STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 20TH JUDICIAL CIRCUIT ST. CLAIR COUNTY- IN PROBATE In the Matter of the Estate of ) ) ) ) ) Case No.:________________________ _______________________________ A Disabled Person PHYSICIAN'S AFFIDAVIT- GUARDIANSHIP ___________________________, on oath states: 1. I am licensed to practice medicine in all its branches in Illinois. 2. On ___________________________, 20_____, I examined __________________________. 3. In my opinion he/ she is _______________________________________________________ (Physically and/ or Mentally) incapable of managing his______________________________________________________ (Person, Estate, or Person and Estate) 4. My opinion is based on these facts: __________________________, 20_______ ____________________________________ Address Signed and sworn to before me __________________________,20_______ ____________________________________ Notary Public ____________________________________ City/ State/ Zip ____________________________________ Telephone No. Name Attorney for Petitioner Address City Telephone American LegalNet, Inc. www.FormsWorkFlow.com