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Addendum To Petition For Guardianship Of An Adult - Requesting Immediate Temporary Guardianship Form. This is a Nevada form and can be use in District Court Statewide.
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Tags: Addendum To Petition For Guardianship Of An Adult - Requesting Immediate Temporary Guardianship, E, Nevada Statewide, District Court
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(Your name) _____________________________
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(Your address)_____________________________
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_____________________________
(Telephone)
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_____________________________
In Proper Person
IN THE ______ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
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IN AND FOR THE COUNTY OF _____________
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In the Matter of the Guardianship of
the person,
the estate,
the person and estate.
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______________________________,
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An Adult.
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_________________________________________)
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DEPT. NO: _____________
ADDENDUM TO PETITION FOR GUARDIANSHIP OF AN ADULT
REQUESTING IMMEDIATE TEMPORARY GUARDIANSHIP
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CASE NO. _____________
_________________________________and_____________________________________
(Name of Petitioner)
(Name of Co-Petitioner)
Petitioner(s) in this matter, state(s) as follows:
1.
A Verified Petition For Guardianship was filed in this matter on (Date Petition
was filed)_____________________________by the above-named Petitioner(s) to be appointed
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guardian(s) of (Name of Ward) _________________________________________
2.
This Request For Immediate Temporary Guardianship is made for the following
reasons:
One of the following questions, A or B, must be answered with a “yes” in order for an
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immediate guardianship to be considered. Both A and B may apply. If so, answer “yes”
on both A and B lines. Carefully, and in detail, explain your answers to the statements.
A. _______ The Ward faces a substantial risk of immediate physical harm or needs
immediate medical attention and the Ward lacks the capacity to respond to the risk of harm or to
Adult Addendum/Temporary
Addendum to Petition
1 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
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obtain the necessary medical attention because:
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___________________________________________________________________________
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____________________________________________________________________________
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___________________________________________________________________________
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_____________________________________________________________________________
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___________________________________________________________________________
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___________________________________________________________________________
(If you need more space, you may attach additional pages. Be sure the pages clearly indicate
they are a continuation of this portion of the document.)
B. _______ The Ward is unable to respond to a substantial and immediate risk of
financial loss and the Ward lacks the capacity to respond to the risk of loss because:
___________________________________________________________________________
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____________________________________________________________________________
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__________________________________________________________________________
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Adult Addendum/Temporary
Addendum to Petition
2 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
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____________________________________________________________________________
_____________________________________________________________________________
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___________________________________________________________________________
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____________________________________________________________________________
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____________________________________________________________________________
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____________________________________________________________________________
(If you need more space, you may attach additional pages. Be sure the pages clearly indicate
they are a continuation of this portion of the document.)
3.
I have filed a certificate signed by a physician licensed to practice in this state which
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states that the proposed Ward is unable to respond to a substantial and immediate risk of
physical
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harm, or, the Ward is in need of immediate medical attention, or, the Ward faces a substantial
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risk of financial loss, and the Ward lacks capacity to respond to those risks, or, I have filed an
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Affidavit explaining why the certificate is not available at this time.
4.
I (have or have not) ______________ tried in good faith to notify the following
people of this Request For Immediate Guardianship:
Carefully read the following statements and print “yes” or “no” to each statement.
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________ Husband or Wife of the Ward on ________________________.
(yes or no)
(date contact was made)
