Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR For Clerk's Use Only Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the Guardianship of: Case Number: JG . ____________________________ a Minor AFFIDAVIT OF PERSON TO BE APPOINTED GUARDIAN INSTRUCTIONS: A signed and completed copy of this form must be submitted by each person who wants to be appointed guardian. If there are to be co-guardians, make a copy before writing on this form. Answer each statement as TRUE or FALSE. Each answer that is false must be explained in writing in an attachment to this affidavit. STATEMENTS MADE UNDER OATH OR AFFIRMATION TO THE COURT: Arizona law A.R.S. §14-5106 requires the person seeking appointment to answer items 1-12. This document must be filed with the "Petition for Permanent (or Temporary) Appointment of Guardian for a Minor". The nature of my relationship to the Minor is: (Example: grandparent/sister/uncle) I met the Minor under the following circumstances: 1. 2. 3. 4. 5. True or True or False. False. I have not been convicted of a felony in any jurisdiction. I have not acted as a guardian for another person for at least three years before I filed this Petition. I know and understand the powers and duties I would have as a guardian. I have not had a power of attorney for anyone for at least three years before I filed this Petition. Arizona law requires that a guardian file an annual report with the Court. If I have been a guardian before, I either filed the required documents on time, or within 3 months of receiving a notice from the court that the report was due. I have never been removed as a guardian or conservator by the Court. JG11f ­ 050115 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com True or True or False. False. True or False Does Not Apply. 6. True or False. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED AFF Case No. JG 7. True or False. I have never received anything of value greater than a total of one hundred dollars in any one year by gift, or will, or inheritance from an individual or the estate of an individual to whom I was not related by blood or marriage and for whom I served at any time as guardian, conservator, trustee, or attorney-in-fact. No business in which I have an interest has ever received anything of value greater than a total of one hundred dollars in any one year by gift, or will, or inheritance from an individual or the estate of an individual to whom I am not related by blood or marriage and for whom I served at any time as guardian, conservator, trustee, or attorney-in-fact. To the best of my knowledge, I am not named as a personal representative, trustee, beneficiary, or other type of beneficiary for any individual to whom I am not related by blood or marriage and for whom I have ever served as guardian, conservator, trustee, or attorney-in-fact. To the best of my knowledge, no business in which I have an interest is named as a personal representative, trustee, beneficiary, or other type of beneficiary for any individual to whom I am not related by blood or marriage and for whom I have ever served as guardian, conservator, trustee, or attorney-in-fact. I have no interest in any business that provides housing, health care, nursing care, residential care, assisted living, home health services, or comfort care services to any individual. I have never been charged with or convicted of any kind of abuse, neglect or mistreatment of a child or an elderly person. I am not named on any Registry of this State or any other of Sex Offenders or persons who have committed acts of abuse, violence or neglect against children or elderly persons. (If you checked "False", be prepared to explain the circumstances and why the Court should appoint you as a guardian in this case.) 8. True or False. 9. True or False. 10. True or False. 11. True or False. 12. True or False. OATH OR AFFIRMATION OF THE PERSON SEEKING TO BE APPOINTED GUARDIAN I have read this document. The information contained in this document is true, correct, and complete to the best of my belief and knowledge. Signature of Person to be Appointed Guardian STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) . (notary seal) Deputy Clerk or Notary Public by NOTE: IF YOU ANSWERED "FALSE" TO ANY QUESTION ABOVE, YOU MUST ATTACH AN EXPLANATION AS INSTRUCTED ON THE NEXT PAGE. The page following is an instruction page only. Do not file it with the Court. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED JG11f ­ 050115 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com AFF Case No. JG EXPLANATIONS THAT MUST BE ADDED TO THE AFFIDAVIT OF PERSON WHO WANTS TO BE APPOINTED (Required by Arizona Law: A.R.S. § 14-5106) You must explain the following as an attachment to your Affidavit for any statement which you marked "F" (false). FILE THE EXPLANATIONS WITH THE AFFIDAVIT, BUT DO NOT FILE THIS INSTRUCTION SHEET. All the information in the explanations is also under oath to the court. 1. As to each felony for which you have been convicted, list: DO NOT FILE THIS SHEET a. The nature of the offense. WITH THE CLERK'S OFFICE b. The name and address of the sentencing court. c. The case number. INSTRUCTION SHEET ONLY d. The date of conviction. e. The terms of the sentence. f. The name and telephone number of any current probation or parole officer. g. The reasons why the conviction should not disqualify you from appointment. If you have acted as guardian or conservator within three years before filing this petition, list: a. The names of individuals for whom you are currently serving, and court case numbers. b. The names of individuals for whom your appointment has been terminated within the three-year period, and the court case number. If you do not have the required information, please explain how you intend to obtain this information. State the total number of persons for whom you have done this. If you have acted under a power of attorney for the Minor/protected person, explain: a. The date the power of attorney was signed. b. The place where it was signed. c. The actions you have taken pursuant to the power of attorney. d. Whether the power of attorney is currently in effect. List the name and location of the court and the name and case number of the files in which you were delinquent in filing the