700-00074 226 Petition to Appoint Guardian for an Adult (Voluntary) (08/2018)Page 1 of 1 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No. In re: PETITION TO APPOINT GUARDIAN FOR AN ADULT (Voluntary) I, request the Court to appoint a guardian pursuant to 14 V.S.A. 2472671 to Name of Petitionerassist me in the management of my affairs. In support of this petition, I state: 1.I am 18 years old or older. My date of birth is ;2.I understand the nature, extend and consequences of the guardianship;3.I understand how the guardianship can be ended;4.I ask that | be appointed to act as myName of Proposed Guardian Name of Proposed Co-Guardianguardian with the following powers (check all that apply):to have general supervision over me, including my care, habilitation, education, employment andchoosing or changing where I live, subject to the requirements of 14 V.S.A. 2472472691, 3073 and 3074;to seek, approve or refuse medical or dental treatment, subject to the provisions of 14 V.S.A. 2473075and any constitutional right of mine to refuse treatment;to supervise my income and resources;to approve or withhold approval of any contract I wish to make, except a contract for my basicneeds;to approve or withhold approval of the sale, lease or encumbrance of my real property subject to theprovisions of 14 V.S.A. 2472881 226 2891;to seek legal advice and to start or defend against a court action in my name.5.I am (check one):physically able to appear before the court at a hearing on this petition; ORnot physically able to appear before the Court at a hearing on this petition for the following reason: I voluntarily request the appointment of a guardian. This request is not made in response to coercion or duress. Date Signature of Petitioner Petitioner222s Mailing Address Petitioner222s Phone/Email GUARDIAN222S CONSENT I consent to be appointed guardian of: | Date Signature of Guardian Signature of Co-Guardian, if any | Guardian222s Mailing Address Co-Guardian222s Mailing Address | Guardian222s Phone/Email Co-Guardian222s Phone/Email American LegalNet, Inc. www.FormsWorkFlow.com