STATE OF MAINE DISTRICT COURT Location ________________ Docket No. ______________ In re: ______________________ Minor 1. Petitioner Information: Name: Legal residence: Mailing address: Telephone: Date of Birth: PETITION FOR APPOINTMENT OF TEMPORARY GUARDIAN OF MINOR 18-A M.R.S. �� 5-105, 5-204, 5-207(c) LIMITED FULL 2. Minor Subject of Temporary Guardianship Information: Name: Legal residence: Mailing address: Telephone: Date of Birth: 3. Relationship of nominated temporary guardian to the minor: 4. Current location of minor (If same as item 2, enter "same"): 5. Names and addresses of all persons who must be notified and the relationship of each person to the minor. (Use separate sheet if necessary) The following must be notified: the minor if 14 or older who has not otherwise consented or waived notice; the person who has had principal care and custody of the minor during the 60 days immediately preceding date of petition; any living parent of minor; and any other interested party as directed by the District Court Judge. NAME ADDRESS RELATIONSHIP GS-001, Rev. 7/16 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 6. NOMINATION AND CONSENT OF MINOR. I, ______________________________________, being 14 years of age or older do hereby nominate ______________________________________to be my (CHOOSE ONE) FULL LIMITED temporary guardian and consent to his/her appointment as such without attending a hearing. Dated:__________________________ ___________________________________ Signature of minor 7. State the reasons why a temporary guardian is necessary. 8. State the qualifications of the proposed guardian and why his/her appointment will be in the best interest of the minor. 9. Petitioner is requesting (CHOOSE ONE) FULL LIMITED temporary guardianship. If limited, explain in detail the specific duties and powers you propose to have as the guardian and the specific parental rights and responsibilities you propose to be kept by the parent(s) of the minor(s)?: _____________________________________________________ 10. Have you attached an acceptance of appointment? filed. Yes No. If no, state when it is to be WHEREFORE, the Petitioner respectfully requests that the court grant the Petition for Appointment of (CHOOSE ONE) FULL LIMITED Temporary Guardian of the minor. GS-001, Rev. 7/16 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Dated: ____________________ ______________________________ Signature of Petitioner or Attorney Attorney for Petitioner(s), if any: Name and Maine Bar Registration Number Address Phone Number Attorney for Other Party, if any: (Signature of Attorney and Maine Bar Registration Number) Name Address Phone Number STATE OF MAINE COUNTY Personally appeared the above-named , and ____________________________________, and made oath that the foregoing statements are true. Before me, Date: Attorney at Law/Notary Public/Deputy Clerk GS-001, Rev. 7/16 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com