CCP N202 A (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 TEMPORARY GUARDIAN OF ALLEGED PERSON WITH A DISABILITY In accordance with §11a-4 of the Probate Act of 1975 ("Probate Act") [755 ILCS 5/11a-4] and §§201-204 of the Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act ("UAGPPJA") [755 ILCS 8/201-204], the Petitioner, [printed name of the Petitioner] , states under the penalties of perjury: 1. On Guardian of the (estate) (person) (estate and person) , a Petition was filed herein for the appointment of a of [printed name of the alleged person with a disability] (the "Respondent"); 2. A Temporary Guardian is necessary for the immediate welfare and protection of the of the Respondent because (estate) (person) (estate and person) ; *3. (a) Illinois is the Respondent's "home state" as defined in §201(a)(2) of the UAGPPJA. is the Respondent's "home state", but Illinois is a "significant-connection state" as defined in §201(a)(3) of the UAGPPJA, and one of the additional requirements specified in §203(2)(A)-(B) of UAGPPJA applies. (c) 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 "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 proposed Guardian] [post office address/city/state/zip code] (b) age years, [relationship to the Respondent] , [occupation] , who is qualified and willing to act and who appointed as Temporary Guardian of the * Check the appropriate basis for jurisdiction. (has) (has not) (estate and person) (estate only) been convicted of a felony, be of the Respondent with DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 1 of 2 CCP N202 B (Rev. 08/16/16) File No. the following powers: ** B. be appointed even though (he) (she) [printed name of the proposed Guardian] has been convicted of a felony because: (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. Attorney Number _______________________________ Name ________________________________________ Firm Name ____________________________________ Attorneys for __________________________________ Address _______________________________________ City/State/Zip __________________________________ Telephone _____________________________________ Email ________________________________________ [signature of the Petitioner] [address of the Petitioner] Service via Email will be accepted at: by consent pursuant to Ill. Sup. Court Rules 11 and 131. Attorney Certification [city/state/zip code] DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Page 2 of 2