Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Licensed Fiduciary 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 Guardianship and Conservatorship of: Case Number PB: PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN and CONSERVATOR FOR AN ADULT, or a Minor at least 17.5 years of age, to become effective at age 18 Name of Person to be Protected UNDER OATH OR BY AFFIRMATION: INFORMATION REQUIRED BY ARIZONA LAW (A.R.S. § 14-5303 and 5404) 1. INFORMATION ABOUT THE PETITIONER (the person filing this petition) (My) Name: Address: Telephone: Date of Birth: My interest in or relationship to the person to be protected is: (examples: mother, father, sister, brother, grandparent, legal guardian) © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED APE PBGCA11f-010714 Page 1 of 9 American LegalNet, Inc. www.FormsWorkFlow.com Case No. _____________ 2. INFORMATION ABOUT THE PERSON TO BE PROTECTED (also known as "the proposed protected person" or "the ward") Name: Address: Telephone: Date of Birth: 3. INFORMATION ABOUT THE PROPOSED GUARDIAN AND CONSERVATOR: (Complete this only if the proposed guardian/ conservator is someone other than Petitioner.) Name: Address: Telephone: Relationship to the person to be protected is: (examples: mother, father, sister, brother, grandparent, legal guardian) Date of Birth: A. The proposed guardian and conservator has priority for appointment as a conservator under Arizona law A.R.S. § 14-5410, because he or she is: (Already) A conservator, guardian of property or other similar fiduciary appointed or recognized by the appropriate court of any other jurisdiction in which the person to be protected resides. An individual or corporation nominated by the protected person if the protected person is at least fourteen years of age and has, in the opinion of the court, sufficient mental capacity to make an intelligent choice. The person nominated to serve as conservator in the protected person's most recent durable power of attorney. The spouse of the protected person. An adult child of the protected person. A parent of the protected person, or a person nominated by the will of a deceased parent. Any relative of the protected person with whom the protected person has resided for more than six months before the filing of the petition. The nominee of a person who is caring for or paying benefits to the protected person. If the protected person is a veteran, the spouse of a veteran or the minor child of a veteran, the department of veterans' services. © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED APE Page 2 of 9 PBGCA11f-010714 American LegalNet, Inc. www.FormsWorkFlow.com Case No. _____________ A fiduciary who is licensed pursuant to Arizona law, A.R.S. § 14-5651, other than a public fiduciary. A public fiduciary who is licensed pursuant to Arizona law A.R.S. § 14-5651. OTHER. Explain: B. The proposed guardian and conservator named above has priority for appointment as a guardian under Arizona law A.R.S. § 14-5311, because he or she is: The spouse of the incapacitated person; An individual nominated by the incapacitated person to be the guardian; An adult child of the incapacitated person; The parent of the incapacitated person; A relative of the incapacitated person and has lived with the person more than six months before filing this petition; Nominated by someone who is caring for or is paying benefits for the incapacitated person; Is a private fiduciary, a professional guardian, conservator, or the Arizona Veterans' Service Commission. Other (explain): 4. REASONS FOR GUARDIANSHIP: The person to be protected needs a guardian because he or she is incapacitated as defined by Arizona Law, A.R.S. §14-5101(1), to the extent that he or she lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his or her own self-interests. Appointment of a guardian is necessary or desirable to provide continuing care and supervision of the person, and is in his or her best interests. THE PERSON TO BE PROTECTED IS INCAPACITATED AND IN NEED OF CONTINUING CARE AND SUPERVISION DUE TO: (Check all that apply): Mental illness, mental deficiency, mental disorder; Physical illness or disability; Other (explain): Chronic use of drugs; Chronic intoxication; © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED APE Page 3 of 9 PBGCA11f-010714 American LegalNet, Inc. www.FormsWorkFlow.com Case No. _____________ 5. TYPE OF GUARDIANSHIP: LIMITED OR GENERAL: (A.R.S. § 14-5303(B)(8)) A. A LIMITED GUARDIANSHIP is requested with the following specific powers: 1. Authority for the guardian to: Consent to Medical Treatment Arrange Education or Training Consent to Make Living Arrangements Consent to Marriage Apply for Public Assistance or Social Services Consent to Outpatient Mental Health Care and Treatment 2. INPATIENT Mental Health Powers: The ward is incapacitated as a result of mental health disorder as defined in A.R.S. § 36-501. Authority is requested for the Guardian to place the ward in a level one behavioral health facility for inpatient mental health care and treatment. This request is supported by the opinion of a licensed psychiatrist or psychologist, included and made part of this document. 3. OTHER LIMITED POWERS REQUESTED: (List and Describe) Continues on attachment "Powers Requested", made part of this document. (OR) B. GENERAL GUARDIANSHIP is requested. As required by Arizona law, A.R.S. §14-5303(B)(8), less restrictive alternatives to "general" guardianship, including technological assistance, have been considered, however: (Check the box if true*) The proposed ward is incapacitated in a manner or to an extent that a limited guardianship would not adequately protect and provide for the proposed ward's care and well-being. (Optional additional information) * For the court to order a general guardianship, you must check the box and be prepared to offer clear and convincing evidence that less restrictive means of meeting the proposed ward's demonstrated needs would not be sufficient. (A.R.S. § 14-5304(B)) NOTE: A general or "non-limited" guardianship includes authority to consent to outpatient mental health treatment but the Court must specifically grant authority to place the ward in