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