
Affidavit Of Person To Be Appointed Guardian Or Conservator {PBGC13f}
This is a Arizona form that can be used for Probate within Local County, Maricopa, Superior Court.
Last updated:
Description
Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Licensed Fiduciary Number: ____________________________________ Representing Self, without a Lawyer or Attorney for Petitioner OR FOR CLERK'S USE ONLY Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of the Guardianship and/or Conservatorship of: Case Number: PB AFFIDAVIT OF PERSON TO BE APPOINTED GUARDIAN OR CONSERVATOR A.R.S. § 14-5106 an Adult or a Minor INSTRUCTIONS: As required by Arizona law A.R.S. § 14-5106, indicate whether statements 1-11 below are true or false, and provide the information requested to complete "12" and "13". Explain any "false" statements on separate page(s) and attach to this document before filing. Sign the document in the presence of a Clerk of the Court or a Notary Public, and file along with the Petition for Appointment of Guardian and/or Conservator. UNDER PENALTY OF PERJURY, I SWEAR OR AFFIRM: 1. 2. True or True or False. False. I have not been convicted of a felony in any jurisdiction. I have not acted as a guardian or conservator for another person for at least three years before I filed this Petition. I know and understand the powers and duties I would have as a guardian and/or conservator. I have not had a power of attorney for anyone for at least three years before I filed this Petition. To the best of my knowledge, neither I nor any business in which I have an interest is listed in the Elder Abuse Registry at the Office of the Arizona Attorney General. 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. I have never been removed by the court as a guardian or conservator. PBGC13f - 050115 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 3. 4. True or True or False. False. 5. True or False. 6. True or False. 7. True or False. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED AFF Case No.: ____________________ 8. True or False. Neither I nor any 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 was not related by blood or marriage and for whom I served at any time as guardian, conservator, trustee, or attorney-in-fact. To the best of my knowledge, neither I nor any business in which I have an interest is named as a personal representative, trustee, devisee (beneficiary of a will), 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. 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. 9. True or False. 10. True or False. (Explain every "false" above on separate page(s) and attach to this document before filing.) 11. My relationship to the proposed person in need of protection is: (Examples: parent/grandparent/sister/caregiver/friend) 12. I met the proposed ward under the following circumstances: OATH OR AFFIRMATION OF THE PERSON TO BE APPOINTED GUARDIAN AND/OR CONSERVATOR I swear or affirm that I have read and understand the contents of this document, and that the information I have provided is true and correct to the best of my knowledge and belief. Date Signature Printed Name STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) . by (notary seal) Deputy Clerk or Notary Public NOTE: IF YOU ANSWERED "FALSE" TO ANY QUESTION ABOVE, YOU MUST ATTACH AN EXPLANATION AS INSTRUCTED ON THE NEXT PAGE. The page following is an instruction page only. Do NOT file it with the Court. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED AFF PBGC13f - 050115 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Case No.: ____________________ EXPLANATIONS THAT MUST BE ADDED TO THE AFFIDAVIT OF A PERSON WHO WANTS TO BE APPOINTED GUARDIAN OR CONSERVATOR (Required by Arizona Law: A.R.S. § 14-5106) For any corresponding numbered statement on the Affidavit which you marked "False", explain the following on a separate page or pages and attach to your Affidavit. The information provided in the attachment is covered by the same oath or affirmation and penalty of perjury as the Affidavit. FILE THE EXPLANATIONS WITH THE AFFIDAVIT, BUT DO NOT FILE THIS PAGE. 1. As to each felony for which you have been convicted, list: a. The nature of the offense. DO NOT FILE THIS SHEET b. The name and address of the sentencing court. WITH THE CLERK'S OFFICE c. The case number. d. The date of conviction. INSTRUCTION SHEET ONLY e. The terms of the sentence. f. The name and telephone number of any current probation or parole officer. g. The reasons why the conviction should not disqualify you from appointment. If you have acted as guardian or conservator within three years before filing this petition, list: a. The names of individuals for whom you are currently serving, and court case numbers. b. The names of individuals for whom your appointment has been terminated within the three-year period, and the court case number. State the total number of persons for whom you have served as a guardian or conservator. If you have acted under a power of attorney for the proposed ward/protected person, explain: a. The date the power of attorney was signed. b. The place where it was signed. c. The actions you have taken pursuant to the power of attorney. d. Whether the power of attorney is currently in effect. If you do not have the required information, please explain how you intend to obtain this information. State the reason for such listing on Elder Abuse Registry and the name of any business in which you have an interest that is listed on the Registry. List the name and location of the court and the name and case number of the files in which you were delinquent in filing the required report. List the name and location of the court, the name and case number of each file, and the circumstances of your removal. State the number of occasions on which you and/or any business in which you have an interest received such gifts, list and describe the gifts, the dates received, and list the value of each. State the number of occasions on which
Related forms
-
Acceptance Of Service
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Application For Informal Appointment Of Personal Representative (Intestate) Or Application For Informal Probate Of Will (Testate)
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Claim Against Estate
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Closing Statement And Proof Of Mailing Or Delivery Closing Statement
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Court Order Regarding Termination Of Guardianship And Or Conservatorship Of Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Estate Management Plan And Proof Of Mailing
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Form For Submission Of Annual Accounting For Conservatorships
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Form For Submission Of Final Accounting For Informal Probate
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Instrument Or Deed Of Distribution
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Inventory And Appraisement And Proof Of Mailing
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Inventory And Appraisement Of Property And Proof Of Mailing Or Delivery Of Inventory And Appraisement
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Hearing Regarding Temporary Appointment Of Guardianship And Or Conservatorship
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Non Appearance Hearing Regarding Final Accounting
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice To Creditors Of Informal Appointment Of Personal Representative And Or Informal Probate Of Will
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Objection And Request For Formal Proceeding
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Objection To Petition For Guardian And Or Conservator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Appointing Attorney Physician and Court Investigator For Guardian And Conservator For Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Appointing Attorney Physician And Court Investigator For Guardian For Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Appointing Attorney Physician And Or Court Investigator For Conservator For Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Of Appointment Of Permanent Conservator Of Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Of Appointment Of Permanent Conservator Of Minor
