Petition For Appointment Of Guardian For Disabled Person Form - Lake County, Illinois
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2IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
Hearing on petition is set for
_________________, 20___, at ________
ESTATE OF
)
Park City Courthouse, Courtroom B
)
301 S Greenleaf Ave.
)
Park City, IL 60085
)
)
_________________________________________
)
Case No: ___________________
Alleged Disabled Person.
)
)
PETITION FOR APPOINTMENT OF GUARDIAN FOR DISABLED PERSON
_________________________________________, the Petitioner(s), under penalties of perjury as provided
under Section 1-109 of the Code of Civil Procedure, state(s):
1. The Respondent’s name is: ______________________________ ; date of birth is ___________________ ; and
place of residence is_____________________________________________________________________________
(address)
(city)
(county)
(state)
OR The Respondent ____________________________ is a nonresident of the State of Illinois but this Court has
jurisdiction because Respondent
Owns real estate in this county: _______________________________________________________________
(address)
(city)
(county)
(state)
Owns personal property located in this county as follows: ___________________________________________
2. The relationship to and interest of the Petitioner to the Respondent is:
______________________________________________________________________________________________
3. The reason for this guardianship is that the Respondent is a disabled person due to:
______________________________________________________________________________________________
______________________________________________________________________________________________
and because of such disability:
Lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the
care of the Respondent’s person.
Is unable to manage the Respondent’s estate or financial affairs.
4. a. The approximate value of estate: Personal $ ________________ Real $ ___________________
b. The anticipated gross annual income and other receipts of the Respondent are: $ __________________
5. The names and post office addresses of Respondent’s nearest relatives, if any, are (list spouse or civil union partner
and adult children; if none, then the Respondent’s parents and adult brothers and sisters if none, then nearest
kindred):
Name
Relationship
Post Office Address
6. The names and post office address of the Respondent’s agent(s) under a Power of Attorney for Property or a Power
of Attorney for Health Care, and previously Court appointed Guardian of Respondent’s Estate or Person, if any, are:
Name
Relationship
Post Office Address
Page 1 of 2
171P-69 (Rev. 8/12)
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