COMMONWEALTH OF KENTUCKY ex rel þ PETI TIONERVS. þ RESPONDENT 1. þ Comes Petitioner and requests appointment as emergency limited guardian OR conservator for þ Respondent for the purpose of: þ þ þ þ 2. þ Petitioner states his/her relationship to Respondent is: and his/her þ þ þ þ þ þ þ 3. þ Petitioner offers as surety on his/her bond the following: þ þ 4. þ Respondent is years of age and re sides at: þ þ þ þ þ þ þ þ þ þ (name and address): þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 7. þ Respondent222s Durable Power of Attorney OR Health Care Surrogate is: þ Name: þ Address: þ þ 8. þ þ such appointment. þ þ þ þ Page 1 of 2Commonwealth þ þ þ þ www.courts.ky.gov þ þ þ PETITION/APPLICATION FOREMERGENCY APPOINTMENTOF FIDUCIARY FOR DISABLED PERSONS lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. Court þ County þ þ American LegalNet, Inc. www.FormsWorkFlow.com þ þ þ þ þ Name: þ Address: þ þ þ Relationship: þ Name: þ Address: þ þ þ Relationship: þ þ þ requests that a hearing be held þ þ þ þ þ þ þ þ þ þ Petitioner222s Name: Address: Telephone Number: þ Social Security No. þ Date þ Petitioner222s Signature AOC-747 þ Page 2 of 2WAIVER OF NOTICE AND REQUESTFOR APPOINTMENT OF FIDUCIARY þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ appointment herein applied for: þ þ þ þ þ þ þ þ þ þ þ þ Attorney222s Name: Address: þ þ Telephone Number: þ Date þ Attorney Signature þ þ þ þ þ þ þ þ þ þ þ My Commission expires:. þ þ Distribution: þ Petitioner/Attorney þ County Attorney þ Respondent/Attorney American LegalNet, Inc. www.FormsWorkFlow.com