Fill and Sign the Free Notice of Limited Scope Representation Form Name

Name: ____________________________________________ Address: __________________________________________ City, State. Zip: ____________________________________ Telephone: ________________________________________ State Bar #: _______________________________________ Client: ___________________________________________IN THE SUPERIOR COURT OF THE STATE OF ARIZONA In and for the County of ____________________ ___________________________________________ IN RE THE MATTER OF: CASE NO. CONSENT OF MOTHER TO [ ] GUARDIANSHIP AND [ ] CONSERVATOR __________________________________________________________________________________G&C3M STATE OF ARIZONA ) )ss County of ______________ ) I, _________________________________, the undersigned, being first duly sworn upon oath, deposes and says: 1. That I am the natural mother of the minor child, _________________________. 2. That I consent to the appointment of __________________________________ as [ ] Guardians and/or [ ] Conservators of the said minor child; and 3. That I waive notice of all further proceedings in this matter. Dated this____________ day of ______________________________, 1996. ____________________________________ Signature of Mother ____________________________________ Address____________________________________ City, State, Zip Code SUBSCRIBED AND SWORN BEFORE ME THIS DATE : ________________________________ Notary Public ______________________________________________ (seal )