IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI PROBATE DIVISION AT In the Matter of Estate Number , Respondent PETITION FOR APPOINTMENT OF GUARDIAN AND CONSERVATOR Comes now petitioner and states: 1. age , domiciled in County, , whose present residence address is , (Street) (City) , is unable by reason of: (State) (Zip) to receive and evaluate information or to communicatedecisions to such an extent that respondent lacks capacity *(in part) to meet essentialrequirementsfor food, clothing,shelter, safety or other care such that serious physical injury, i llness or disease is likely to occur. Respondent is also unable as a result of the above described conditions to receive and evaluate information to communicate decisions to such an extent that respondent lacks ability to manage *(in part) his financial r esources. That respondent,by reason of the conditions described above, is unable to meet respondents essential daily needs of living and/or to manage his financial resources without supervision and that there are no less intrusive alternatives to *(limited) guardia nshipand/or *(limited) conservatorship available to provide for respondents care and financial needs. 2. The nature, extent and e stimate value of respondents assets so far as is known to petitioner the major part of which is located in County, Missouri is set forth in Exhibit A attached hereto and incorporated herein by thisreference. 3. The name and address of respondents parents, s pouse,children, and the childrens ages, respondents other close relatives and any person having power to act in a fiduciary capacity with respect to any of respondentsfinancialresources or health care needs are set forth in Exhibit B attached hereto and incorporated herein by this reference. 4. The name and address of the person having custody of >>>> 2respondent is: 5. The name and address of respondents guardian orconservator appointed in this or any other state, if any, is: 6. The proposed guardian and/or conservatoris not guardian or conservator for any other person except: 7. Attached hereto and incorporatedherein by this reference as Exhibit C is the consent of the proposed guardian/conservatorto act if appointed. 8. If the proposed guardian/conservatoris a non-residentof Missouri, attachedhereto and incorporatedherein by this reference as Exhibit D is the proposed guardian/conservatorsdesignationof resident agent and the agents consent to act. 9. Attached hereto and incorporatedherein by this reference as Exhibit E is a list of the names and addresses of the witnesses who may be called to testify in support of this petition. WHEREFORE, petitioner prays that a hearing be held and if the court finds respondent to be *(partially) inc apacitated and/or*(partially) disabled, the court appoint: as *(limited) guardian and *(limited) conservator of the estate of respondent. Petitioner Attorney for Petitioner: MO BAR No Address & Telephone No.: ( ) Fax Number:( ) E-Mail Address: Serve Respondent At: *Strike Inapplicable. Form 10193