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 _____________________________________ SUPERIOR COURT OF ARIZONA MOHAVE COUNTY In the Matter of the (check one or both) Guardianship Conservatorship of Case No:_________________________ _________________________________________ the Ward (an Incapacitated or Protected Adult) 1. PETITION FOR DISCHARGE OF GUARDIAN/CONSERVATOR and/or TERMINATION OF GUARDIANSHIP/ CONSERVATORSHIP OF AN ADULT INFORMATION ABOUT THE CURRENT GUARDIAN and/or CONSERVATOR: (Name) ______________________________________________ was appointed and accepted appointment as: (check one box): Guardian and Conservator on ________________________ (date) Guardian ________________________ (date) Conservator ________________________ (date) Guardian/Conservator’s address: __________________________________________________________ 2. INFORMATION ABOUT THE WARD, the incapacitated or protected adult: Name:_________________________________________________ Date of Birth:___________________ 3. FOR PETITIONS TO TERMINATE THE GUARDIANSHIP and/or CONSERVATORSHIP: The need for the guardian and/or conservator has ended because: The ward died on this date: _______________________ (Attach death certificate or obituary). The ward moved out of state on (date)________________ to (where)______________________. The need for the guardian and/or conservator has ended because the ward is now capable of conducting his or her own affairs. (Attach current Physician’s Report). 4. FOR PETITIONS TO DISCHARGE THE GUARDIAN and/or CONSERVATOR: Guardianship and/or conservatorship has already been terminated or should be, as requested above. A successor (replacement) guardian and/or conservator has already been appointed, or has applied for appointment and the appointment is pending, or should be appointed to serve by the court. The name of the person appointed, or who seeks appointment as successor guardian and/or conservator, or who is being nominated to serve as successor guardian and/or conservator is: ______________________________________________________________________________ NOTE: If a successor (replacement) guardian and/or conservator is appointed, or will be appointed, then the case will continue to be open until terminated by the court. 3/7/2010 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________________________ The current guardian and/or conservator is no longer able to serve, does not want to serve, or should not be allowed to continue to serve as guardian and/or conservator and a successor guardian and/or conservator should be appointed by the court. (Explain here or attach explanation). ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Numbers 5,6,7,8, apply to Conservatorships only. If no Conservatorship, skip to #9. 5. RESTRICTED ASSETS: INFORMATION ABOUT THE CURRENT RESTRICTED ACCOUNT A. Restricted Financial Assets: 1. Amount now in restricted account: $________________________________ 2. Financial Account Number: (last 4 numbers) _________________________________ 3. Name and address of financial institution: _________________________________ ______________________________________________________________________________ Information about additional restricted financial assets is listed on attached page. B. Restricted Real Property: 1. Estimated market value of real property: $________________________________ 2. Estimated lien(s) owed on real property: _________________________________ 3. Address for real property: _________________________________ ______________________________________________________________________________ Information about additional restricted real property is listed on attached page. 6. STATEMENT ABOUT RESTRICTED FUNDS: (check one box) I HAVE NOT MADE OR I HAVE MADE previous withdrawals from this or any other restricted account without a written order of this court, as follows (explain carefully; give details about amount, date, reason): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 7. REQUEST ABOUT RESTRICTED FINDS: (check one box) I ask that the restricted funds be released to the ward’s estate because the ward has died. The name of the personal representative (“executor”) of the estate is___________________________, and the administration of the decedent’s estate is pending in Case No.:______________________, in the State of ___________________, in ___________________ County. I ask that the restricted funds be released to the ward because he or she is now capable of controlling the funds currently held for his or her benefit. Other (Explain):_________________________________________________________________ ______________________________________________________________________________ 3/7/2010 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________________________ 8. 9. There are no restricted assets in the conservatorship, and the final accounting for this conservatorship is filed with this Petition or has been filed separately. The court is asked to review and approve the Final Accounting. THEREFORE, I ask the court to schedule a hearing and to enter an order: (Read carefully and check the boxes to indicate exactly what you want the court to order.) A. Discharging the person currently serving as: guardian and conservator guardian (only) conservator (only) B. Terminating and closing the case because the protected person no longer needs a guardian or a conservator. C. Relating to Conservatorships only: 1. Directing the release of funds to the former ward as requested in the Petition 2. Requiring proof that the funds have been released to the former ward or his or her estate within 30 days after entry of an order 3. Approving the final Accounting 4. Releasing restricted real property at: Address: _________________________________________________________ Tax Assessor’s Parcel ID #___________________________________________ Address: _________________________________________________________ Tax Assessor’s Parcel ID #___________________________________________ D. Other (Explain):____________________________________________________ _________________________________________________________________ _________________________________________________________________ OATH OR AFFIRMATION STATE OF ARIZONA County of Mohave ) ) I swear or affirm that the contents of this document are true and correct to the best of my knowledge and belief, under penalty of perjury. _______________________________________________ Signature Date: ____________________ Sworn to or affirmed before me this ____________ day of _____________, 20_____ by ____________________________________________ My Commission Expires:_____________________ 3/7/2010 ______________________________________ Notary Public / Deputy Clerk Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com