IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY, ILLINOIS - IN PROBATE IN RE THE ESTATE OF __________________________________________ Name of disabled adult CASE NO: ___________________________ Respondent, Alleged Disabled Adult PETITION FOR APPOINTMENT OF TEMPORARY GUARDIAN FOR A DISABLED ADULT Now comes ________________________________________ and on oath states as follows: Name of person filing petition 1. That on Date of Petition for Guardianship filed , a petition for the appointment of a plenary guardian of person/ Check one the estate/ person and estate of Name of alleged disabled adult , was filed. 2. That a temporary guardian of ________________________________________ is necessary for the Name of alleged disabled adult immediate welfare and protection of the respondent because: ______________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ List the reasons why a temporary guardianship is needed COMPLETE THE FOLLOWING IF NURSING HOME OR RESIDENTIAL PLACEMENT IS NEEDED 3. That pursuant to 755 ILCS 5/11a-14.1, this court may authorize the guardian to allow residential placement of a ward if the court finds that residential placement is in the best interest of the ward and is necessary to prevent substantial harm to the ward. 4. That residential placement is necessary for the ward for the following reason(s): ________________________________________________________________________________________ ________________________________________________________________________________________ List reason(s) why alleged disabled adult requires nursing home or residential placement. WHEREFORE, the petitioner prays that: ___________________________________ be adjudged a disabled adult and that: Name of alleged disabled adult (a) _________________________________, qualified and willing to act, be appointed temporary Name of guardian guardian of the person/ Check one estate/ person and estate of Name of alleged disabled adult . ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 61 A - Part 1 (Revised 12/16) (b) That the temporary guardian of the person be authorized to place the ward in an appropriate residential facility (MARK IF NURSING HOME OR RESIDENTIAL PLACEMENT IS NEEDED). _________________________________________________ (Signature of Petitioner) Address of Petitioner:________________________________ _________________________________________________ CERTIFICATION I affirm under penalty of perjury that I have read the foregoing document, that I know the contents thereof, and that the same are true and correct to the best of my knowledge and belief. _________________________________________________ (Signature of Petitioner) Prepared by: _______________________________________________ Attorney __________________________________________________ ARDC # __________________________________________________ Firm _____________________________________________________ Address ___________________________________________________ City & Zip ________________________________________________ Telephone_________________________________________________ ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT OF WILL COUNTY American LegalNet, Inc. www.FormsWorkFlow.com 61 A - Part 2 (Revised 12/16