CCP 0219 (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 TO EXTEND TEMPORARY GUARDIANSHIP OF ALLEGED PERSON WITH A DISABILITY In accordance with §11a-4 of the Probate Act of 1975 ("Probate Act") [755 ILCS 5/11a-4], the Petitioner, [printed name of the Petitioner] states under the penalties of perjury: 1. On [date on which the Temporary Guardian was originally appointed] , the Court appointed [printed name of the Temporary Guardian] (estate) (person) (estate and person) as Temporary Guardian of the [printed name of alleged person with a disability] of (the "Respondent"); 2. The Respondent has not been adjudicated a person with a disability and a Petition pursuant to §11a-8 of the Probate Act [755 ILCS 5/11a-8] is pending; 3. It is in the best interest of the Respondent to extend the temporary guardianship so as to protect the Respondent from any potential abuse, neglect, self-neglect, exploitation or other harm, because: ; The Petitioner asks that the temporary guardianship of the Respondent be extended to *, and that the powers and duties of the Temporary Guardian be modified as follows: [a date not more than 120 days from the date the Temporary Guardian was originally appointed] * 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] [city/state/zip] Service via email 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 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com