FOR CLERK'S USE ONLY Name of Person Filing: Address: City, State, Zip Code: Telephone Number: Attorney Bar Number (if applicable) __________________________________ Representing: Self (Without a Lawyer) or Attorney for ________________________________ SUPERIOR COURT OF ARIZONA MOHAVE COUNTY In the Matter of the Guardianship and/or Conservatorship of Case Number:___________________________ PROOF OF NOTICE OF HEARING FOR (check all that apply) Permanent Guardianship Permanent Conservatorship Termination of Guardianship/Conservatorship Release of Restricted Funds Budget and/or Accounting ___________________________________ an Adult a Minor The undersigned states that copies of the following Court documents were provided to the persons listed below. 1. DOCUMENTS PROVIDED: I provided copies of the following court documents. List specifically each court document you provided. Be sure you provided and you list the "NOTICE OF HEARING." 1.__________________________________________________________________________________ 2.__________________________________________________________________________________ 3.__________________________________________________________________________________ 4.__________________________________________________________________________________ 5.__________________________________________________________________________________ 6.__________________________________________________________________________________ 2. TO WHOM I GAVE NOTICE: These are the people to whom I gave copies of all the documents listed in Number 1 above. State the relationship between the person who has or will have the guardianship and/or conservatorship and the person you gave the copies to. Be sure to list the ATTORNEY for the person who has or will have the guardian or conservator if the person is an adult. Be sure to list the COURT INVESTIGATOR if this is about a "Petition to Appoint a Guardian and/or Conservator for an Adult." (Use extra paper if necessary.) A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Revised: 8/30/2012 Case No.______________________________ A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ A. B. C. D. E. Name: _______________________________________________________________________ Address: _______________________________________________________________________ Relationship to person: __________________________________________________________ Date I sent the documents: ________________________________________________________ How documents were sent: ________________________________________________________ STATE OF ARIZONA ) County of Mohave ) ss. By signing this document, I state to the Court, under penalty of perjury, that the information I have provided on this form is true and correct to the best of my knowledge and belief. SIGNATURE:________________________________________ Date:__________________________ SUBSCRIBED AND SWORN TO before me this ________ day of ____________, 20________. By:_________________________________________ My Commission Expires:________________________ _________________________________ Notary Public / Deputy Clerk Revised: 8/30/2012 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com