Page 1 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) DISTRICT COURT COUNTY, NEVADA PETITION FOR APPOINTMENT OF GUARDIAN(S) OVER ADULT INCLUDING REQUEST FOR TEMPORARY GUARDIANSHIP Petitioner(s) (first petitioner222s name) and request the Court approve a guardianship for the above-named adult. In accordance with Chapter 159 of the Nevada Revised Statutes, Petitioner(s) respectfully represents the following to this Honorable Court: Information Regarding the Proposed Protected Person 1.Adult222s full legal name:. 2.Adult222s date of birth:; current age: . 3.Address. Adult222s residenceAddress City, State, Zip Code 251 2018 Nevada Supreme Court COURT CODE: Your Name: Address: City,of: CASE NO.: DEPT: ( name of adult who needs a guardian ) A Proposed Protected Person. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) Adult222s mailing address (if different than residence address): Address City, State, Zip Code 4.Residency. The adult named above has been a resident of the State of (state) since (date) address since (date) . and has lived at the above 5.Caretaker. The adult in need of a guardianship is currently under the care of: Name Address City, State, Zip Code The care provider above is caring for the adult because: Medicaid. Does the adult receive Medicaid, or has the adult ever received Medicaid?( check one)YesNoImmediate Need. ( check one and complete)The adult needs immediate medical attention, specifically (explain)but cannot obtain the necessary medical care because (explain) The adult cannot respond to a substantial and immediate risk of physical harm,specifically (explain) American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) but is unable to respond to the risk of harm because (explain) The adult is facing a substantial and immediate risk of financial harm, specifically(explain) but is unable to respond to the risk of harm because (explain) 8.Need for Permanent Guardianship. The adult needs a guardian because (explain why/if aguardian will be needed after the current emergency is over): 9.Alternatives. What less restrictive alternatives have been tried before filing this request?( check all that apply)Supported Decision Making AgreementPower of AttorneyPower of Attorney for People with Intellectual DisabilitiesRepresentative Payee DesignationMicroboard / Circle of Friends Other: Explain why the items marked above are not working: 10.Powers Requested. If appointed, what specific powers, if any, would the guardian need?(explain if the guardian will need the ability to manage investments, loans, handle businesstransactions, sell property, etc.) American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) 11. Voting Rights: ( check one) The adult should keep his/her right to vote. The adult does not have the mental capacity to vote because he/she cannot communicate, with or without accommodations, a specific desire to participate in the voting process. 12. Firearms/Guns: ( check one) The adult should be allowed to possess a firearm. The adult should not be allowed to possess a firearm. The adult is a danger to him/herself or others because of a mental condition, or the adult does not have the capacity to contract or manage his/her own affairs because of a mental condition. 13. Driving: ( check one) The adult should be allowed to drive. The adult should not be allowed to drive. 14. The adult ( check one) is is not a party to any pending criminal or civil lawsuit. Explain if the adult is a party to litigation: 15. This guardianship ( check one) is is not sought for the purpose of initiating a lawsuit. Explain if guardianship is sought to initiate lawsuit: 16. Abuse/Neglect Report: ( check one) The guardianship IS NOT requested because of an investigation of abuse, neglect, exploitation, isolation or abandonment of the adult. The guardianship IS requested because of an investigation of abuse, neglect, exploitation, isolation or abandonment of the adult. The investigating agency is (name of agency) , which is ( check one) law enforcement a state agency a county agency. American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) 17.Documents. The adult executed the following documents, copies of which will be filedwith this Petition: ( check all that apply) Written nomination of guardian. The nominated guardian is (name of personnominated to serve as guardian)NOTICE: The Court will check the Nevada Secretary of State Lockbox to determine ifa guardian has already been designated by the proposed protected person.Durable power of attorney for financial matters. The agent is Durable power of attorney for health care. The agent is Revocable or living trust. The agent is None of the above.Unknown if the adult has executed any of the above documents.*Copies of any of the above should be submitted confidentially to the Court for review. 18.Assets. The value of the proposed person222s assets is estimated at: ( check one)Less than $10,000. If the guardianship is granted, the court should treat this case as223summary administration224 and not require annual accountings or a final accounting.More than $10,000. Information Regarding the Petitioner 19.Full legal name:. 20.Date of birth:; current age: . 21.Relationship to adult in need of a guardian: . If you are the spouse, the date of marriage was: (date). 22.Residence address: Address City, State, Zip Code American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) Mailing address (if different than residence address): Address City, State, Zip Code 23.Nomination of Guardian: ( check one) I want to be the guardian over the adult. I am competent and capable of acting asguardian of the proposed protected person and consent to act in this capacity.I do not want to be the guardian. Instead, the Court should appoint (insert name) to be the guardian over the adult. (if you selected this option, skip ahead to #32) 24.If you do not live in the State of Nevada: ( check one) A person or care provider in this State is providing continuing care and supervisionfor the adult;The adult is in a secured residential long-term care facility in this State;The guardian will move to the State of Nevada within 30 days of appointment; orThe proposed protected person will move to the guardian222s state of residence within30 days of appointment. [NOTE: If a nonresident is appointed as guardian for an adult, the guardian must designate a registered agent in the State of Nevada in the same manner as a represented entity pursuant to Nevada Revised Statutes Chapter 77.] 25.Qualifications. (Answer each item listed; 223Has224 answers must be explained)The Petitioner: ( check one for each) has has not been convicted of a crime of moral turpitude, a crime involving domestic violence or a crime involving the abuse, neglect, exploitation, isolation or abandonment of a child, his or her spouse, his or her parent or any other adult. Explain if Yes: has has never been convicted of a felony. Explain if Yes: Petitioner was convicted of (describe conviction) Petitioner ( check one) check one) American LegalNet, Inc. www.FormsWorkFlow.com Page 7 of 13 226 Petition for Appointment of Guardian Including Temporary Guardianship (Adult) has has never been suspended for misconduct or disbarred from the practice of law, the practice of accounting or any other profession which involves the management or sale of money, investments, securities or real property and requires licensure in Nevada or any other state. Explain if Yes: has has not filed for bankruptcy within the past 7 years. is is not a party to pending criminal or civil litigation. Explain if Yes: Information Regarding the Co-Petitioner Not Applicable (check if there is only one proposed guardian, and go to #33) 26.Full legal name:. 27.Date