Petition For Appointment Of Guardian Page 2

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K
9. The adult
is
is not
entitled to receive Veterans Administration benefits. The Veterans Administration
claimant number is
.
10. The alleged incapacitated individual has
L
a spouse whose name and address are listed below.
adult child(ren) whose name(s) and address(es) are listed below.
living parent(s) whose name(s) and address(es) are listed below.
no spouse, child(ren), or parent(s). The names and addresses of presumptive heirs are listed below.
none of the above (must notify Attorney General - see instructions for the address of the Attorney General).
NAME
RELATIONSHIP
ADDRESS AND TELEPHONE NUMBER
Street address
Telephone no.
City
State
Zip
Street address
Zip
Telephone no.
City
State
Street address
City
Zip
Telephone no.
State
M
11. None of the adults named above is under any legal incapacity except
.
Give name, legal incapacity, and representative of the person, if any
N
12. I REQUEST that the court determine the adult is an incapacitated individual and appoint
Name
Address
, who has priority as
City
State
Zip
Telephone no.
,
full guardian with all powers provided by statute.
Priority relationship
limited guardian with the following powers:
.
O
13. No other person appears to have authority to act in the circumstances. I request that a temporary guardian be appointed
pending a hearing on this petition because of the following emergency:
I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of
my information, knowledge, and belief.
P
Date
Attorney signature
Attorney name (type or print)
Petitioner signature
Bar no.
Petitioner address
Attorney address
City, state, zip
Telephone no.
City, state, zip
Telephone no.
Q
14. NOMINATION BY THE ALLEGED INCAPACITATED INDIVIDUAL In the event the court finds that I require a
guardian, I nominate:
Name, address, and telephone no.
Signature of alleged incapacitated individual
Date

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