, apply for resealing of a foreign order to appoint _____________________________________________________________as: (applicant/guardian) (check as appropriate)  personal co-decision-maker for ________________________________________________ pursuant to section 14 of The Adult Guardianship and Co-decision-making Act  personal guardian for ________________________________________________________ pursuant to section 14 of The Adult Guardianship and Co-decision-making Act  property co-decision-maker for ________________________________________________ pursuant to section 40 of The Adult Guardianship and Co-decision-making Act  with a bond for $ ______________  without a bond for  property guardian for ________________________________________________________ pursuant to section 40 of The Adult Guardianship and Co-decision-making Act  with a bond for $ ______________  without a bond for 2. On or about _________________the ___________________ court found that ______________________________ (date) (adult’s name) was in need of a personal/property guardian or co-decision-maker (or whatever the term is in the foreign jurisdiction). 3. The court named _________________________________________of ___________________in _____________________ (applicant) (city) (province/country) as _________________________________________________. (type of guardian) 4. I am seeking to reseal the order of ______________________________________________________________ because:  the adult has property in Saskatchewan;  the adult has moved to Saskatchewan. 5. With respect to the requirement to fi le a bond (choose one):  I was required by the ___________________________________to give security in the sum of $ _____________, (court of the other jurisdiction) and this amount is suffi cient to cover the assets within that jurisdiction and within Saskatchewan;  I undertake to fi le a bond in the amount of $ __________________________________pursuant to section 65.2 of The Adult Guardianship and Co-decision-making Act (see Form M)  the adult’s assets do not exceed $10,000. 59 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 6. Service NOTE: You must include the addresses of the persons listed below that have been served other than the Minister of Social Services and the Public Guardian and Trustee. (a) I have served the following persons with a copy of the application and a copy of the foreign order (check as appropriate):  the adult with respect to whom the application is made  the Public Guardian and Trustee (where application is for the appointment of a property co-decision-maker or property guardian)  the nearest relatives Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the Minister of Social Services (where the adult is receiving services pursuant to section 10 or 56 of The Child and Family Services Act)  the personal co-decision-maker, personal guardian or temporary personal guardian of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the property co-decision-maker, property guardian or temporary property guardian of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the attorney under a power of attorney given by the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the proxy under a health care directive made by the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the supporter nominated by the adult pursuant to section 9 of The Personal Care Homes Regulations, 1996 Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________  the person(s) who act(s) as trustee for the purpose of administering fi nancial benefi ts on behalf of the adult Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ 60 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING  other: (specify) _______________________________________________________________________________ _____________________________________________________________________________________________ (b) (If applicable) I seek an order stating that I am not required to serve the following persons: NOTE: The Adult Guardianship and Co-decision-making Act, 2011 provides that the court shall not dispense with service on the adult unless it is satisfi ed, on the basis of suffi cient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ Name: ______________________________________________________________________________________ Relationship: ________________________________________________________________________________ 5. Summary of Facts I request that the order be reviewed for the following reasons: 7. Review I request that the order include the following terms: (check as appropriate)  that the order be reviewed by the court in _________months; NOTE: The Adult Guardianship and Co-decision-making Act provides that the court shall determine whether it is in the best interests of the adult to require a review of the order, and if a review is required, shall specify the period within which the review is to take place.  that the order be reviewed by the court 8. Fees I plan to charge a fee and seek  to receive the following fee for services: $ _________________ or  to charge fees as set out in the Regulations or  I will not charge a fee 9. Documents Attached  I will not charge a fee The following documents are fi led with the court as part of this application: (check as appropriate)  proof of service of application on all persons required to be served.  affi davit of the applicant.  inventory of the estate of the adult (where application is for the appointment of a property co-decision-maker or property guardian) (see Form K). 61 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1  the foreign order to be resealed.  certifi cate from the clerk/registrar of the court outside Saskatchewan that the foreign order is wholly unrevoked and of full effect.  bond undertaking to properly act as a co-decision-maker or guardian (where application is for resealing of a foreign order appointing a property guardian) or a certifi cate from the clerk or registrar of the court in _____________________ (province/country) stating that security has been given in that court in an amount suffi cient to cover assets in Saskatchewan.  other: (describe) _______________________________________________________________________________ _______________________________________________________________________________________________ Dated at ____________________________ , ________________________, this _______ day of ___________, 20 _____. _______________________________________________ (Signature of Applicant) Address for service: __________________________ Phone: ________________Fax: _________________ E-mail: ______________________________________ Permanent address (if different from address for service): ________________________________________________________________________ Phone: _____________________________ Fax: _____________________________ E-mail: _________________________________________________________________ 23 Sep 2011 SR 66/2011 s19; 3 May 2024 SR 30/2024 s4. 62 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING Form T [Clause 3(t)] In the King’s Bench Judicial Centre of _______________________________________ Affi davit in Support of an Application to Reseal a Foreign Order I, _________________________________, of __________________________, ________________________________________, MAKE OATH AND SAY (OR DECLARE): 1. THAT I am the applicant and have personal knowledge of the matters deposed to in this affi davit, except where stated to be on information and belief, and where so stated I believe them to be true. 2. Attached as Exhibit “A” is a copy of my application in the __________________________________________________ (court of other jurisdiction) for the order I am seeking to have resealed. 3. Attached as Exhibit “B” is a certifi ed copy of the original guardianship order issued by the _____________________ (court) of ____________________________________________ . (province/country) 4. Attached as Exhibit “C” is a certifi cate from the ____________________________ of ___________________________ (court) (province/country) showing that the order of ______________________________________________is wholly unrevoked and of full effect. (date) 5. Attached as Exhibit “D” is a certifi cate from the ________________________ of _______________________________ (court) (province/country) stating that security has been given in that court in an amount suffi cient to cover assets within Saskatchewan. 