IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF KING In the Guardianship of: ______________________________, ) ) ) ) ) ) ) Case No.: PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE RCW 11.88.030 (PTAPGD) An Alleged Incapacitated Person. I. ALLEGED INCAPACITATED PERSON INFORMATION The name, age, address of present residence, and post office address of the Alleged Incapacitated Person are: A. Name: B. Age: C. Present Residence: D. Post Office Address: II. minor) Mother's name, phone number and address:_________________________________ Father's name, phone number and address:__________________________________ Mother/Father has __has not ___signed a written consent for this guardianship. [ ] A guardian should be appointed as to the estate of the child. ______________________________ ______________________________ ______________________________ ______________________________ INFORMATION CONCERNING A GUARDIANSHIP FOR A CHILD UNDER 18 (This section to be filled out only if guardianship is sought with respect to a PETITION FOR GUARDIANSHIP- 1 11/2011 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com [ ] A guardian should be appointed as to the person of the child. (If this box is checked the following additional information must be provided: Name, address and date of birth of the proposed Guardian and all other adult persons living in the Guardian's household): ______________________________________________ (The proposed guardian and all other adult persons living in the Guardian's household understand that they may be required to undergo a criminal and child protective services background check before an order appointing guardian may be entered. The guardian and all other adult members in his or her household must sign an authorization to release CPS records.) The child is ___ is not ___ a member of an Indian tribe nor a child of a member of an Indian tribe. Tribal Name and Address is:_____________________________________________ III. NATURE AND DEGREE OF ALLEGED INCAPACITY The nature and degree of the alleged incapacity are as follows: A. Nature of Alleged Incapacity: B. Degree of Alleged Incapacity: IV. ______________________________ ______________________________ DESCRIPTION/VALUES OF PROPERTY The approximate value and the description of the property owned by the Alleged Incapacitated Person is: A. Real Property: C. Mortgages and Notes: D. Bank Accounts E. Furniture: F. Other Personal Property: $______________________________ $______________________________ $______________________________ $______________________________ $______________________________ $__________________ B. Stock, Mutual Funds and Bonds: $______________________________ Total Approximate Value of Assets is: PETITION FOR GUARDIANSHIP- 2 11/2011 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com There are periodic compensation, pension, insurance, and allowances as follows: A. Social Security Benefits: B. Veterans Benefits C. Washington State Assistance D. Other: $____________________________ /month $____________________________ /month $____________________________ /month $____________________________ /month $______________________ Approximate Total Monthly Income: V. EXISTING OR PENDING GUARDIANSHIPS There [ ] is [ ] is not an existing or pending Guardianship action for the person and/or the estate of the Alleged Incapacitated Person. If there is an existing or pending Guardianship, set forth the following: A. State Where Guardianship/Limited Guardianship Pending or Established: ______________________________________ B. Name of Guardian/Limited Guardian: ______________________________ C. Date of Appointment: ______________________________ D. Type of Guardianship: ______________________________ VI. NOMINEE The name, address, telephone number, date of birth, and age of the proposed Guardian and the relationship of the Alleged Incapacitated Person are as follows: A. Name of Nominee: ______________________________ B. Address: ______________________________ C. Telephone Number: ______________________________ D. Age: ______________________________ E. Relationship to Alleged Incapacitated Person: _________________________ Only complete Section F below if a nominee has been identified and they are not a Certified Professional Guardian. F. The nominee: [ ] Has completed the mandatory guardianship training requirement and proof is filed with this petition PETITION FOR GUARDIANSHIP- 3 11/2011 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com [] [] VII. Has not completed the mandatory guardianship training requirement at the time of filing this petition and requests an extension by the court. Requests the requirement for training be waived because:_______________ _____________________________________________________________. RELATIVES The name and addresses, and the nature of the relationship of the persons most closely related by blood or marriage to the Alleged Incapacitated Person are as follows: A. Name: Address: Relationship: B. Name: Address: Relationship: C. Name: Address: Relationship: ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ VIII. CUSTODIAN OF PERSON TO BE ASSISTED The name, address, and telephone number of the person or facility having the care and custody of the Alleged Incapacitated Person and the length of time of said care and custody is: A. Name: B. Address: C. Telephone: IX. ______________________________ ______________________________ ______________________________ D. Length of Time at Facility:______________________________ REASON FOR GUARDIANSHIP PETITION FOR GUARDIANSHIP- 4 11/2011 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com A. The reason for petitioning for Guardianship is as follows: _______________________________________________________________ B. The interest of the Petitioner in the appointment is as follows: _______________________________________________________________ C. Designate whether the appointment is sought as Guardian or Limited Guardian of the Person, the Estate, or both: _____________________________________. D. Describe any alternative arrangements previously made by the Alleged Incapacitated Person, such as trusts, powers of at