FORM 16 A/I Name: ____________________________________ Attorney: _______________________________________________ File #: ____________________________________ Atty. Phone #: ___________________________________________ Preliminary Decree Citation with Notice Final Order Consent to Serve Doctor Deposition: A.I.P. _____can Form SP 4-131 (No Guns) __________ __________ __________ __________ ______cannot attend hearing : . __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ Name, age, residence and P.O. address of A.I.P. Names and addresses of spouse, parents and presumptive adult heirs of A.I.P. Name and address of person or institution providing residential services to A.I.P. Names and addresses of other services providers Names and addresses of persons or entity whom petition seeks to have appointed guardian Averment that proposed guardian has no interest adverse to A.I.P. Reasons for seeking guardian Description of functional limitations and physical and mental condition of A.I.P. Steps taken to find LRA’s (less restrictive alternatives) Specific areas of incapacity for which guardian is to be assigned powers Qualifications of proposed guardian Gross value of estate and net income from all sources to the extent known (required if seeking guardianship of the estate __________ By Petitioner, not counsel - O.C. Rule L.3.4A(2) __________ Petition, and any answer and reply must be endorsed with the name, address, zip code, telephone # and Atty ID # of attorney representing the party filing. __________ Proposed notice in large type and simple language Notice states date, time and place of hearing and rights of A.I.P., including right to counsel Notice sets forth purpose and seriousness of hearing and that rights may be lost American LegalNet, Inc. www.FormsWorkFlow.com FORM 16 __________ __________ A.I.P. is a resident of County, or of long-term facility within the Co. of Chester A.I.P. does not reside in County but beneficiary of an estate of trust in the Co. of Chester A.I.P. does not reside in County but has assets in Co. of Chester No other guardian has been appointed __________ __________ __________ __________ Individuals _________________________________________________________ Corporation_________________________________________________________ Guardian Officer ____________________________________________________ No adverse interest/adverse interest but no one else available __________ DUE AT LEAST 7 DAYS BEFORE HEARING: _________ _________ Affidavit of Service Notice of Retention/Non-Retention of Counsel by A.I.P. __________ __________ __________ Personal Service At least 20 days before hearing By qualified person (include qualifications on affidavit) __________ __________ Next of kin or presumptive heirs (necessary) Person/institution providing residential services, if any Others whom Court may direct, including other service providers (inform Judge at least 7 days before hearing if no counsel has been retained by A.I.P. __________ Requested Appointed: ___________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com