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Of Appointment Of Permanent Guardian And Conservator Of Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Of Appointment Of Permanent Guardian And Conservator Of Minor
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Regarding Petition For Approval Of Final Accounting And Fee Statement
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Releasing Funds From Restricted Account And Requiring Proof Of Use Of Funds
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order To Personal Representative And Acknowledgment And Information To Heirs
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petition For Approval Of Final Accounting And Or Fee Statement
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petition For Permanent Appointment Of Guardian And Conservator Of Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petition For Release Of Funds From Restricted Account
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petition For Temporary Appointment Of Guardian And Or Conservator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petition For Termination Of Guardianship And Or Conservatorship Of Minor And Or Release Of Restricted Funds
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petitioners Information Sheet To Court Investigator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Proof Of Delivery Or Mailing Notice Of Application In Informal Proceeding
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Proof Of Notice Of Hearing
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Proof Of Restricted Account From Depository Or Financial Institution
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Proof Of Use Of Funds Released From Restricted Account And Proof Of Mailing
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Publication Of Notice Of Creditors
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Request For Hearing Date And Instructions For Petition For Release Of Funds From Restricted Account
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Request For Hearing Date And Instructions For Petition For Termination Of Guardianship Conservatorship Of Minor
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Response To Court Accountant Report Final Accounting Of Personal Representative
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Statement Of Informal Appointment Of Personal Representative And Or Informal Probate Of Will
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Supplemental Information For Application For Waiver Of Fees And Costs For Service Of Process And Or Publication
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Temporary Order For Guardianship And Or Conservatorship
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Waiver Of Bond
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Waiver Of Notice Of Hearing On Petition For Final Accounting
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Waiver Of Notice Of Hearing On Petition Regarding Guardianship And Or Conservatorship Or Accounting
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Waiver Of Right To Appointment As Personal Representative And Consent To Appointment Of Personal Representative
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit Of Proposed Appointee
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Hearing On Petition For Approval Of Sale Of Real Property
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Procedures And Request For Hearing Date-Guardianship-Conservatorship Of Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Receipt Of Restricted Funds By Former Protected Person
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Fee Statement And Proof Of Mailing
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Application For Deferral Or Waiver Of Court Fees And Costs
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit Of Notice Of Hearing Regarding Discharge Or Termination And Or Release Of Funds In A
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit Supporting Deferral Or Waiver Of Service Costs
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Waiver Of Notice Of Hearing For Discharge Or Termination And Or Release Of Funds In A
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Regarding Petition For Termination Discharge Release Of Funds Of A Protected Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Of Appointment Of A Permanent Guardian Of An Adult
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order For Emergency Appointment Of Special Administrator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Letters Of Appointment And Acceptance Of Appointment Of Special Administrator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Proof Of Delivery Or Mailing Or Publishing Notice To Creditors
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit Of Person To Be Appointed Guardian
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Declaration Supporting Publication
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Juvenile Guardianship Information Sheet
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order To Guardians Of An Adult And Acknowledgment And Information To Interested Persons
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Petition For Permanent Appointment Of Guardian And Conservator Of Minor
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Consent Of Parent To Guardianship And Or Conservatorship Of Minor Child And Waiver of Notice
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Acknowledgement Of Conservator And Lawyers Undertaking And Obligation
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit For Collection Of All Personal Property
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit For Transfer Of Title To Real Property
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Affidavit Of Person To Be Appointed Guardian Or Conservator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Court Order Regarding Petition For Approval Of Annual Accounting And Fee Statement
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Declaration Of Notice Provided Regarding A Matter Of Guardianship And Or Conservatorship
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Fee Statement And Proof Of Mailing (Regarding A Deceased Person)
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Non Appearance Hearing Regarding Annual Accounting
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Hearing Regarding Guardianship And Or Conservatorship
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Informal Appointment Of Personal Representative Or Informal Probate Of A Will
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order For Waiver Of Fees For Service Of Process Or Publication
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order To Conservators For An Adult And Acknowledgment And Information To Interested Persons
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order To Guardian And Or Conservator Of An Adult Or Minor And Acknowledgment
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Response To Court Accountant Report Annual Accounting Of Conservator
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Waiver Of Notice Of Hearing On Petition For Annual Account
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Request And Order For Hearing
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Annual Report Of Guardian
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Guidelines For Health Professionals Report
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Notice Of Application In Informal Proceeding
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Order Deferring Waiving Or Denying Of Court Fees And Costs
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Probate Coversheet
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Letters Of Appointment Of Personal Representative
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Letters Of Appointment As Temporary Guardian And Acceptance Of Temporary Appointment
Arizona/Local County/Maricopa/Superior Court/Probate/ -
Letters Of Appointment As Permanent Guardian And Or Conservator And Acceptance Of Letters
Arizona/Local County/Maricopa/Superior Court/Probate/
Form Preview
Contact Us
Success: Your message was sent.
Thank you!