IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division PETITION FOR APPOINTMENT OF EMERGENCY TEMPORARY GUARDIAN Petitioner 1. Petitioner's residence is , petitioner's post office address is , and petitioner's telephone number is 2. A Petition to Determine Incapacity has been filed in this Court with respect to , an alleged incapacitated person, but a guardian has not been appointed. 3. 4. Petitioner is an adult interested in the welfare of the alleged incapacitated person. There appears to be imminent danger that the physical or mental health or safety of the . alleges: alleged incapacitated person will be seriously impaired or that the property of that person is in danger of being wasted, misappropriated or lost unless immediate action is taken because: Bar Form No. G-3.010 - 1 of 3 © Florida Lawyers Support Services, Inc. Revised January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 5. an alleged incapacitated person whose date of birth was is years of age. The residence of the alleged incapacitated person is , is ,and who , and the post office address of the alleged incapacitated person is . 6. The nature of the alleged incapacitated person's alleged incapacity is . 7. NAME The names and addresses of the next of kin of the alleged incapacitated person are: ADDRESS RELATIONSHIP 8. The proposed emergency temporary guardian , whose residence is ; whose post office address is ; and who is sui juris and otherwise qualified under the laws of Florida to act as guardian of the alleged incapacitated person ( is not ) a professional guardian and if a professional guardian has complied with the registration requirements of Florida Statutes Section 744.2002. 9. The relationship and previous association of the proposed emergency temporary guardian to . the alleged incapacitated person is Bar Form No. G-3.010 - 2 of 3 © Florida Lawyers Support Services, Inc. Revised January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 10. The proposed emergency temporary guardian should be appointed because: 11. The nature and value of the property subject to guardianship are as follows: Petitioner requests that summary proceedings be held upon this petition, that the court appoint an attorney to represent the alleged incapacitated person in these proceedings, and that an emergency temporary guardian of the [person] [property][ person and property] be appointed for the alleged incapacitated person. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Signed on this day of , . Petitioner Attorney for Petitioner Email Addresses: ____________________________________ _______________________________________ Florida Bar No. (address) Telephone: [Print or Type Names Under All Signature Lines] Bar Form No. G-3.010 - 3 of 3 © Florida Lawyers Support Services, Inc. Revised January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com