CERTIFICATE OF GUARDIANSHIP / CONSERVATORSHIP TERMINATED Make Electronic Submissions via the Georgia Criminal Justice Information System (CJIS) Network -OR- forms to: Georgia Crime Information Center Attention: Georgia Crime Information Center Attention: CJIS Operations Unit 3121 Panthersville Rd. Decatur, Georgia 30034 *DATE OF ORDER *JUDGE’S NAME (mm/dd/yyyy) *PROBATE COURT COUNTY/ORI NUMBER *ESTATE NUMBER THE FOLLOWING INDIVIDUAL HAS BEEN ADJUDICATED TO LACK SUFFICIENT MENTAL CAPACITY AND GUARDIANSHIP/CONSERVATORSHIP HAS BEEN ESTABLISHED. THE ORDER REFERENCED ABOVE TERMINATES SUCH APPOINTMENT. *NAME (Last, First, Middle) *SEX *RACE *DATE OF BIRTH SOCIAL SECURITY NUMBER (mm/dd/yyyy) (###-##-####) CURRENT ADDRESS (Street Address) CITY STATE ZIP CODE SIGNATURE DATE SIGNED (Court Official) *Court Official’s Title *Mandatory Field
CERTIFICATE OF GUARDIANSHIP / CONSERVATORSHIP TERMINATED Make Electronic Submissions via the Georgia Criminal Justice Information System (CJIS) Network -OR- forms to: Georgia Crime Information Center Attention: Georgia Crime Information Center Attention: CJIS Operations Unit 3121 Panthersville Rd. Decatur, Georgia 30034 *DATE OF ORDER (mm/dd/yyyy) *JUDGE’S NAME *PROBATE COURT COUNTY/ORI NUMBER *ESTATE NUMBER THE FOLLOWING INDIVIDUAL HAS BEEN ADJUDICATED TO LACK SUFFICIENT MENTAL CAPACITY AND GUARDIANSHIP/CONSERVATORSHIP HAS BEEN ESTABLISHED. THE ORDER REFERENCED ABOVE TERMINATES SUCH APPOINTMENT. *NAME (Last, First, Middle) *SEX *RACE *DATE OF BIRTH (mm/dd/yyyy) SOCIAL SECURITY NUMBER (###-##-####) CURRENT ADDRESS (Street Address) CITY STATE ZIP CODE SIGNATURE (Court Official) DATE SIGNED *Court Official’s Title *Mandatory Field
Form-65-Petition-for-the-Restoration-of-an-Individual-Formerly-Found-to-Be-in-Need-of-a-Gdn-and-or-Consv.docx