STATEOFILLINOISINTHECIRCUITCOURTOFTHEFOURTHJUDICIALCIRCUITCHRISTIANCOUNTY,ILLINOISInRetheGuardianshipof:)))CaseNo: )AllegedDisabledPerson)REPORTONPETITIONFORTHEAPPOINTMENTOFAGUARDIANTheundersigned,onoathstate:1.ThenatureandtypeofdisabilityoftheRespondent is 2.OurevaluationsofRespondent222smental,physical,andeducationalcondition,adaptivebehavior,andsocialskillsare: TheseevaluationsarebaseduponexaminationofRespondenton 3.Inouropinionplenaryguardianship,bothofthepersonandoftheestateofRespondent,isneededbecause: 4.Werecommend,asthemostappropriatetreatmentorhabilitationplanandlivingarrangementforRespondent: 5.Signature(s)ofperson(s)performingevaluations(oneofwhommustbealicensedphysician): PhysicianPsychologist SocialWorkerEducator American LegalNet, Inc. www.FormsWorkFlow.com STATEOFILLINOIS))COUNTYOFCLINTON)Subscribedandsworntobeforeme,this dayof ,20 NotaryPublic/ClerkPreparedby: Attorneyfor: Address: Telephone: AttorneyNo.: Notes:I.R.S.110275Sec.11a1223Developmentaldisability224meansadisabilitywhichisattributableto:(a)mentalretardation,cerebralpalsy,epilepsyorautism;orto(b)anyotherconditionwhichresultsinimpairmentsimilartothatcausedbymentalretardationandwhichrequiresservicessimilartothoserequiredbymentallyretardedpersons.Suchdisabilitymustoriginatebeforetheageof18years,beexpectedtocontinueindefinitely,andconstituteasubstantialhandicap.Sec.11a2223Disabledperson224meansapersonof18yearsorolderwho(a)becauseofmentaldeteriorationorphysicalincapacityisnotFULLYabletomanagehispersonorestate,or(b)ismentallyillordevelopmentallydisabledandwhobecauseofhismentalillnessordevelopmentaldisabilityisnotfullyabletomanagehispersonorestate,or(c)becauseofgambling,idleness,debaucheryorexcessiveuseofintoxicantsordrugs,sospendsorwastehisestateastoexposehimselforhisfamilytowantorsuffering.Sec.11a9(a)Thepetitionforappointmentofaguardianshouldbeaccompaniedbyareportwhichcontains(1)adescriptionofthenatureandtypeoftherespondent222sdisability;(2)evaluationsoftherespondentsmental,physicalandeducationalcondition,adaptivebehaviorandsocialskills;(3)anopinionastowhetherguardianshipisneeded,thetypeandscopeoftheguardianshipneeded,andthereasonstherefore;(4)arecommendationastothemostappropriatetreatmentorhabilitationplanandlivingarrangementfortherespondent;andthereasonstherefore;(5)thesignaturesofALLPERSONSwhoperformedtheevaluationsuponwhichthereportisbased,oneofwhomshallbealicensedphysician. American LegalNet, Inc. www.FormsWorkFlow.com