Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 1 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 Superior Court of Washington County of In the Guardianship of: An Alleged Incapacitated Person Case No .: Petition for Guardianship of Person and/or Estate (RCW 11.88.030) (PTAPGD) I ask the court to appoint a guardian or limited guardian for (name), who is an alleged incapacitated person (AIP). The court should consider the following information. 1. Information about the Petitioner Name: Telephone Number*: Current Residence: Post Office Address: Relationship to AIP: 2. Information about the AIP Name: Age: Current Residence: Post Office Address: American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 2 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 3. Nature of the Alleged Incapacity The individual is incapacitated because: He or she is unable to adequately provide for nutrition, health, housing, or physical safety and is at significant risk of personal harm. He or she needs a guardian of the person. He or she is unable to adequately manage property or financial affairs and is at significant risk of financial harm. He or she needs a guardian of the estate. and/or The individual is also incapacitated because: . 4. Financial Information The approximate value and the description of the property owned by the AIP are: A. Assets: 1. Real Property: $ 2. Stocks, Mutual Funds, & Bonds: $ 3. Mortgages and Notes: $ 4. Bank Accounts: $ 5. Other Property: $ Description of other property: The total approximate value of assets is: $ The AIP receives compensation, pension, insurance, and allowances as follows: B. Income: 1. Social Security Benefits: $ per month 2. Veterans222 Benefits : $ per month 3. Washington State Assistance: $ per month 4. Retirement Income: $ per month 5. : $ per month American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 3 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 6. : $ per month 7. : $ per month The total approximate income is: $ per month 5. Waiver of Filing Fee I do not ask the court to waive the filing fee. I ask the court to waive the filing fee because: The AIP has total assets of a value of less than $3,000. Payment of the filing fee would impose a hardship upon the AIP because: . 6. Existing or Pending Guardianships or Other Court Cases There is no guardian, limited guardian, or pending guardianship action in any state for the person or the estate of the AIP. There is a guardian, limited guardian, or pending guardianship action in any state for the person or the estate of the AIP: Where is the case filed? (State or Washington State County) Was a Guardian appointed? yes no If yes: Name of guardian: Date of appointment: Type of guardianship: Other court cases such as protection order cases that limit contact between the AIP and other persons: American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 4 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 7. Reason to Appoint Guardian A guardian should be appointed because: . 8. Petitioner222s Interest in Appointment My interest in the court appointing a guardian is: . 9. Protection and Assistance for the AIP The person is incapacitated to this nature and degree: . The AIP needs these specific areas of protection and assistance: . 10. Restrictions on Incapacitated Person222s Right To Communicate, Visit, Interact with Others (Laws of 2017, Ch. 268, s1) Contact with the following individuals should be restricted as specified: . American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 5 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 These facts support my requests. Please be as specific as possible. You can use more paper or attach documents if you want. . 11. Limits on the AIP222s Rights If the court grants the petition, the court should: Revoke the following rights: To vote or hold an elected office. To marry, divorce, or enter into or end a state registered domestic partnership. To make or revoke a will. To enter into a contract. To appoint someone to act on his or her behalf. To sue and be sued other than through a guardian. To possess a license to drive. To buy, sell, own, mortgage, or lease property. To consent to or refuse medical treatment. To decide who shall provide care and assistance. To make decisions regarding social aspects of his or her life. Grant the following other limitations and restrictions: 12. Type of Guardianship Sought I seek the following type of guardianship: Guardianship of the person: full or limited and/or Guardianship of the estate: full or limited 13. Duration of Guardianship I request that the Guardianship exist: Until it is terminated pursuant to RCW 11.88.140; Indefinitely until the court orders that it is modified or terminated; Until the incapacitated person, who is a minor, turns 18 years old; or American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 6 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 Other:. 14. Alternatives to Guardianship The AIP did not previously make any alternative arrangements to guardianship, such as a trust or power of attorney. The AIP did previously make alternative arrangements to guardianship, such as a trust or power of attorney, as follows: . Even though the AIP made alternative arrangements, I believe a guardianship is still necessary because: . The AIP did did not nominate a guardian in a power of attorney or other document. The nominated guardian, if any, is (name) . 15. Nomination of Guardian I am not asking the court to appoint a specific person as guardian or limited guardian. I am asking the court to appoint (name(s)) as guardian or limited guardian. The proposed guardian of the person222s residence and post office address are: Telephone Number:* Residence: Post Office Address: Relationship to AIP: The proposed guardian of the estate222s residence and post office address are: Telephone Number:* Residence: American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 7 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 Post Office Address: Relationship to AIP: 16. Lay Guardian Training The proposed guardian, (name) has already completed lay guardian training. Evidence that he or she successfully completed the training is attached to the petition or filed separately. I am requesting a quick (expedited) appointment of a guardian because of urgent circumstances. I request an extension of up to 90 days after appointment for the guardian to complete and file proof of completion of the training because: . (If the court grants your request, evidence of successful completion of the lay guardian training will be required later.) The proposed guardian, (name) , is not required to complete lay guardian training because he or she is: a certified professional guardian, a financial institution subject to the jurisdiction of the department of financial institutions and authorized to exercise trust powers, or a federally chartered financial institution authorized to serve as a guardian of the estate. 17. Relatives As far as I know or can reasonably ascertain, the following people are most closely related by blood, marriage, or state registered domestic partnership to the AIP: Name: Address: Nature of Relationship: Name: Address: Nature of Relationship: American LegalNet, Inc. www.FormsWorkFlow.com Pt for Guardianship of Person and/or Estate (PTAPGD) - Page 8 of 9 GDN 01.0100 (07/2017) RCW 11.88.030 Name: Address: Nature of Relationship: (Attach more sheets if you need to.) 18. Custodian of AIP The AIP is in the care and custody of this person or facility: Name of Person or Facility: Address: 19. Nomination of Guardian ad Litem I am not proposing that a specific individual act as guardian ad litem. I am proposing that a specific individual, (name) act as guardian ad litem (GAL). The proposed guardian ad litem does does not have knowledge of or a relationship to any of the parties. Explain: . I nominate this person as guardian ad litem because: . 20. Summary of Requests I