In person By telephone
In writing
________ Children of the Ward on _____________________________.
(yes or no)
(date contact was made)
In person By telephone
In writing
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Adult Addendum/Temporary
Addendum to Petition
3 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
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________ Parents of the Ward on _____________________________
(yes or no)
(date contact was made)
In person By telephone
In writing
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_______ Current Legal Guardian of the Ward on ____________________
(yes or no)
(date contact was made)
In person By telephone
In writing
________ Brothers and/or Sisters of the Ward who are over the age of 14 years on
(yes or no)
________________________
(date contact was made)
In person By telephone
In writing
________ Current Legal Guardians of any brothers and sisters of the Ward who are under the
(yes or no)
age of 14 years on ___________________
(date contact was made)
In person By telephone
In writing
________ The current person or officer of a care provider having the care, custody or control
(yes or no)
of the Ward on ___________________
(date contact was made)
In person By telephone
In writing
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________ The Ward has no spouse and there are no known relatives, therefore, I contacted the
(yes or no)
Public Guardian on __________________________
(date contact was made)
In person By telephone
In writing
If you answered “no” to any of the questions above, explain why those people
have not been contacted prior to the filing of this Request For Immediate
Temporary Guardianship.
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______________________________________________________________________________
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_______________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Adult Addendum/Temporary
Addendum to Petition
4 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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_____________________________________________________________________________
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(If you need more space, you may attach additional pages. Be sure the pages clearly indicate
they are a continuation of this portion of the pleading.)
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Dated ______________________________
Dated ______________________________
____________________________________
(Signature of Petitioner)
___________________________________
(Signature of Co-Petitioner)
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Adult Addendum/Temporary
Addendum to Petition
5 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
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VERIFICATION OF PETITIONER
STATE OF NEVADA
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COUNTY OF __________________)
I, (your name) ______________________________________, being first duly sworn under
penalty of perjury, hereby depose and say:
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That I am the Petitioner in the within action; that I have read the foregoing Addendum to the
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Petition For Guardianship Requesting Immediate Temporary Guardianship and know the contents
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thereof; that the same is true of my knowledge except as to those matters therein stated upon
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information and belief and as to those matters, I believe them to be true.
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___________________________________
Petitioner
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SIGNED and SWORN to before me by (Petitioner’s name) ___________________________
on the _____ day of ____________________, _____.
__________________________________
NOTARY PUBLIC
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ACKNOWLEDGMENT OF PETITIONER
STATE OF NEVADA
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COUNTY OF __________________)
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On this ______day of ________________, _________, before me, the undersigned Notary
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Public in and for the said County and State, personally appeared (your name)___________________
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____________________________ known to me to be the person described in and who executed the
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foregoing instrument, and who acknowledged to me that he/she did so freely and voluntarily and for
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the purposes and uses and purposes therein mentioned.
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WITNESS my hand and official seal.
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__________________________________
NOTARY PUBLIC
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Adult Addendum/Temporary
Addendum to Petition
6 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
American LegalNet, Inc.
www.FormsWorkflow.com
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VERIFICATION OF CO-PETITIONER
STATE OF NEVADA
)
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COUNTY OF __________________)
I, (name of co-petitioner) ______________________________________, being first duly
sworn under penalty of perjury, hereby depose and say:
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That I am the Co-Petitioner in the within action; that I have read the foregoing Addendum to
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the Petition For Guardianship Requesting Immediate Temporary Guardianship and know the
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contents thereof; that the same is true of my knowledge except as to those matters therein stated
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upon information and belief and as to those matters, I believe them to be true.
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___________________________________
Co-Petitioner
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SIGNED and SWORN to before me by (Co-Petitioner’s name)
___________________________
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on the _____ day of ____________________, _____.
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__________________________________
NOTARY PUBLIC
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ACKNOWLEDGMENT OF CO-PETITIONER
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STATE OF NEVADA
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COUNTY OF __________________)
On this ______day of ________________, _________, before me, the undersigned Notary
Public in and for the said County and State, personally appeared (co-petitioner’s name)
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_________________________________ known to me to be the person described in and who
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executed the foregoing instrument, and who acknowledged to me that he/she did so freely and
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voluntarily and for the purposes and uses and purposes therein mentioned.
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WITNESS my hand and official seal.
__________________________________
NOTARY PUBLIC
Adult Addendum/Temporary
Addendum to Petition
7 of 7
©2006 Nevada Supreme Court
Revised December 14, 2006
American LegalNet, Inc.
www.FormsWorkflow.com
