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Form C - Petition For Appointment As Guardian Advocate Of The Person And Appointment Of Standby Guardian Advocate - Seminole County Page 3

13. The relationship that Petitioner has or had with the provider of health care services,

residential services or other services of the person with the developmental disability is:

14. The reasons why the Petitioner believes he or she should be appointed Guardian

Advocate are:

15. The Petitioner requests that _________________________ be appointed Standby

Guardian Advocate.

16. The proposed Standby Guardian Advocate’s relationship and any previous connections

with the person with developmental disabilities are: ______________________________

___________________________________________________________________________

17. The proposed Standby Guardian Advocate’s residence is _________________________

___________________________________________________________________________

18. The reason the proposed Standby Guardian Advocate should be appointed is _________

___________________________________________________________________________

WHEREFORE:

Petitioner requests to be appointed as Guardian Advocate of the person with the

developmental disability.

The Petitioner requests the appointment of the proposed Standby Guardian Advocate.

The Petitioner is sui juris and otherwise qualified under the laws of the State of Florida to act

in such capacity.

Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged

Page 3 of 4 of Form C

Form C - Petition For Appointment As Guardian Advocate Of The Person And Appointment Of Standby Guardian Advocate - Seminole County Page 3