COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.Name of Person Filing Document: Your Address: Your City, State, Zip Code: Your Telephone Number: Attorney Bar Number (if applicable): RepresentingJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)Self (Without a Lawyer) ORAttorney for:SUPERIOR COURT OF ARIZONA MARICOPA COUNTY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .In the Matter of theCase Number: PB Guardianship and/or Conservatorship ofAFFIDAVIT OF PERSON TO BE APPOINTED THE PEOPLE OF THE STATE OF NEW YORK TOGUARDIAN AND/OR CONSERVATOR an Adult ora MinorINSTRUCTIONS: The person who wants to be appointed the guardian and/or conservator must answer each statement as TRUE or FALSE. Each answer that is false must be explained in writing in an attachment to this affidavit. STATEMENTS MADE UNDER OATH TO THE COURT: Arizona law A.R.S. §14-5106 requires the person seeking appointment to answer items 1-15. Additionally, the Superior Court in Maricopa County requires the person to complete the information requested in item 16. This document must be filed with the Petition for Appointment of Guardian and/or Conservator. 1.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomTrue orFalse.I have not been convicted of a felony in any jurisdiction.2.True orFalse.I have not acted as a guardian or conservator for another person for at least three years before I filed this Petition.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.3.True orFalse.I know and understand the powers and duties I would have as a guardian and/or conservator.4.True orFalse.I have not had a power of attorney for anyone for at least three years before I filed this Petition., one of the Justices of theCourt in Witness, Honorableday of, 20 County,5.True orFalse.I am not, to the best of my knowledge, listed in the Elder Abuse Registry at the Office of the Arizona Attorney General.(Attorney must sign above and type name below)6.True orFalse.To the best of my knowledge, no business in which I have an interest is listed in the Elder Abuse Registry at the Office of the Arizona Attorney General.7.True orFalse.Arizona law requires that a guardian/conservator file an annual report/accounting with the court. If I have been a guardian/conservator before, I either filed the required documents on time, or within 3 months of receiving a notice from the court that the report/accounting was due.Attorney(s) for8.True orI have never been removed by the court as a guardian or conservator.False.Office and P.O. Address9.The nature of my relationship to the proposed ward or protected person is:False.True orTelephone No.: Facsimile No.: E-Mail Address:©Superior Court of Arizona in Maricopa CountyPBGC11f January 6, 2003Page 1 of 3Use only most current version ALL RIGHTS RESERVED AFFMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)10.True orFalse.I met the proposed ward under the following circumstances:11.True orFalse.I have never received anything of value greater than a total of one hundred dollars in any one year by gift, or will, or inheritance from an individual or the estate of an individual to whom I was not related by blood or marriage and for whom I served at any time as guardian, conservator, trustee, or attorney-in-fact.12.True orFalse.No business in which I have an interest has ever received anything of value greater than a total of one hundred dollars in any one year by gift, or will, or inheritance from an individual or the estate of an individual to whom I am not related by blood or marriage and for whom I served at any time as guardian, conservator, trustee, or attorney-in-fact.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK TO13.True orFalse.To the best of my knowledge, I am not named as a personal representative, trustee, beneficiary, or other type of beneficiary for any individual to whom I am not related by blood or marriage and for whom I have ever served as guardian, conservator, trustee, or attorney-in-fact.14.True orFalse.To the best of my knowledge, no business in which I have an interest is named as a personal representative, trustee, beneficiary, or other type of beneficiary for any individual to whom I am not related by blood or marriage and for whom I have ever served as guardian, conservator, trustee, or attorney-in-fact.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,15.True orFalse.I have no interest in any business that provides housing, health care, nursing care, residential care, assisted living, home health services, or comfort care services to any individual.located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room16.Additional identifying information about the person seeking this appointment: Gender:Height: Weight:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Color of eyes: Color of Hair:Date of birth: Driver License Number:State issuing license: Expiration Date:Social Security Number:, one of the Justices of theOATH OF THE PERSON SEEKING TO BE APPOINTED AS GUARDIAN AND CONSERVATOR: STATE OF ARIZONA ) MARICOPA COUNTY ) ss. I have read, understood, and completed the above statements and the attached document. Everything I have said is true and correct to the best o
|
Get this form for FREE as a print-only pdf
