Name of Person Filing Document: Address: City, State, Zip Code: Telephone Number: Attorney Bar Number (if applicable): Self or Attorney for Representing FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the Conservatorship of: Case Number PB: PETITION FOR PERMANENT APPOINTMENT OF CONSERVATOR OF AN ADULT (Protected Person) REQUIRED INFORMATION FROM PETITIONER, UNDER OATH OR AFFIRMATION: 1. INFORMATION ABOUT ME. I am called the Petitioner: Name: Address: Telephone: Date of Birth: My relationship to the person I say needs a conservator is: 2. INFORMATION ABOUT THE PERSON I SAY NEEDS A CONSERVATOR. This person is called the proposed protected person (for a conservatorship): Name: Address: Telephone: 3. Date of Birth: PERSONS WHO ARE ENTITLED TO NOTICE of the court matter under Arizona law 14-5405 for conservators, and to whom I will give notice of this case: (See instructions) Name Address Relationship to Person Who I Say Needs a Conservator A. B. C. D. Case No. © Superior Court of Arizona in Maricopa County January 27, 2009 ALL RIGHTS RESERVED Page 1 of 4 PBCA11f Use only most current version APE American LegalNet, Inc. www.FormsWorkFlow.com 4. ASSETS OF PERSON WHOM I SAY NEEDS CONSERVATOR: (check one box) The person who needs a conservator has no substantial assets or income. No bond by Petitioner is required; The person who needs a conservator has assets and/or annual income in the approximate amount of . Explain: $ 5. PERSON TO BE APPOINTED CONSERVATOR (complete this only if the person is a different person than Petitioner): Name: Address: Telephone: Date of Birth: My relationship to the person I say needs a conservator: 6. INFORMATION REGARDING CONSERVATORSHIP. To the best of my knowledge, (check one box): No Guardian and/or Conservator has been appointed in any other court, and no court proceedings are pending for such appointment; OR Someone has been appointed Guardian and/or Conservator, or court proceedings are pending. Explain who, when, in what court, and if the appointee is guardian or conservator: 7. REASONS FOR CONSERVATORSHIP: The person needs a Conservator because he or she has property which will be wasted or used up unless proper management is provided, and (check one or both boxes that apply): He or she needs funds for his or her support, care and welfare; Funds are needed for the support, care and welfare of those entitled to be supported by the person. 8. REASONS PERSON CANNOT MANAGE HIS or HER PROPERTY: (check all that you believe apply): Mental illness, mental deficiency, or mental disorder Chronic use of drugs Confinement Disappearance. 9. Physical illness or disability Chronic intoxication Detention by a foreign power; APPOINTMENT OF AN ATTORNEY (You cannot ask the court for conservatorship unless the adult has a lawyer appointed to represent him or her. See the instructions on how to do this.) (Check one box only and fill in the information requested): The person I say is a protected person already has an attorney who will represent the person in court about this conservatorship: Case No. © Superior Court of Arizona in Maricopa County January 27, 2009 ALL RIGHTS RESERVED Page 2 of 4 PBCA11f Use only most current version APE American LegalNet, Inc. www.FormsWorkFlow.com NAME OF ATTORNEY: ADDRESS: TELEPHONE: OR, The protected person has no attorney to represent him or her in court, and I will contact the contact the Office of Public Defense Services at (602) 506-7437 after I file this paperwork so that a lawyer can be appointed by the court. 10. INFORMATION FOR APPOINTMENT OF A PHYSICIAN: I have the name, address, and telephone number of a physician who will examine the person I say needs protection and whose written Yes or No. report I will file with the court. REQUIRED STATEMENTS TO THE COURT, UNDER OATH OR AFFIRMATION: (Note: you must check each box as true, and all these statements must be true, or you cannot file this Petition.) 11. TRUE 12. TRUE 13. TRUE Venue (the court in which you are filing this Petition) is proper in this county because the person who is said to need a conservatorship lives in or is present in this county, or the person to be protected has assets in this county. The person who is requesting to be the conservator has completed the required document called Affidavit of Person to be Appointed as Conservator of an Adult and is filing that Affidavit with this Petition as required by Arizona law, A.R.S. § 14-5106. I or the person I request to be appointed in Paragraph 5 is a suitable and proper person to act as conservator and is entitled to consideration for appointment under Arizona Law, A.R.S. § 14-5106, 5311, and/or 5410. REQUEST TO THE COURT FOR AN ORDER, UNDER OATH OR AFFIRMATION: Petitioner asks the court to do the following: 1. Schedule a hearing to determine if a Conservatorship is appropriate; 2. Appoint a lawyer to represent the person, and appoint a physician and court investigator, if necessary. 3. After Petitioner gives notice of the hearing to all interested persons and to those required by law, hold a hearing to determine if the Court should order a Conservatorship; 4. Make a finding that the person needs protection under law including a conservator; 5. Appoint a Conservator of the proposed protected person; 6. Make any other orders the Court decides are in the best interests of the proposed protected person. © Superior Court of Arizona in Maricopa County January 27, 2009 ALL RIGHTS RESERVED Page 3 of 4 PBCA11f Use only most current version APE American LegalNet, Inc. www.FormsWorkFlow.com Case No. OATH OR AFFIRMATION The contents of this document are true and correct to the best of my knowledge and belief. Date Signature Signed & Sworn to or Affirmed before me this date: Date Seal/My Commission Expires Deputy Clerk or Notary Public © Superior Court of Arizona in Maricopa County January 27, 2009 ALL RIGHTS RESERVED Page 4 of 4 PBCA11f Use only most current version APE American LegalNet, Inc. www.FormsWorkFlow.com