STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT CLINTON COUNTY, ILLINOIS In Re the Guardianship of: ) ) ) Case No: ) Alleged Disabled Person ) PETITION FOR THE APPOINTMENT OF A GUARDIAN , a reputable citizen of Illinois, on oath states: 1. , whose place of residence is , whose date of birth is , is disabled and incapable of managing his/her (Estate, Person, or Estate and Person) because 2. Approximate value of the personal estate $ Anticipated gross annual income and other receipts $ 3. The names and addresses of his/her nearest relatives are (list spouse and children; if none, parents, brothers and sisters; if none, nearest kindred): Name Relationship Address Petitioner asks that be adjudged as a disabled person; Petitioner asks that: (a) , (Name) (Address) , age years, (City, State, Zip) (Occupation) American LegalNet, Inc. www.FormsWorkFlow.com qualified and willing to act, be appointed as guardian of the (Estate and or Estate and Person) of the disabled person; (b) , (Name) (Address) , age years, (City, State, Zip) (Occupation) qualified and willing to act, be appointed as guardian of the person of the disabled person; and (c) (an or no) authorization to appraise goods and chattels issue to the following, qualified to act /s/ Petitioner Subscribed and sworn to before me on: Date: Notary Public Prepared by: Address: Telephone: Email: American LegalNet, Inc. www.FormsWorkFlow.com