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