Petition For Appointment Of Conservator/protective Order Page 2
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7. The individual to be protected has an estate approximately valued at:
$
$
$
$
Real property
Personal property
Insurance
Monthly income
I
8. The individual to be protected is receiving the following benefits from governmental agencies:
Social Security $
SSI $
MDHHS $
Veterans Administration $
, claimant number
Other:
$
J
9. The individual to be protected has
a spouse whose name and address are listed below.
child(ren) whose name(s) and address(es) are listed below.
descendants of deceased child(ren) whose name(s) and address(es) are listed below.
if no child(ren) or descendants of deceased child(ren), parents whose name(s) and address(es) are listed below.
if none of the above, presumptive heirs whose name(s) and address(es) are listed below.
none of the above (must notify the Attorney General - see instructions for the address of the Attorney General).
AGE/DOB
NAME
ADDRESS AND TELEPHONE NUMBER
RELATIONSHIP
(if minor)
Street address
City
State
Zip
Telephone no.
Street address
City
State
Zip
Telephone no.
K
10. None of the persons named above are under any legal incapacity except
.
Name, incapacity, and representative of the person, if any
L
11. The individual is currently found at
.
Address or location
Telephone no.
M
12. It is necessary that a preliminary protective order be entered pending the regular hearing because
.
I REQUEST that the court:
N
13. Appoint
,
Name, address, and telephone no.
who has priority as
, as conservator of the estate to be protected.
Priority relationship
O
14. Preserve and apply the individual's property pending the appointment of a conservator as follows:
15. Enter a protective order that provides
.
P
16. Appoint the guardian as special conservator with authority to sell or otherwise dispose of the ward's real property or
Q
interest in real property.
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.
Attorney signature
Date
R
Attorney name (type or print)
Bar no. Petitioner signature
Attorney address
Petitioner address
City, state, zip
Telephone no. City, state, zip
Telephone no.
17. NOMINATION BY PERSON TO BE PROTECTED: I am 14 years of age or older. I nominate as my conservator
S
.
Name, address, and telephone no.
Date
Signature of person to be protected
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