Page 1 of 5 Revised December 2017 251 2017 Coconino County Law Library Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self COCONINO COUNTY SUPERIOR COURT In the Matter of the Guardianship and/or Conservatorship of : an Adult Case Number: GC PETITION FOR: [ ] G UARDIANSHIP ONLY [ ] CONSERVATOR SHIP ONLY [ ] GUARDIANSHIP AND C ONSERVATOR SHIP The Proposed Ward: Name: Mailing Address: City, State, Zip: Phone: Birthdate: Age: The proposed ward lives in Coconino County. The Proposed Guardian And/Or Conservator: : Street Address: City, State, Zip: Phone Number : Relationship to the P roposed W ard: Proposed Co - : Street Address: City, State, Zip: Phone Number : Relationship to the P roposed W ard: Guardianship And/Or Conservatorship: [ ] The proposed ward does not currently have a guardian or conservator. [ ] conservator. Hearings are set in that case on these dates: American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 5 Revised December 2017 251 2017 Coconino County Law Library No proceeding to appoint a guardian or conservator for the ward is pending in another court. An Affidavit of each Person to Be Appointed Guardian and/or Conservator is filed with this Petition. A guardian should be appointed because: The proposed ward is incapacitated for the reasons below, and guardianship is needed to provide for their needs, which cant be met by less restrictive means, including technological assistance. [ ] Mental illness, deficiency, or disorder [ ] Chronic drug use or intoxication [ ] Physical illness or disability [ ] Other: General or Limited Guardianship: The authority granted to the guardian may include the authority to withhold or withdraw life sustaining treatment, including artificial food and fluid. [ ] General Guardianship: Other alternatives have been explored, and a limited guardianship is not appropriate because of the extent of the proposed wards incapacity. [ ] Limited Guardianship: I ask for only the following rights and/or responsibilities: [ ] Custody of the ward [ ] Responsibility for the wards personal needs, including food, clothing, and shelter [ ] Responsibility for the wards educational, social, and religious activities [ ] Responsibility for the wards medical needs [ ] Other: Driving Privileges: Should the proposed be suspended? [ ] Yes [ ] No Voting Rights: Should the proposed vote be suspended? [ ] Yes [ ] No A conservator should be appointed because: [ ] The proposed ward has property that will be wasted without a conservator. [ ] Protection is necessary or desireable to obtain or provide funds needed for the support, care, and welfare of the proposed ward or those entitled to be supported by them. The proposed ward cant manage their estate and affairs effectively because of: [ ] Mental illness, deficiency, or disorder [ ] Physical illness or disability [ ] Chronic drug use or intoxication [ ] Confinement [ ] Other: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 Revised December 2017 251 2017 Coconino County Law Library The proposed guardian and/or conservator should be appointed because they: [ ] Were chosen by the proposed ward [ ] Were chosen in the proposed wards most recent durable power of attorney [ ] Are the proposed wards spouse [ ] Are the proposed wards adult child [ ] Are the proposed wards parent [ ] Were chosen as conservator by a deceased parents will [ ] Are the proposed wards relative and has lived with the proposed ward for at least six months before filing this Petition [ ] Were chosen by someone caring for or paying benefits for the proposed ward [ ] Were given legal decision-making authority over the ward by a court when the ward was a minor. Name of that court: Case number: A copy of the court order is attached. The ward turned 18 [ ] less than two years ago or [ ] more than two years ago. [ ] Other: I interested in the proposed wards welfare because: Appointment Of An Attorney And Health Professional: The PAttorney: (complete this section if the proposed ward has an attorney): Name: Phone Number: Street Address: City, State, Zip: Health Professional: (In all guardianship and some conservatorship cases, the court will appoint a health professional to examine the proposed ward and report to the court. You must pay the health professional for this. If health care authority, it must be a psychologist or psychiatrist.) Name: Phone Number: Street Address: City, State, Zip: American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 5 Revised December 2017 251 2017 Coconino County Law Library People Entitled To Notice: List the proposed ward; their living parent; their spouse; their children over 17; each person having care or custody of them; each person who filed a demand for notice; and, if you can locate no parent, spouse, or child over 17, their closest adult relative. Name Street Address City, State, Zip Code The proposed ward: Their living parents: Their spouse: Th eir adult children: People having care or custody of them : People who filed a demand for notice: Their closest adult relative : [ ] The proposed ward has no substantial assets or income. [ ] The proposed ward has the following assets or income. Property: Est imated Fair Market Value Cash (checking, savings, certificates of deposit, etc.) $ Marketable securities (stocks, bonds, brokerage accounts, etc.) $ Other Personal Pr operty (ca rs, etc.) $ Real Property (land and buildings) $ Total: $ Annual Income (including compensation, insurance, or allowance): Social Security $ Pensions $ Dividends $ Trust Income $ Other : $ Total: $ I Ask for These Orders: Appoint a health professional to examine the proposed ward. Appoint an investigator to report to the court. Appoint Petitioner guardian and/or conservator of the proposed ward. Make any other orders in the proposed wardbest interest. American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 5 Revised December 2017 251 2017 Coconino County Law Library [ ] Appoint an attorney to represent the proposed ward (check the box if the ward does not already have an attorney). [ ] Grant Petitioner inpatient mental health care authority. I have read this Petition, and it is true and complete to the best of my knowledge. Propos Signature: State of Arizona County of ) ) ) Subscribed and sworn before me this date: by: Seal: Notary Public: Notary Expiration Date: I have read this Petition, and it is true and complete to the best of my knowledge. Proposed Co- Signature: State of Arizona County of ) ) ) Subscribed and sworn before me this date: by: Seal: Notary Public: Notary Expiration Date: American LegalNet, Inc. www.FormsWorkFlow.com