FOR CLERK’S USE ONLY Name of Person Filing: ___________________________________________ Mailing Address: ___________________________________________ City, State, Zip Code: ___________________________________________ Daytime/Evening Phone No.________________________________________ ATLAS Number (if applicable)_______________________________________ Attorney Bar Number (if applicable)___________________________________ Self (Without a Lawyer OR Representing: Attorney for: Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY In the Matter of Guardianship and/or Conservatorship of Case Number: ________________________ PETITION FOR TEMPORARY/ EMERGENCY APPOINTMENT OF _____________________________________ an Adult or a Minor (Check one box) Guardian and Conservator Guardian Conservator EMERGENCY APPOINTMENT WITHOUT NOTICE REQUESTED INFORMATION FROM GUARDIANS AND/OR CONSERVATORS, UNDER OATH: 1. INFORMATION ABOUT THE PERSON TO BE PROTECTED BY THIS TEMPORARY ORDER: Name:_____________________________________ Date of Birth: __________________________ Street Address:______________________________________________________________________ City, State, Zip Code:________________________________________ 2. INFORMATION ABOUT THE PETITION THAT WAS FILED FOR PERMANENT GUARDIANSHIP AND/OR CONSERVATORSHIP (if applicable): A. Date Petition was filed:_____________________________. B. Name of Court where petition was filed: ________________________________________. C. Type of order requested: (check one) Guardianship and Conservatorship; D. Guardianship; Conservatorship Information about Court hearing scheduled for that petition: 1. DATE AND TIME OF HEARING: _________________________________________ 2. LOCATION OF HEARING: ______________________________________________ 3. NAME OF JUDGE/COMMISSIONER TO HEAR CASE: _______________________ 3. REASONS FOR TEMPORARY APPOINTMENT: The temporary appointment of a guardian and/or conservator is necessary because: Explain why the temporary appointment is necessary.) ____________________________________________________________________________________ Revised: 3/12/2010 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No._______________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 4. PETITIONER’S RELATIONSHIP to the person you say needs a guardian and/or conservator: ____________________________________________________________________________________ 5. WHY SHOULD THIS COURT CHOOSE THE PERSON YOU SAY SHOULD BE THE GUARDIAN AND/OR CONSERVATOR: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 6. INFORMATION ABOUT PERSON TO BE APPOINTED GUARDIAN AND/OR CONSERVATOR: (if different person than petitioner) Name:_____________________________________ Date of Birth: ___________________________ Street Address:_______________________________________________________________________ City, State, Zip Code:______________________________________ Telephone:___________________ Relationship to the proposed incapacitated and/or protected person:______________________________ 7. TO THE BEST OF MY KNOWLEDGE: (Check one box) No guardian and/or conservator has been appointed in any other court, and no court proceedings are pending for such appointment; Someone has been appointed or court proceedings are pending (explain who, when, in what court, and if appointee, whether guardian or conservator, or both): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ COMPLETE 8 AND 9 ONLY IF THIS TEMPORARY APPOINTMENT IS AN EMERGENCY, IF THIS IS NOT AN EMERGENCY, SKIP TO NUMBER 10. 8. EMERGENCY SITUATION. This case is an emergency and the appointment is necessary without notice to the person whom I say needs the guardian and/or conservator, or his/her attorney, because (explain here in detail why this needs to be done right away and without notice): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 9. PHYSICIAN’S REPORT. Complete this only if the person you say needs the temporary guardian and/or conservator is an ADULT: An affidavit or physician’s report describing the need for a guardian and/or conservator and the reason for emergency: Revised: 3/12/2010 Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No._____________________________ is attached to this Petition. is not attached to this Petition (explain why not)._______________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 10. PERSONS ENTITLED TO NOTICE under Arizona Law, A.R.S. §14-5309 (adults), 5207 (minors) and §14-5310 (emergency) for guardians and 14-5405 (adults and minors) and 14-5401 for conservators. (check one box, A or B): A. I have given notice to the person who needs a guardian, or his/her attorney, or others as follows, Name Address Relationship to Person who needs guardian or conservator 1._____________________________________________________________________________________ 2._____________________________________________________________________________________ 3._____________________________________________________________________________________ 4._____________________________________________________________________________________ 5._____________________________________________________________________________________ OR I have not given notice to the person who needs a guardian, or his/her attorney, or others because (explain here why no advance notice about this court case should be given). I will give notice by personal service to all persons required by law no later than 72 hours after the judge signs the Temporary Order: ____________________________________________________________________________________ B. ____________________________________________________________________________________ ____________________________________________________________________________________ REQUESTS TO THE COURT: 1. To find that the person about whom this petition is filed is in need of a temporary guardian and/or conservator. 2. Check this box only if you are asking for an emergency appointment without notice, and have completed Question 9: To find that an emergency exists and this Temporary Order is necessary without notice to the person I say needs the guardian and/or conservator, or his/her attorney; 3. To appoint the person identified in this petition as the temporary guardian and/or conservator for that person until a court hearing can take place on this matter, or until further order of the court. Revised: 3/12/2010 Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No._______________________________ OATH OR AFFIRMATION STATE OF ARIZONA County of Mohave ) ) ss. ) I, ____________________________the Petitioner, declare under penalty of perjury, that I have read this Petition. All the statements in the Petition are true and correct and complete to the best of my knowledge and belief. _____________________________________________ Petitioner’s Signature ________________________________ Date Sworn to or affirmed before me this ______________ day of _____________, 20____ by _____________________________________. My Commission Expires:____________________ Revised: 3/12/2010 ____________________________________ Notary Public/Deputy Clerk Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com