Guardianship Intake Form

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Guardianship Intake Form
Please answer the following questions in order to provide information required to
pursue Guardianship. Please let us know if you are unsure of any of your responses.
Today’s Date _______________
Your name
______________________________________________________________
Your address and phone number
_____________________________________________
___________________________________________________________________
_____
How were you referred to this office?
_________________________________________
Name and permanent address of the proposed Ward
______________________________
___________________________________________________________________
_____
Current address of the proposed Ward
_________________________________________
Your relationship to the proposed Ward
_______________________________________
The proposed Ward’s date of birth
___________________________________________
The proposed Ward’s social security number
___________________________________
Has anyone pursued guardianship or conservatorship of the proposed ward before?
_____
Is the proposed Ward married?
______________________________________________
Does the proposed Ward have any children?
____________________________________
Does the proposed Ward have any living parents?
_______________________________
Please list the next of kin of the proposed Ward, including their addresses and their
relationship to the proposed Ward

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