STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT COUNTY OF WINNEBAGO FILE STAMP In the Matter of Case No. ____________________ ______________________________ A Minor PETITION TO APPOINT A GUARDIAN FOR A MINOR ________________________________________, a reputable citizen of Illinois, hereby certifies: 1. Each of the following is a minor in need of a guardian: ______________________ ______________________ ______________________ Name ____________ ____________ ____________ Date of Birth _________________________ _________________________ _________________________ Address ______________ ______________ ______________ (relationship to minor) County 2. The minor is in the physical custody of ______________________________, _______________________. 3. The approximate value of the minor's personal estate is $__________; the amount of the minor's anticipated gross annual income and other receipts is $___________. 4. Petitioner seeks the appointment of _________________________________________________________, (name of person qualified and willing to act as guardian) ________________, of ___________________________________________________________________ (date of birth) (complete address) who is ______ years of age, whose occupation is ________________________________________, whose relationship to the minor is ________________________ and who is qualified and willing to act, as the guardian of the ______________________________ of the minor. (person, estate or person & estate) 5. _________________________________, the biological mother of the above mentioned minor: a) has consented to the appointment of ______________________________ as guardian; b) is unwilling and/or unable to make and carry out the day-to-day child care decisions concerning the minor; c) has a last known address of ________________________________________________________ d) Is deceased; or __________________________________________________________________ e) has had her parental rights terminated (a copy of the Order is attached and herein incorporated). Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CC ­ 120 V1 6. _______________________________, the biological father of the above-mentioned minor: a) has consented to the appointment of ______________________________ as guardian; b) is unwilling and/or unable to make and carry out the day-to-day child care decisions concerning the minor; c) has a last known address of _______________________________________________________ d) Is deceased; or _________________________________________________________________ e) has had his parental rights terminated (a copy of the Order is attached and herein incorporated); or f) is unknown. 7. a) Petitioner is unaware of another appointment of a guardian for the minor or of any juvenile, adoption, parentage, dissolution or guardianship court action concerning the minor. b) There are other court actions involving the minor pending in case number ________________, in the county of ______________________, State of _________________. a) This guardian was designated by a parent of the minor in (i) a written instrument dated ____________________, (ii) a will admitted to probate on _________________, a copy of which is attached to or made a part of this petition. b) Petitioner is unaware of any designation of guardian by a parent of the minor. (proposed guardian name) 8. 9. It is in the minor's best interest that ____________________________________ be appointed guardian of _____________________________ because: _________________________________________________ (person, estate or person & estate) __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Accordingly, Petitioner asks that ____________________________________________________, residing at (name of person qualified and willing to act as guardian) ______________________________________________________________, who is qualified and willing to (complete address) act, be appointed as guardian of ___________________________________________________________ (person, estate or person & estate) Under penalties as provided by law pursuant to Section 1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that they verily believe the same to be true. __________________________________________ Petitioner's Signature Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com CC ­ 120 V1