CCP N200 (Rev. 08/16/16) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT ­ PROBATE DIVISION File No. Estate of Alleged Person with a Disability PETITION FOR APPOINTMENT OF GUARDIAN OF A PERSON WITH A DISABILITY Does the Petitioner expect the Alleged Person With A Disability to appear in court? Yes No In accordance with §11a-8 of the Probate Act of 1975 ("Probate Act") [755 ILCS 5/11a-8] and §§201 - 204 of the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act ("UAGPPJA") [755 ILCS 8/201 - 204], the Petitioner, _________________________________________________________________________________________ states under the penalties of perjury: 1. whose year of birth is place of residence is 2. The relationship to and interest in the Respondent of the Petitioner is *3. The reasons for the guardianship are that the Respondent is a person with a disability due to (a) ackssufficientunderstandingorcapacitytomakeorcommunicateresponsibledecisionsconcerningthe l care of the Respondent's person; (b) isunabletomanagetheRespondent'sestateorfinancialaffairs; 4. (a) The approximate value of the Respondent's estate is: Personal $ Real $ ; (b) The amount of the Respondent's anticipated annual gross income and other receipts are: $ ; 5. henamesandpostofficeaddressesoftheRespondent'sGuardian,ifany,oroftheRespondent'sagent(s)appointed T under any Power of Attorney Act, if any, and of the Respondent's nearest relatives entitled to notice, are listed on Exhibit A attached to this Petition "Nearest relatives" means, in the following order, (a) the spouse (including a party to a civil union) and adult children, the parents and adult brothers and sisters or, if none, (b) the nearest adult kindred known to the Petitioner; 6. henamesandpostofficeaddressesofanyminororadultwhoisdependentupontheRespondentarealsolistedon T Exhibit A attached to this Petition. 7. The name and address of the person with whom, or the facility in which, the Respondent is residing is * 8. **9. (a) No Petition for the appointment of a Guardian of the Respondent is pending in any other jurisdiction; (b) A Petition for the appointment of a Guardian of the Respondent is pending in [description of disability] [address/city/county/state/zip code] [printed name of the Petitioner] [printed name of the alleged person with a disability] (the "Respondent"), , who is 18 years or older, who resides in Cook County, and whose , is a person with a disability; and because of that disability ; (a) IllinoisistheRespondent's"homestate"asdefinedin§201(a)(2)oftheUAGPPJA. (b) istheRespondent's"homestate",butIllinoisisa"significant-connectionstate"as definedin§201(a)(3)oftheUAGPPJA,andoneoftheadditionalrequirementsspecifiedin§203(2)(A)-(B) of UAGPPJA applies. American LegalNet, Inc. www.FormsWorkFlow.com * Check the appropriate box or boxes ** Check the appropriate basis for jurisdiction DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 5 CCPN200B(Rev.08/16/16) File No. (c) llinois is not the Respondent's "home state" or a "significant-connection state" as defined in I §201(a)(2)-(3) of the UAGPPJA, but the "home state" and every "significant-connection state" have declined to exercise jurisdiction because Illinois is the most appropriate forum. (d) Illinois is not the Respondent's "home state" or a "significant-connection state" as defined in §201(a)(2)-(3) of the UAGPPJA, but the circumstances involved constitute an "emergency" as defined in §201(a)(1) of the UAGPPJA, and, as a result, the Court has "special jurisdiction" under §204(a) of the UAGPPJA. The Petitioner asks that A. [printed name of the Respondent] be adjudged a person with a disability, and that [printed name of the proposed Guardian] [postofficeaddress/city/state/zipcode] age years, [relationship to the Respondent] , [occupation] , whoisqualifiedandwillingtoactandwho appointed as Guardian of the *** B. (has) (has not) been convicted of a felony, be of the Respondent. (estate and person) (estate only) [printed name of the proposed Guardian] [postofficeaddress/city/state/zipcode] age years, [relationship to the Respondent] , (has) (has not) [occupation] , whoisqualifiedandwillingtoactandwho *** C. be appointed even though (he) (she) been convicted of a felony, be appointed as Guardian of the person only of the Respondent. has been convicted of a felony because: [printed name of the proposed Guardian] (i) the appointment is in the Respondent's best interests, after considering the nature and date of the offense and the evidence of the proposed Guardian's rehabilitation, and (ii) the offense is not one which, under §11a-5(5) of the Probate Act, would prohibit the appointment. *** Strike if not applicable. [signature of the Petitioner] Attorney Number _______________________________ Name ________________________________________ Firm Name ____________________________________ Attorneys for __________________________________ Address _______________________________________ City/State/Zip __________________________________ Telephone _____________________________________ Email ________________________________________ Page 2 of 5 [address of the Petitioner] Service via Email will be accepted at: by consent pursuant to Ill. Sup. Court Rules 11 and 131. AttorneyCertification [city/state/zip code] DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS American LegalNet, Inc. www.FormsWorkFlow.com CCP N200 C (Rev. 08/16/16) File No. Exhibit A Attached to and made a part of a PETITION FOR APPOINTMENT OF GUARDIAN OF A PERSON WITH A DISABILITY Listthenamesandpostofficeaddresses(i)ofthepersonsentitledtoreceivenoticeunderparagraph5,and(ii) of the minors or adults who are dependent upon the Respondent under paragraph 6, of the Petition to which this Exhibit A is attached. I. Respondent's Guardian(s) or agent(s) appointed under the Illinois Power of Attorney Act Has a Court appointed a Guardian for the Respondent? Yes No Unknown Has the Respondent executed a Power of Attorney for Property? Yes No Unknown Has the Respondent executed a Power of Attorney for Health Care? Yes No Unknown Provide the following information with respect to each Guardian and agent: _________________________________________ [name] _________________________________________ [name] _________________________________________ [address] _________________________________________ [address] _________________________________________ [city/state/zip] __________________________