IN THE CIRCUIT COURT FOR THE SIXTEENTH JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS Case No. ______________________ ESTATE OF: (Alleged Disabled Person) Name Hearing on Petition set for: Address _________________________________, 20___ at ________M. DeKalb County Courthouse, Sycamore, Illinois. City State Zip ______________________________________________________ JUDGE PETITION FOR APPOINTMENT OF GUARDIAN FOR DISABLED PERSON Your Petitioner, ______________________________________, on oath states: The above named, whose residence is set forth herein, and whose date of birth is __________________, 20___, is a disabled person owning real estate and/or personal property in DeKalb County, Illinois. The relationship to and interest of your Petitioner in the respondent is: The respondent is a disabled person due to: ________________________________________________________________________ ___________________________________________________________________________________________________________ and because of such disability, respondent lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the care of respondent’s person, and/or is unable to manage his/her estate or financial affairs. The approximate value of respondent’s estate: Personal $___________________________ Real $_____________________________ The anticipated gross annual income and other receipts of respondent are: (Itemize) The respondent’s nearest relatives, and guardian (if any) are (list spouse and children: if none, list parents, brothers and sisters; if none, nearest kindred): Name Relationship Post Office Address City State 1. 2. 3. The name and address of the person with whom, or facility in which respondent is residing is: Now, therefore, your Petitioner asks that said respondent be adjudged a disabled person, and that a [ ] Temporary [ ] Limited [ ] Plenary Guardian be appointed for and on behalf of the alleged disabled person; and, that _____________________________________________, ___________________________________________________________ (Name) (Address) who is 18 years of age or older, and whose occupation is _______________________________ who is qualified to act, be appointed [ ] Temporary [ ] Limited [ ] Plenary Guardian of the [ ] Estate [ ] Person [ ] Estate and Person for the limited purpose of ______ ______________________________________________________________________________________________ for and on behalf of the said respondent: and, that [ ] An [ ] No Authorization to appraise the goods and chattels of the respondent issue to __________________________________________________________________________________________________________. SIGNED AND SWORN to before me this __________________________________, 20_____ __________________________________________ (Notary Public – Clerk of the Court) _______ ____________________________________ Petitioner Address____________________________________ City & State_______________________Zip_______ Probate07 9/7/05 American LegalNet, Inc. www.FormsWorkflow.com