STATE OF ILLINOIS
TH
IN THE CIRCUIT COURT OF THE 17
JUDICIAL CIRCUIT
COUNTY OF WINNEBAGO
FILE STAMP
In the Matter of
Case No. ____________________
______________________________
A Minor
PETITION TO APPOINT A GUARDIAN FOR A MINOR
________________________________________, a reputable citizen of Illinois, hereby certifies:
1. Each of the following is a minor in need of a guardian:
Name
Date of Birth
Address
County
______________________
____________
_________________________
______________
______________________
____________
_________________________
______________
______________________
____________
_________________________
______________
2.
The minor is in the physical custody of ______________________________, _______________________.
(relationship to minor)
3. The approximate value of the minor’s personal estate is $__________; the amount of the minor’s
anticipated gross annual income and other receipts is $___________.
4. Petitioner seeks the appointment of _________________________________________________________,
(
)
name of person qualified and willing to act as guardian
________________, of ___________________________________________________________________
(date of birth)
(complete address)
who is ______ years of age, whose occupation is ________________________________________, whose
relationship to the minor is ________________________ and who is qualified and willing to act, as the
guardian of the ______________________________ of the minor.
(person, estate or person & estate)
5. _________________________________, the biological mother of the above mentioned minor:
a)
has consented to the appointment of ______________________________ as guardian;
b)
is unwilling and/or unable to make and carry out the day-to-day child care decisions
concerning the minor;
c)
has a last known address of ________________________________________________________
d)
Is deceased; or __________________________________________________________________
e)
has had her parental rights terminated (a copy of the Order is attached and herein incorporated).
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