CCP 0223 A (Rev. 08/16/16) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT ­ PROBATE DIVISION File No. Estate of A Person with a Disability PETITION FOR APPOINTMENT OF STANDBY GUARDIAN OF A PERSON WITH A DISABILITY In accordance with §11a-8.1 of the Probate Act of 1975 ("Probate Act") [755 ILCS 5/11a-8.1], the Petitioner, [printed name of the Petitioner] states under the penalties of perjury: [printed name of the person with a disability] 1. whose year of birth is is a person with a disability. , , who is 18 years or older, whose place of residence is 2. The names and post office addresses of the person with a disability'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. 3. a. is the Guardian of the b. is acting as [printed name and post office address of the Guardian] (estate) (person) (estate and person) , of the person with a disability. , [printed name and post office address of the agent under power of attorney] (health care) (property) (health care and property) agent of the person with a disability under the Illinois , , and who is qualified and willing of the person with a disability. Power of Attorney Act. 4. a. The Petitioner seeks the appointment of [printed name of the proposed standby Guardian] [post office address of the proposed standby Guardian] who is years of age, whose occupation is (estate) (person) (estate and person) to act, as standby Guardian of the * b. The Petitioner seeks the appointment of , [printed name of the proposed successor standby Guardian] [post office address of the proposed successor standby Guardian] , who is years of age, whose occupation is (estate) (person) (estate and person) and who is qualified and willing of the person with a disability if the to act, as standby Guardian of the person named in subparagraph (a) above cannot or will not act as standby Guardian. 5. a. The preference of a person with a disability as to the choice of a standby Guardian of the *Strike if not applicable. Page 1 of 2 (estate) (person) (estate and person) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS CCP 0223 B (Rev. 08/16/16) File No. is * b. The preference of a person with a disability as to the choice of a standby Guardian of the person is 6. The facts concerning the consent of the Guardian of the person with a disability to the appointment of the standby Guardian, or the willingness and ability of the Guardian of the person with a disability to make and carry out day-to-day care decisions concerning the person with a disability are the following: [printed name of person with a disability's preference to serve as standby Guardian of the person] [printed name of person with a disability's preference to serve as standby Guardian] . . 7. The facts concerning the execution or admission to probate of the written designation of the standby guardian, if any, a copy of which is attached as Exhibit B to this Petition, are the following: 8. The facts concerning any guardianship court actions pending concerning the person with a disability are the following: 9. The facts concerning the willingness of the proposed standby Guardian to serve, and in the case of the Office of State Guardian or the Public Guardian, evidence of a written acceptance to serve signed by the State Guardian, or the Public Guardian or an authorized representative of the State Guardian or the Public Guardian, consistent with subsection (b) of §11a-3.1 of the Probate Act, are the following: The Petitioner asks that be appointed as standby Guardian of the *and that [printed name of the proposed standby Guardian] (estate) (person) (estate and person) [printed name of the proposed successor standby Guardian] (estate) (person) (estate and person) , of the Respondent be appointed as successor standby Guardian of the *Strike if inapplicable. Attorney Number Name Firm Name Attorneys for Address City/State/Zip Telephone Email of the Respondent. [signature of the Petitioner] [address of the Petitioner] [city/state/zip] Service via email from opposing party/counsel will be accepted at: by consent pursuant to Ill. Sup. Ct. Rules 11 and 131. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of 2