IN THE CIRCUIT COURT OF THE TWENTY-SECOND JUDICIAL CIRCUIT McHENRY COUNTY, ILLINOIS Probate Division IN THE MATTER OF ______________________________________________ Alleged Disabled Person ) ) ) ) Case Number_______________________________ PETITION FOR APPOINTMENT OF TEMPORARY GUARDIAN FOR DISABLED PERSON ________________________________________________________________________ hereby certifies: 1. On ______________________________, 20____, a petition was filed herein for the appointment of a guardian of the ____________________________ of __________________________________________________, an (Estate and Person, Estate, Person) alleged disabled person whose date of birth is ___________________ and whose place of residence is_______ _________________________________________________________________________________________ (Address) (City) (County) (State) 2. A temporary guardian is necessary for the welfare and protection of the respondent because: _________________________________________________________________________________________ _________________________________________________________________________________________ 3. Petitioner is ___________________________________________ to the alleged disabled person. (State relationship and interest to respondent) 4. The name and address of the respondent's * (a) Guardian (b) Agent under the Durable Power of Attorney Law is _______________________________________________________________________________________ 5. The names and addresses of the respondent's nearest relatives are as follows: (if none, respondent's nearest adult kindred known to Petitioner) Spouse and Adult Children: Name Address Relationship to respondent 6. The name and address of the person with whom, or the facility in which the respondent is residing is: _________________________________________________________________________________________ 7. (a) Approximate value of respondent's personal estate: $___________________________________________ (b) Approximate value of respondent's real estate: $_______________________________________________ (c) The anticipated gross annual income and other receipts of the respondent are: $______________________ 8. Petitioner asks that _________________________________________________________________________ (Name) (age) (Occupation) (Estate and Person, Estate, Person) *Strike either (a) or (b) The undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true. (Address) (City and State) ___________ years, _____________________________________, qualified and willing to act, be appointed as temporary guardian of the ___________________________________ of the alleged disabled person. Name________________________________________ Attorney for___________________________________ Address______________________________________ City, State Zip_________________________________ Telephone____________________________________ _____________________________________________ Petitioner's Signature PR-PET3: Revised 12/01/06 Disabled Guardianship American LegalNet, Inc. www.FormsWorkflow.com