Child’s Six-Month Temporary Guardianship

Child’s Six-Month Temporary Guardianship

This questionnaire collects information for a temporary guardianship under Nevada A.B. 319 (2017). It is not a final Order signed by a Judge. It is a notarized legal document between the parents and the guardian. If there are two guardians, each guardian must have their own Six-Month Temporary Guardianship. If more than one child, each child must have their own Six-Month Temporary Guardianship.
NRS240A DISCLOSURE - Read Carefully.

I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Parent's Information

Please provide your information as the natural parent (Mother or Father) or legal custodian.
What County will this be notarized in? (ex.Elko County, Lander County, etc.)
Parent’s Full Legal Name

First NameMiddle NameLast Name
Parent’s Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent’s Email Address
example@example.com
Are you the child’s legal custodian?
Other Parent's Information

Provide information about the child’s other natural parent (Mother or Father), if applicable.
Other Parent’s Full Legal Name

First NameMiddle NameLast Name
Is the whereabouts of the other parent known?
Have the parental rights of the other parent been terminated?
Is the other parent willing and able to provide care for the child?
Child Information

Enter the information for the child to be placed under temporary guardianship.
Child’s Full Legal Name

First NameMiddle NameLast Name
Child’s Date of Birth

MonthDayYear
Date
Child’s Age
Guardian Information

Provide information about the person who will serve as the temporary guardian.
Guardian’s Full Legal Name

First NameMiddle NameLast Name
Guardian’s Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Guardian’s Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Guardian’s Email Address
example@example.com
Other Parent Consent (if required)

If the other parent’s consent is required, please complete this section.
I, as the other parent, consent to the appointment of the above-named temporary guardian for my child for up to six months.
Minor Consent (if child is age 14 or older)

If the child is 14 years of age or older, their consent is required.
I, as the minor (age 14 or older), consent to the appointment of the above-named temporary guardian for up to six months.
Guardian Acceptance

Guardian must accept responsibility.
Acknowledgment: The temporary guardianship will automatically expire six months from the effective date unless renewed in accordance with Nevada law.
Acknowledgment: The temporary guardianship may terminate earlier if the parent revokes consent, the child is returned to the parent, or as otherwise provided by law.
I, as the named guardian, accept the duties and responsibilities of temporary guardianship for the above-named child.
NRS240A DISCLOSURE - Read Carefully

Please review and confirm the information below.
I, DEBORAH BARNHART, DOING BUSINESS AS DPS OF NORTHERN NEVADA, AM NOT AN ATTORNEY IN THE STATE OF NEVADA. I AM NOT AUTHORIZED TO GIVE LEGAL ADVICE OR LEGAL REPRESENTATION. I MAY NOT ACCEPT FEES FOR GIVING LEGAL ADVICE OR LEGAL REPRESENTATION.
Name

First NameMiddle NameLast NameSuffix
Should be Empty:

Child’s Six-Month Temporary Guardianship

NRS240A DISCLOSURE - Read Carefully.

Parent's Information

Other Parent's Information

Child Information

Guardian Information

Other Parent Consent (if required)

Minor Consent (if child is age 14 or older)

Guardian Acceptance

NRS240A DISCLOSURE - Read Carefully