6. THAT I am the ___________________________________________of the adult named in the application (the “adult”). (state relationship) 7. THAT the nearest relative(s) of the adult, other than myself, is (are): Name Address Relationship _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 8. THAT the adult was born on ______________________________________________ , and is now ______years of age. 9. THAT the adult currently resides at: Address: ________________________________________________________________________________________________ Phone: __________________________________________________________________________________________________ 10. THAT I believe I would be a suitable ______________________________________________ for the following reasons (where the deponent is not the Public Guardian and Trustee) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 11. THAT I (check as appropriate) have / have not been appointed as a decision-maker for another person pursuant to The Dependent Adults Act or The Adult Guardianship and Co-decision-making Act (where the deponent is not the public guardian and trustee). Details, including name and address of adult, date of order, authority granted and fees for services received (if applicable): _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 63 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 12. THAT I (check as appropriate) have / have not been in a relationship of fi nancial trust with another person, including under a power of attorney. Details, (if applicable): _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 13. THAT I (check as appropriate) have / have not been convicted of, or received a pardon for, a criminal offence relating to assault, sexual assault or other acts of violence, intimidation, criminal harassment, uttering threats, theft or fraud. NOTE: Attach a copy of a criminal record check completed by your local police service. Details, (if applicable): _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 14. THAT I (check as appropriate) have / have not been a respondent pursuant to The Victims of Domestic Violence Act or a defendant pursuant to a section of the Criminal Code relating to securing a peace bond. Details, (if applicable): _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 15. THAT I (check as appropriate) have / have not been petitioned into bankruptcy. Details, including the status or outcome of that application or petition:

(if applicable) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 16. THAT the estimated value of the adult’s estate is as follows: (where application is for the appointment of a property co-decision- maker or property guardian) _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 17. (If applicable) THAT the reasons I seek an order stating that I am not required to serve the following persons are: Name: __________________________________________________________________________________________________ Relationship: ____________________________________________________________________________________________ Reason for dispensing with service: _______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Name: __________________________________________________________________________________________________ Relationship: ____________________________________________________________________________________________ Reason for dispensing with service: _______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ NOTE: The Adult Guardianship and Co-decision-making Act, 2011 provides that the court shall not dispense with service on the adult unless it is satisfi ed, on the basis of suffi cient medical evidence, that special circumstances exist and service would be injurious to the adult and contrary to the best interests of the adult. 64 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING 18. THAT attached are the following exhibits, marked E to ___________, all of which I believe to be true copies of the originals: (check as appropriate)  power of attorney given by the adult (where order appointing property co-decision-maker or property guardian is requested)  health care directive made by the adult (where order appointing personal co-decision-maker or personal guardian with authority respecting health care decisions is requested)  last will and testament made by the adult (where order appointing property co-decision-maker or property guardian is requested)  other: (describe) ______________________________________________________________________________________ ____________________________________________________________________________________________________ 19. THAT no other application, other than the following, has been made to this court for the appointment of a personal co-decision-maker, personal guardian, property co-decision-maker or property guardian for the adult, to the best of my information and belief: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 20. THAT I am not aware of any confl ict of interest that presently exists or will exist if I should be so appointed. 21. THAT I understand that I must account annually to the court and the Public Guardian and Trustee (where application for the appointment of a property co-decision-maker or property guardian). 22. THAT I will undertake, on my appointment as co-decision-maker or guardian, to exercise the duties and powers assigned to me by the court diligently, in good faith and in the best interests of the adult. I will exercise my powers and duties in a way that encourages the adult to participate as fully as possible in decision-making and to act independently in all matters where he or she is able. I will protect the adult’s civil and human rights and limit my interference in his or her life to the greatest extent possible. 23. THAT I make this affi davit in support of an application pursuant to The Adult Guardianship and Co-decision-making Act for an Order resealing the order of _____________________________ of ____________________________________ (date) (court) of ______________________________________________ appointing me as the _________________________________ (province/country) for ________________________________________________________________. (adult’s name) SWORN (OR DECLARED) before me at __________________________________) Saskatchewan, this _______________________ day) of ________________________________, 20 ________) ________________________________________________ (Signature of Applicant) ______________________________________________ A Commissioner for Oaths in and for Saskatchewan My appointment expires ______________________ 3 May 2024 SR 30/2024 s4. 65 ADULT GUARDIANSHIP AND CO-DECISION-MAKING A-5.3 REG 1 Form U [Clause 3(u)] In the King’s Bench Judicial Centre of _______________________________________ Order for Resealing of Foreign Order On the application of _________________________________________________________________, and on having read the application and documents fi led as part of and in support of the application, all fi led: The Court fi nds that the __________________________ of _________________________________________ made an order (court) (province/country) appointing _________________________________ as guardian (or equivalent) for _____________________________________ (applicant) (adult’s name) and that order is wholly unrevoked and of full effect; It is therefore ordered that: 1. The order of ___________________________________ of __________________________________________ be resealed. (court) (province/country) 2. The resealing order is subject to the following limitations, conditions or requirements (if applicable): _______________________________________________________________________________________________________ _______________________________________________________________________________________________________. 3. The applicant shall fi le a bond in the amount of $ _____________ and must renew the bond prior to its expiration (if applicable). 4. (if applicable) Service of the application and/or order on the following persons is not required: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ 5. (if applicable) The _________________________ shall bring this order to be reviewed by the court in ________months. ISSUED at ___________________ , __________________ , this _______ day of ______________________, 20 _____. 3 May 2024 SR 30/2024 s4. 66 A-5.3 REG 1 ADULT GUARDIANSHIP AND CO-DECISION-MAKING REGINA, SASKATCHEWAN Printed by the authority of THE KING’S PRINTER Copyright©2024