FOR CLERK’S USE ONLY Name of Person Filing: ________________________________________ Mailing Address: ________________________________________ City, State, Zip Code: ________________________________________ Day/Evening Telephone: ________________________________________ Attorney Bar Number (if applicable) ___________________________________ Self (Without a Lawyer) OR Representing: Attorney for __________________________________ In the Matter of Case Number: ______________________________ ________________________________ a Protected or Incapacitated Adult AFFIDAVIT OF NOTICE OF HEARING REGARDING DISCHARGE/TERMINATION and/or RELEASE OF FUNDS in a Guardianship and Conservatorship Guardianship (only) Conservatorship (only) STATEMENTS MADE UNDER OATH TO THE COURT: 1. I PROVIDED COPIES OF THE FOLLOWING COURT DOCUMENTS: PETITION for Discharge of Guardian and/or Conservator and/or Termination of Guardianship and/or Conservatorship and Release of Funds. NOTICE OF HEARING OTHER (if applicable) List specifically each court document you provided. ________________________________________ _______________________________________ ________________________________________ _______________________________________ ________________________________________ _______________________________________ 2. I PROVIDED THE DOCUMENTS LISTED ABOVE TO THE PERSONS whose relation to the protected person as well as the date and manner of delivery is listed below. (If the protected person is an adult, be sure to include his or her attorney, if any.) A. B. C. Name: (printed) Relation to protected person: Date documents were sent: (or delivered) __________________________________________________ __________________________________________________ __________________________________________________ D. How the documents were sent: (Check box(es) below and fill-in appropriate information) 1st class mail, postage prepaid Certified mail Registered mail (attach green return receipt card to this paper) Hand delivery by: (name) _______________________________________________ Personal Service (by “Acceptance of Service,” Sheriff, or Private Process Server)* (*File “Affidavit of Acceptance” or affidavit of process server or sheriff) A. B. C. 3/4/2011 Name: (printed) Relation to protected person: Date documents were sent: (or delivered) __________________________________________________ __________________________________________________ __________________________________________________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________ D. How the documents were sent: (Check box(es) below and fill-in appropriate information) 1st class mail, postage prepaid Certified mail Registered mail (attach green return receipt card to this paper) Hand delivery by: (name) _______________________________________________ Personal Service (by “Acceptance of Service,” Sheriff, or Private Process Server)* (*File “Affidavit of Acceptance” or affidavit of process server or sheriff) A. B. C. Name: (printed) Relation to protected person: Date documents were sent: (or delivered) __________________________________________________ __________________________________________________ __________________________________________________ D. How the documents were sent: (Check box(es) below and fill-in appropriate information) 1st class mail, postage prepaid Certified mail Registered mail (attach green return receipt card to this paper) Hand delivery by: (name) _______________________________________________ Personal Service (by “Acceptance of Service,” Sheriff, or Private Process Server)* (*File “Affidavit of Acceptance” or affidavit of process server or sheriff) STATE OF ARIZONA ) County of Mohave ) ss. UNDER OATH OR BY AFFIRMATION I state to the court under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. SIGNATURE: ___________________________________ DATE:___________________ Sworn to or Affirmed before me this: __________________ by ___________________________________ (date) My Commission Expires: ______________________ 3/4/2011 ____________________________________ Deputy Clerk / Notary Public Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com