(Copy Receipt) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE (Clerk’s Date Stamp) In the Guardianship of: CASE NO. _____________________ ______________________________________ An Alleged Incapacitated Person PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE RCW 11.88.030 (PTAPGD) I. ALLEGED INCAPACITATED PERSON INFORMATION The name, date of birth, address of present residence, length of time at residence and post office address of the Alleged Incapacitated Person are: A. Name: ____________________________________ B. Age: ____________________________________ If the alleged incapacitated person is a minor, provide the minor’s date of birth on form #S3 – Sealed Confidential Information Form – Minor and file in the confidential file. C. Present Residence: ____________________________________ D. Length of Time at Residence: ____________________________________ E. Post Office Address: ____________________________________ II. 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: __________________________________________ #01-PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE PAGE 1 OF 6 Revised 10/07 American LegalNet, Inc. www.FormsWorkflow.com III. DESCRIPTION/VALUES OF PROPERTY The approximate value and the description of the property owned by the Alleged Incapacitated Person is: A. Real Property: $_________________________ B. Stock, Mutual Funds and Bonds: $_________________________ C. Mortgages and Notes: $_________________________ D. Bank Accounts $_________________________ E. Furniture: $_________________________ F. Other Personal Property: $_________________________ Total Approximate Value of Assets is: $_____________ There are periodic compensation, pension, insurance, and allowances as follows: A. Social Security Benefits: $_________________ /month B. Veterans Benefits $_________________ /month C. Washington State Assistance $_________________ /month D. Other: $_________________ /month Approximate Total Monthly Income: $______________________ IV. 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 Established: ___________________ B. Name of Guardian/Limited Guardian: ______________________________________ C. Date of Appointment: __________________________________________________ #01-PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE PAGE 2 OF 6 Revised 10/07 American LegalNet, Inc. www.FormsWorkflow.com D. Type of Guardianship: __________________________________________________ V. 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 #(s): Business ________________ Personal _________________ D. Age: __________________________________________________________ E. Relationship to Alleged Incapacitated Person: _________________________ VI. 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: ________________________________________________ VII. 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 #(s): Business _________________ Personal ________________ D. Length of Time at Facility: ________________________________________ #01-PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE PAGE 3 OF 6 Revised 10/07 American LegalNet, Inc. www.FormsWorkflow.com VIII. REASON FOR GUARDIANSHIP: 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 attorney including any Guardianship nominations contained in a power of attorney, and why a Guardianship is nevertheless necessary. ___________________________________________________________________ ___________________________________________________________________ IX. AREAS OF ASSISTANCE A. The nature and degree of the alleged incapacity: ____________________________ B. The following are specific areas of protection and assistance required: ___________ ___________________________________________________________________ C. The duration of Guardianship should be as follows: __________________________ X. GUARDIAN AD LITEM Guardian ad Litem to be appointed from registry. A Guardian ad Litem should be appointed from the Court’s Registry. Guardian ad Litem to be appointed by request of petitioner. A Guardian ad Litem should not be appointed from the Court’s Registry because of the following extraordinary circumstances: ___________________________________ ______________________________________________________________________ ______________________________________________________________________ The name, address, and telephone number of the proposed Guardian ad Litem. Name: __________________________________________________________ Address __________________________________________________________ Telephone: _______________________________________________________ #01-PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE PAGE 4 OF 6 Revised 10/07 American LegalNet, Inc. www.FormsWorkflow.com The knowledge of a relationship of the proposed Guardian ad Litem to parties is as follows: ____________________________________________________________ XI. BONDS AND FEES A. A bond in the amount of $_____________________ should be established OR waived for the following reasons: ______________________________________________ B. The payment of Guardian ad Litem’s fees should be provided as follows: ___________________________________________________________________ XII. SUMMARY The Petitioner(s) request(s) the following relief: An Order appointing a Guardian ad Litem for the Alleged Incapacitated Person; An Order waiving the requirement for a filing fee; An Order directing that the Guardian ad Litem’s fees in this matter be paid by: _________________________________________________________________ An Order approving payment, by Petitioner(s), of reasonable attorney’s fees and costs incurred in preparation and presentation of this Guardianship Petition; and An Order appointing _____________________________________________ as Full Limited Guardian(s) of the Person and/or Estate of ________________________ subject to review in ________________ months with the bond waived set in the amount of $________________________ . Other relief requested: _________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ #01-PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE PAGE 5 OF 6 Revised 10/07 American LegalNet, Inc. www.FormsWorkflow.com I certify (or declare) under penalty of perjury under the laws of the State of Washington that to the best of my knowledge the statements above are true and correct. Signature of Petitioner/Attorney Printed Name of Petitioner/Attorney, WSBA/CPG# Address City, State, Zip Code *Telephone/Fax Number Email Address *Under GR 22 (b) (6), parties’ personal telephone number(s) are confidential information. If you do not want your personal phone number(s) on this public form, complete form #S2Sealed Confidential Information and file in the confidential file. #01-PETITION FOR GUARDIANSHIP OF PERSON AND/OR ESTATE PAGE 6 OF 6 Revised 10/07 American LegalNet, Inc. www.FormsWorkflow.com