JDF 841SC R6/19 PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT Page 1 of 7 District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Respondent COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #.: Case Number: Division Courtroom PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT 1. No court proceeding is pending in this state or elsewhere concerning the respondent. The following proceeding(s) concern(s) the respondent. Identify name of court, case number, state, date, and type of proceeding if any. Name of Court Case Number State Date of Proceeding Type of Proceeding 2. The petitioner is: a person interested in the welfare of the respondent. or the respondent. This is a petition for appointment of a(n): Permanent Guardian. (247 15-14-304(1) and (2), C.R.S.) Emergency Guardian. (not to exceed 60 days). (247 15-14-312, C.R.S.) 3. Information about the petitioner: Name: List all names used (also known as, formerly known as, etc.): Relationship to Respondent: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email Address: Does petitioner need an interpreter? NoYes (Language:) American LegalNet, Inc. www.FormsWorkFlow.com JDF 841SC R6/19 PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT Page 2 of 7 4. Information about the respondent: Name (REQUIRED): Age: Date of Birth (REQUIRED): Sex (REQUIRED): Street address: City: State: Zip Code: Mailing address, if different: City: State: Zip Code: County of Residence: Primary phone: Alternate phone: Email address: Does respondent need an interpreter? NoYes (Language:) If this appointment is made, the respondent222s residence will change to: 5. Information about the respondent222s spouse, partner in a civil union, or adult who has resided with the respondent for more than six months in the last year: Name: Relationship to Respondent: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email address: Does this person need an interpreter? NoYes (Language:) 6. Venue for this proceeding is proper because the respondent resides in this county. is present in this county. (Check this box only if requesting an Emergency Guardian.) (247 15-14-108(2), C.R.S.) is admitted to an institution pursuant to an order of a court of competent jurisdiction sitting in this county. (Attach copy of the Order to the Petition.) 7. An appointment of a guardian for the respondent has been previously made. (Attach copy of the Order to the Petition.) 8. A Power of Attorney exists for financial or medical matters. (Attach a copy of the Power of Attorney to the Petition.) The agent221s name and mailing address is: 9. A valid designated beneficiary agreement exists. (Attach a copy of the agreement to the petition.) The designated beneficiary222s name and mailing address is: American LegalNet, Inc. www.FormsWorkFlow.com JDF 841SC R6/19 PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT Page 3 of 7 10. The respondent is unable to effectively receive or evaluate information or both or make or communicate decisions to such an extent that he or she lacks the ability to satisfy essential requirements for physical health, safety, or self-care, even with appropriate and reasonably available technological assistance. (247 15-14-102(5), C.R.S.) 11. The respondent222s identified needs cannot be met by less restrictive means, including use of appropriate and reasonably available technological assistance. 12. Guardianship is necessary due to the following disabilities or impairments: Physician222s letter attached. 13. Petitioner requests the powers and duties to be unlimited or unrestricted or limited or with restrictions. The requested limitations or restrictions on the guardian222s powers and duties, if any, are as follows: 14. Petitioner is 21 years of age or older, nominates himself or herself and requests to be appointed as guardian. or Petitioner nominates the following person, who is 21 years of age or older, to be appointed as guardian. Name: List all names used (also known as, formerly known as, etc.): Street address: City: State: Zip Code: Mailing address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email Address: Does this person need an interpreter? NoYes (Language:) 15. The nominated guardian has priority for appointment because he or she is: (247 15-14-310, C.R.S.) a guardian currently acting for the respondent in Colorado or elsewhere.nominated in writing by respondent, including nomination in a durable power of attorney or designated beneficiary agreement. an agent under a medical power of attorney. an agent under a general durable power of attorney. the spouse or partner in a civil union of the respondent. the parent of the respondent. American LegalNet, Inc. www.FormsWorkFlow.com JDF 841SC R6/19 PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT Page 4 of 7 an adult child of the respondent. an adult with whom respondent has resided for more than six months immediately before the filing of this petition. other: 16. The respondent nominated the following person as guardian, but the petitioner does not seek that person222s appointment for the following reason: Name: List all names used (also known as, formerly known as, etc.): Relationship to Respondent: Street address: City: State: Zip Code: Mailing address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email address: 17. It is necessary to appoint an Emergency Guardian for the respondent because complying with the normal procedures for the appointment of a guardian will likely result in substantial harm to the respondent222s health, safety, or welfare and no other person appears to have authority and willingness to act in the circumstances. (247 15-14-312, C.R.S.) The nature of the emergency is as follows: 18. Information about respondent222s adult children and parents. None (If none, list an adult relative that can be found with reasonable efforts, such as a brother, sister, aunt, uncle, etc.) Name: Relationship to Respondent: Street address: City: State: Zip Code: Mailing address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email address: Does this person need an interpreter? NoYes (Language:) Name: Relationship to Respondent: Street address: American LegalNet, Inc. www.FormsWorkFlow.com JDF 841SC R6/19 PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT Page 5 of 7 City: State: Zip Code: Mailing address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email address: Does this person need an interpreter? NoYes (Language:) Name: Relationship to Respondent: Street address: City: State: Zip Code: Mailing address, if different: City: State: Zip Code: Primary phone: Alternate phone: Email address: Does this person need an interpreter? NoYes (Language:) 19. Information about each person currently responsible for primary care and custody of the respondent, including the respondent222s treating physician: None Name of Treating Physician: Phone #: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Email Address: Name of Caregiver: Phone #: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Email Address: 20. The following person is the legal representative for the respondent not otherwise designated above. (Representative payee, trustee, custodian of a trust, etc. 247 15-14-102(6), C.R.S.) Name: Type of Legal Representative: Phone #: Email Address: Mailing Address: City: State: Zip Code: American LegalNet, Inc. www.FormsWorkFlow.com JDF 841SC R6/19 PETITION FOR APPOINTMENT OF GUARDIAN FOR ADULT Page 6 of 7 21. The guardian may receive compensation. The hourly rates to be charged, any amounts to be charged pursuant to a published fee schedule, including the rates and basis for charging fees for any extraordinary services, and any other bases upon which a fee charged to the estate will be calculated, are as stated below or in an attachment to this petition. * The basis of compensation has not