Petition For Appointment Of Guardian For Disabled Person Form - Lake County, Illinois Page 2
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27. The name and address of the person with whom, or the facility in which the Respondent is residing is:
______________________________________________________________________________________________
8. Petitioner, ____________________________________ is age _______ years, whose date of birth is _____________
whose address is __________________________________________________________ is qualified and willing to
act, requests appointment as guardian of the Respondent’s Person Estate Estate and Person.
9. Co-Petitioner, ________________________________ is age ______ years, whose date of birth is _____________
whose address is __________________________________________________________ is qualified and willing to
act, requests appointment as guardian of the Respondent’s Person Estate Estate and Person.
Petitioner(s) ask(s) that:
a. The Respondent be adjudged a disabled person;
b. The Petitioner(s) be appointed as Guardian of Respondent’s Person Estate Estate and Person.
c. The guardianship be for the limited purpose of:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
_________________________________________
__________________________________________
Petitioner’s Signature
Co-Petitioner’s Signature
_________________________________________
__________________________________________
Petitioner’s Printed Name
Co-Petitioner’s Printed Name
Dated this _______ day of ____________________, 20_____.
Prepared by:
Attorney's Name: ____________________________________
Address: __________________________________________
City: ______________________________ State: __________
Phone: ______________________Zip Code: _____________
Fax: ______________________________________________
ARDC #: __________________________________________
Page 2 of 2
171P-69 (Rev. 8/12)
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