AOC-777 Doc. Code: PVA & OAG Rev. 8-03 Or OCON Case No._____________________Page 1 of 2 Court________________________Commonwealth of Kentucky VERIFIED PETITION FOR THE VOLUNTARY Court of Justice www.kycourts.net County_______________________ APPOINTMENT OF A GUARDIAN OR CONSERVATOR KRS 387.330 AND STANDBY GUARDIAN AND ORDER IN RE: ____________________________________________ ______________________________________ Petitioners Full Name Social Security No. ____________________________________________ __________________ ____________________ Date of Birth / Age ____________________________________________ Address Pursuant to KRS 387.330, the above-named petitioner hereby requests this Court to appoint ____________________________________, ___________________________________________________________, (Name) (Address) ____________________________________________, as [ ] guardian [ ] conservator of my property. Upon the death, (Telephone Number) resignation, removal, or incapacity of the appointed guardian or conservator, I nominate ______________________________, (Name)____________________________________________________________________, ____________________________, (Address) (Telephone Number)as standby guardian. Petitioner requests that the appointment be made [ ] without bond or [ ] with bond to be fixed in theamount of $________________________________. The Petitioners [ ] Durable Power of Attorney [ ] Health Care Surrogate is: _____________________________________________ Name _____________________________________________ Address _____________________________________________ _____________________________________________ This petition is to be acted upon by the Court only upon one of the following conditions: a. Occurrence of the following event: _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________. The occurrence of the above event shall be established by: _________________________________________________________________________________________________. b. Existence of the following condition of the petitioners mental or physical health: _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________________________________________________________________________. The existence of the above condition shall be established by: ________________________________________________________________________________________________. >>>> 2AOC-777 Doc. Code: PVA & OAG Rev. 8-03 Or OCON Page 2 of 2 Additionally, this petition is to be acted upon by the Court only if accompanied by an affidavit from a licensed physicianindicating that the above-named petitioner is disabled as defined in KRS 387.510. That affidavit [ ] is attached [ ] will befiled later. The proposed ward is hereby advised that a guardians powers are defined in KRS 387.065 and consist of the support,care and education of the ward while not being personally liable for the wards expenses or to third parties. Specifically, aguardian has the power to take custody of the ward, establishing the wards place of abode within the Commonwealth, andto take reasonable care of the wards personal effects and finances. The proposed ward is also advised that a conservatorspowers are defined in KRS 387.137 and unlike the guardians powers, consist only of managing the wards finances and assets._____________________________________________ _____________________________________________ Date Signature of PetitionerSUBSCRIBED AND SWORN TO before me this ______________ day of _____________________________, 2_______. _____________________________________________ Name / Title _____________________________________________ County, Kentucky * * * * * * * * * * * * * * * ORDER Having fully reviewed the above petition, and being otherwise sufficiently advised, IT IS HEREBY ORDERED that _____________________________________________________ [ ] is [ ] is notcompetent and fit to be appointed as guardian or conservator. It is further ordered that _____________________________[ ] is [ ] is not competent and fit to be appointed as standby guardian. Therefore, the Court appoints___________________________________, as [ ] guardian, [ ] conservator and ______________________________,as standby guardian. _____________________________________________ _____________________________________________ Date Judge