Name of Person Filing: __________________________________________ Mailing Address: __________________________________________ City, State, Zip Code: __________________________________________ Day/Evening Phone Number:________________________________________ Attorney Bar Number (if Applicable)__________________________________ Representing: Self (Without a Lawyer) or Attorney for ____________________________________ FOR CLERK'S USE ONLY SUPERIOR COURT OF ARIZONA MOHAVE COUNTY In the Matter of the Guardianship and/or Conservatorship of: Case No:_________________________ _____________________________________ An Adult PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN AND/OR CONSERVATOR OF AN ADULT NOTICE: The authority granted to the guardian may include the authority to withhold or withdraw life sustaining treatment, including artificial food and fluid. A.R.S. §14-5303(B) REQUIRED INFORMATION ABOUT PETITIONER, UNDER OATH OR AFFIRMATION: 1. INFORMATION ABOUT ME (the petitioner): Name: _______________________________________________________________________________ Street Address: ________________________________________________________________________ City, State, Zip Code:____________________________________________________________________ Telephone:__________________________________ Date of Birth: _____________________________ I am related by blood to the person who needs a guardian and/or conservator ("the incapacitated person and/or protected person"). My relationship to the person I say needs a guardian and/or conservator is: ________________________________ 2. INFORMATION ABOUT THE PERSON WHO NEEDS A GUARDIAN AND/OR CONSERVATOR. This person is called the proposed incapacitated person (for a guardianship) and proposed protected person (for a conservatorship): Name: _______________________________________________________________________________ Street Address: ________________________________________________________________________ City, State, Zip Code:____________________________________________________________________ Telephone:__________________________________ Date of Birth: ______________________________ 3. PERSON TO BE APPOINTED GUARDIAN AND/OR CONSERVATOR (Complete this section only if the person is a different person than petitioner): Name: _______________________________________________________________________________ Revised: 12/6/2016 Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________________________ Street Address: ________________________________________________________________________ City, State, Zip Code:____________________________________________________________________ Telephone:_____________________________ Date of Birth: ______________________________ The person to be appointed guardian and/or conservator is related by blood to the person who needs a guardian and/or conservator. If "yes" above, HOW is the person to be appointed guardian and/or conservator related to the proposed incapacitated/proposed protected person? ______________________________________________________________________________ (Examples: grandmother, uncle, sister) 4. PERSON(S) ENTITLED TO NOTICE of this Court matter under Arizona law, A.R.S. §14-5309 for guardians, and §14-5405 for conservators, and to whom I will give notice of this case: (See instructions) A______________________/_______________________________________________ (Name) (Address) _______________________________________________ (Relationship to Person Who I Say needs a Guardian and/or Conservator) B______________________/_______________________________________________ (Name) (Address) _______________________________________________ (Relationship to Person Who I Say needs a Guardian and/or Conservator) C______________________/_______________________________________________ (Name) (Address) _______________________________________________ (Relationship to Person Who I Say needs a Guardian and/or Conservator) D______________________/_______________________________________________ (Name) (Address) _______________________________________________ (Relationship to Person Who I Say needs a Guardian and/or Conservator) 5. INFORMATION REGARDING GUARDIANSHIP AND/OR CONSERVATORSHIP to the best of my knowledge, (check one box): No guardian and/or conservator have been appointed by Will or by any Court Order, and no Court proceedings are pending for such appointment; Someone has been appointed guardian and/or conservator or Court proceedings are pending. Explain who, when, in what Court, and if the appointee is guardian and/or conservator): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 6. ASSETS OF PERSON WHOM I SAY NEEDS GUARDIAN AND/OR CONSERVATOR (check one box) The person who needs a guardian and/or conservator has no substantial assets or income. No bond by petitioner is required; OR, The person who needs a guardian and/or conservator has assets and/or annual income in the approximate amount of $___________________ Revised: 12/6/2016 Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________________________ Explain: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 7. REASONS FOR CONSERVATORSHIP: The person needs a conservator because he or she has property which will be wasted or used up unless proper management is provided, and (check one or both boxes that apply): He or she needs funds for his or her support, care and welfare; Funds are needed for the support, care and welfare of those entitled to be supported by the person. 8. REASONS PERSON CANNOT MANAGE HIS OR HER PROPERTY: (check one or more reasons that you think apply): Mental illness, mental deficiency, or mental disorder; Physical illness or disability; Chronic use of drugs; Chronic intoxication; Confinement; Detention by a foreign power; Disappearance. 9. REASONS FOR GUARDIANSHIP: I believe that the person needs a guardian and is incapacitated as defined by Arizona Law, A.R.S. §14-5101(1) to the extent that he or she lacks sufficient unders