PETITION FOR APPOINTMENT OF GUARDIAN - DISABLED PERSON STATE OF ILLINOIS 3796 (Rev 4/17) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT IN RE THE ESTATE OF CASE NUMBER ALLEGED DISABLED PERSON PETITION FOR APPOINTMENT OF GUARDIAN DISABLED PERSON File Stamp Here , on oath states: 1. and place of residence is 2. The relationship to and interest of the Petitioner to the Respondent is: 3. The reason(s) for the guardianship is that the Respondent is a disabled person due to: and because of such disability: ** 4. The approximate value of the estate: Personal: $ The anticipated gross annual income and other receipts of the Respondent are: $ 5. The names and post office addresses of the Respondent's nearest relatives and guardian, if any, are: (list spouse and children; if not, the Respondent's parent(s), brothers and sisters; if none, nearest kindred.) Real: $ whose date of birth is , * is a disabled person. 6. The name and address of the person with whom, or facility in which the Respondent is residing: Petitioner asks that be adjudged a disabled person and that qualified and willing to act, be appointed the guardian of the Respondent's estate person estate and person The guardianship shall be for the limited purpose of: No less restrictive means will reasonably protect the assets and/or ensure the safety of the alleged disabled person. Pro Se Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Email: Address City, State, Zip Date Circuit Court Clerk / Notary Public * If alleged disabled person is a nonresident, add "owning real estate in this county" or "owning no real estate in Illinois, but owning personal estate in this county." ** (a) Lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the care of the Respondent's person. (b) Is unable to manage the Respondent's estate or financial affairs. (c) Both (a) and (b) CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 American LegalNet, Inc. www.FormsWorkFlow.com