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Petition For Appointment Of Guardian For Disabled Person 171P-69 - Illinois
| Petition For Appointment Of Guardian For Disabled Person Form. This is a Illinois form and can be used in Disabled Person Probate Lake Local County . |
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IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS Hearing on petition is set for ESTATE OF ) ) ) ) ) ) ) ) _________________, 20___, at ________ Park City Courthouse, Courtroom B 301 S Greenleaf Ave. Park City, IL 60085 Case No: ___________________ _________________________________________ Alleged Disabled Person. PETITION FOR APPOINTMENT OF GUARDIAN FOR DISABLED PERSON _________________________________________, the Petitioner(s), under penalties of perjury as provided under Section 1-109 of the Code of Civil Procedure, state(s): 1. The Respondent's name is: ______________________________ ; date of birth is ___________________ ; and place of residence is_____________________________________________________________________________ OR The Respondent ____________________________ is a nonresident of the State of Illinois but this Court has jurisdiction because Respondent Owns real estate in this county: _______________________________________________________________ Owns personal property located in this county as follows: ___________________________________________ 2. The relationship to and interest of the Petitioner to the Respondent is: ______________________________________________________________________________________________ 3. The reason for this guardianship is that the Respondent is a disabled person due to: ______________________________________________________________________________________________ ______________________________________________________________________________________________ and because of such disability: Lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the care of the Respondent's person. Is unable to manage the Respondent's estate or financial affairs. 4. a. The approximate value of estate: Personal $ ________________ Real $ ___________________ b. The anticipated gross annual income and other receipts of the Respondent are: $ __________________ 5. The names and post office addresses of Respondent's nearest relatives, if any, are (list spouse or civil union partner and adult children; if none, then the Respondent's parents and adult brothers and sisters if none, then nearest kindred): Name Relationship Post Office Address (address) (city) (county) (state) (address) (city) (county) (state) 6. The names and post office address of the Respondent's agent(s) under a Power of Attorney for Property or a Power of Attorney for Health Care, and previously Court appointed Guardian of Respondent's Estate or Person, if any, are: Name Relationship Post Office Address Page 1 of 2 171P-69 (Rev. 8/12) American LegalNet, Inc. www.FormsWorkFlow.com 7. The name and address of the person with whom, or the facility in which the Respondent is residing is: ______________________________________________________________________________________________ 8. Petitioner, ____________________________________ is age_______ years, whose date of birth is _____________ whose address is __________________________________________________________ is qualified and willing to act, requests appointment as guardian of the Respondent's Person Estate Estate and Person. 9. Co-Petitioner, ________________________________ is age______ years, whose date of birth is _____________ whose address is __________________________________________________________ is qualified and willing to act, requests appointment as guardian of the Respondent's Person Estate Estate and Person. Petitioner(s) ask(s) that: a. The Respondent be adjudged a disabled person; b. The Petitioner(s) be appointed as Guardian of Respondent's Person Estate Estate and Person. c. The guardianship be for the limited purpose of: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ _________________________________________ Petitioner's Signature __________________________________________ Co-Petitioner's Signature _________________________________________ Petitioner's Printed Name __________________________________________ Co-Petitioner's Printed Name Dated this _______ day of ____________________, 20_____. Prepared by: Attorney's Name: ____________________________________ Address: __________________________________________ City: ______________________________ State: __________ Phone: ______________________Zip Code: _____________ Fax: ______________________________________________ ARDC #: __________________________________________ Page 2 of 2 171P-69 (Rev. 8/12) American LegalNet, Inc. www.FormsWorkFlow.com
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