IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. IN THE MATTER OF THE ESTATE OF (Alleged Disabled Person): Name: Address: City,State, Zip: Date of Birth: File Stamp PETITION FOR APPOINTMENT OF GUARDIAN FOR DISABLED PERSON The petitioner, , whose relationship to and interest in the respondent is certifies: The above named, whose residence and date of birth is set forth herein, 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, and owns real estate and/or personal property in Kane County, Illinois, with the approxiamate value of each being as follows: Real: $ Personal: $ and the anticipated gross annual income and other receipts of respondents are: The respondent's nearest relatives, and guardian, if any, or the respondent's agent(s) appointed under the Illinois Power of Attorney Act (if any) are (list spouse and adult children, parents and adult brother(s)/sisters(s), if any; if none, nearest adult kindred known to the petitioner): (Name/Relationship, Post Office Address, City, State and Zip) 1. 2. 3. The name/address of the residence of facility in which the respondent is residing: The petitioner asks that said respondent be adjudged a disabled person and that , who is qualified to who is 18 years of age or older, and whose occupation is act, be appointed Temporary Plenary guardian of the , Limited guardian for the purpose of Person Estate Person and Estate for and on behalf of said respondent. Complete the following if more than one guardian is requested: , The petitioner asks that said respondent be adjudged a disabled person and that , who is qualified to who is 18 years of age or older, and whose occupation is act, be appointed Temporary Plenary guardian of the Limited guardian for the purpose of Person Estate , Person and Estate for and on behalf of said respondent. PAGDP P1-PR-026A 4/00 Page 1 of 2 2002 © American LegalNet, Inc. Case No. Under penalties as provided by law pursuant to 735 ILCS 5/1-109, the undersigned certifies that the statements set forth in this petition are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies that he/she verily believes the same to be true. Petitioner's Signature Address City, State, Zip Telephone No. Signed pursuant to Supreme Court Rule 137: Attorney or Party Attorney/Pro Se: Address: City, State, Zip: Telephone No.: Attorney Registration No.: NOTE: The petition should be accompanied with a Physician's Report. If for any reason this Report is not attached, the Court shall order appropriate evaluations to be performed by a qualified person(s) and a report prepared and filed with the Court at least ten (10) days prior to the hearing. P1-PR-26B 4/00 Page 2 of 2