1 4-992. Guardianship and conservatorship information sheet; petition. [For use with Rule 1-003.2 NMRA] GUARDIANSHIP AND CONSERVATORSHIP INFORMATION SHEET (Submit with Petition) Type or print responses. To be submitted with a petition for the appointment of a guardian or conservator under Chapter 45, Article 5, Parts 3 and 4, NMSA 1978 THIS SECTION FOR OFFICIAL USE ONLY NOTE TO COURT CLERK: DOCKET EVENT CODE , CRT: G/C Information Sheet (Petition). Scan document, but will not become part of the official record. Case number: Assigned judge: I.Persons entitled to notice and access to court records until the appointmentof a guardian or conservator. 1.Full name, address, and date of birth of person to be protected: 2.Full name and address of petitioner: For each relationship below, indicate whether the petitioner is aware of anyonewith such a relationship to the person to be protected. For each relationship marked 223Yes,224 provide the name and mailing address, if known, of the person with such a relationship to the person to be protected. Attach additional sheets if necessary. 3. 4. If no known spouse, an adult with whom the person is in a long-term relationshipof indefinite duration in which the individual has demonstrated an actualcommitment to the person to be protected similar to the commitment of a spouseand in which the individual and the person to be protected consider themselves tobe responsible for each other222s well-nknown 5. If no known adult children, each parent and adult sibling of the person to be American LegalNet, Inc. www.FormsWorkFlow.com 2 If no known parent or adult sibling, at least one adult nearest in kinship to the person to be protected who can be found with reasonable diligence: 6.Adult stepchildren of the person to be protected whom the person activelyparented during the stepchildren222s minor years and with whom the person had anongoing relationship in the two-year period immediately preceding the filing of 7.A person responsible for the care or custody of the person to be protected: Unknown 8.Any attorney currently representing the person to be protected: 9.Any representative payee appointed by the federal social security administration 10.A guardian or conservator acting for the person to be protected in New Mexico or 11.A trustee or custodian of a trust or custodianship of which the person to be 12.Any fiduciary for the person to be protected appointed by the federal department 13.An agent designated under a power of attorney for health care in which the person 14.An agent designated under a power of attorney for finances in which the person toUnknown 15.A person nominated as guardian or conservator by the person to be protected: 16.A person nominated as guardian by the parent or spouse of the person to be 17. 18.A person known to have routinely assisted the person to be protected withdecision making during the six months immediately preceding the filing of thepetition: American LegalNet, Inc. www.FormsWorkFlow.com 3 19.If the petition is for a guardianship, any person with whom the petitioner seeks toII.Certification/Affirmation. American LegalNet, Inc. www.FormsWorkFlow.com