IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. IN THE MATTER OF THE ESTATE OF (Deceased): Name: Address: City,State, Zip: Date of Birth: File Stamp DESIGNATION OF PERSONAL FIDUCIARY FOR WARD The undersigned Executor/ Administration designates: Name: Street Address: City, State, Zip: to act as a personal fiduciary for the following ward: Name: Street Address: City, State, Zip: Minor Disabled Person This personal fiduciary has full power and the responsibility to protect the interests of this ward during independent administration and to do all acts necessary or appropriate for that purpose which the ward might do if not under disability. Executor or Administrator ACCEPTANCE OF OFFICE The undersigned accepts the office of personal fiduciary for the above disabled person. Personal Fiduciary's Signature Prepared by: Attorney/Pro Se: Address: City, State, Zip: Telephone No.: Attorney Registration No.: Attorney E-mail: P1-PR-035 (11/12) American LegalNet, Inc. www.FormsWorkFlow.com Personal Fiduciary Print Name