PETITION FOR APPOINTMENT OF GUARDIAN OF THE PERSON

CASE INFORMATION

COURT: [Probate Court/Surrogate's Court/Superior Court]

COUNTY: _______________________________________________

STATE: _______________________________________________

IN THE MATTER OF:

[NAME OF ALLEGED INCAPACITATED PERSON],

An Alleged Incapacitated Person.

Case No.: _______________________________________________

PETITION FOR APPOINTMENT OF GUARDIAN OF THE PERSON

COMES NOW the Petitioner, _______________________________________________,
and respectfully petitions this Court for appointment of a Guardian of the Person for the above-named individual, and in support thereof states as follows:

I. PETITIONER INFORMATION

1.1 Identity of Petitioner

Petitioner's Name: _______________________________________________

Address: _______________________________________________

City, State, ZIP: _______________________________________________

Phone: _______________________________________________

Email: _______________________________________________

Relationship to Alleged Incapacitated Person: _______________________________________________

1.2 Interest in Proceeding

The Petitioner is an "interested person" as defined by state law because:

☐ Petitioner is a family member (specify relationship): _______________________________________________

☐ Petitioner is a friend with genuine concern for the AIP's welfare

☐ Petitioner is a healthcare provider or facility

☐ Petitioner is a state agency

☐ Other: _______________________________________________

1.3 Attorney Information (If Represented)

Attorney Name: _______________________________________________

Firm: _______________________________________________

Address: _______________________________________________

Phone: _______________________________________________

Bar Number: _______________________________________________

II. ALLEGED INCAPACITATED PERSON INFORMATION

2.1 Personal Information

Full Legal Name: _______________________________________________

Also Known As: _______________________________________________

Date of Birth: _______________________________________________

Age: _______________________________________________

Social Security Number: _______________________________________________ (last 4 digits)

Current Address/Location:
_______________________________________________
_______________________________________________

☐ Private residence
☐ Hospital: _______________________________________________
☐ Nursing home: _______________________________________________
☐ Assisted living: _______________________________________________
☐ Other: _______________________________________________

Marital Status:
☐ Single ☐ Married ☐ Divorced ☐ Widowed

Spouse's Name (if married): _______________________________________________

2.2 Citizenship and Residency

U.S. Citizen: ☐ Yes ☐ No

County of Residence: _______________________________________________

Length of Residency in County: _______________________________________________

III. GROUNDS FOR GUARDIANSHIP

3.1 Basis for Incapacity

The alleged incapacitated person ("AIP") lacks sufficient capacity to make or communicate responsible decisions concerning his/her person due to the following condition(s):

☐ Dementia/Alzheimer's disease
☐ Intellectual/developmental disability
☐ Mental illness
☐ Traumatic brain injury
☐ Stroke
☐ Other medical condition: _______________________________________________

3.2 Functional Incapacities

As a result of the above condition(s), the AIP is unable to:

☐ Make informed decisions about medical treatment
☐ Understand the nature and consequences of healthcare decisions
☐ Provide for his/her own physical health and safety
☐ Provide for his/her own food, clothing, and shelter
☐ Manage personal care needs
☐ Protect himself/herself from abuse, neglect, or exploitation
☐ Make decisions about place of residence
☐ Recognize or resist predatory individuals
☐ Other: _______________________________________________

3.3 Facts Supporting Incapacity

[Describe specific facts, incidents, and observations that demonstrate incapacity:]

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

3.4 Medical Evidence

☐ A physician's statement/certificate is attached as Exhibit A

☐ A physician's statement will be provided within ___ days

☐ Petitioner requests the Court order a medical/psychological evaluation

Physician Information (if known):

Name: _______________________________________________

Specialty: _______________________________________________

Address: _______________________________________________

Phone: _______________________________________________

Date of most recent examination: _______________________________________________

IV. NEED FOR GUARDIAN

4.1 Lack of Advance Directives

☐ The AIP does not have a valid healthcare power of attorney/healthcare proxy

☐ The AIP has a healthcare power of attorney, but:
☐ The agent is unable or unwilling to serve
☐ The agent is acting contrary to the AIP's best interests
☐ The power of attorney does not address current needs
☐ Other: _______________________________________________

4.2 Inadequacy of Less Restrictive Alternatives

Petitioner states that the following less restrictive alternatives have been considered and are inadequate to meet the AIP's needs:

☐ Power of Attorney: Not available because: _______________________________________________

☐ Representative Payee: Inadequate because: _______________________________________________

☐ Supported Decision-Making: Inadequate because: _______________________________________________

☐ Voluntary Services: Inadequate because: _______________________________________________

☐ Other alternatives considered: _______________________________________________

4.3 Immediate Need (If Applicable)

☐ There is an immediate need for a guardian due to:
_______________________________________________
_______________________________________________

☐ Petitioner requests appointment of an EMERGENCY/TEMPORARY guardian pending full hearing.

V. PROPOSED GUARDIAN

5.1 Proposed Guardian Information

Proposed Guardian Name: _______________________________________________

Address: _______________________________________________

City, State, ZIP: _______________________________________________

Phone: _______________________________________________

Email: _______________________________________________

Date of Birth: _______________________________________________

Relationship to AIP: _______________________________________________

Occupation: _______________________________________________

5.2 Qualifications

The proposed guardian is qualified to serve because:

☐ Is an adult (age 18 or older)
☐ Is a resident of [State] OR [meets non-resident requirements]
☐ Has no conflict of interest with the AIP
☐ Has not been convicted of a felony [or has been rehabilitated]
☐ Has not been found to have abused, neglected, or exploited the AIP or others
☐ Is willing and able to serve

5.3 Relationship and Knowledge

The proposed guardian:

☐ Has known the AIP for ___ years
☐ Is familiar with the AIP's needs, preferences, and values
☐ Lives ☐ Near the AIP ☐ In the same household ☐ Other: _______________

5.4 Alternate/Successor Guardian

Alternate Guardian Name (if proposed): _______________________________________________

Relationship to AIP: _______________________________________________

Address: _______________________________________________

5.5 Proposed Guardian Consent

☐ The proposed guardian has consented to serve (written consent attached)

☐ The proposed guardian will provide written consent prior to hearing

VI. POWERS REQUESTED

6.1 Scope of Guardianship

Petitioner requests that the guardian be granted:

☐ FULL guardianship of the person - authority over all personal and healthcare decisions

☐ LIMITED guardianship - authority only over the following specific areas:

☐ Medical and healthcare decisions
☐ Residential placement decisions
☐ Personal care decisions
☐ Social and recreational decisions
☐ Decisions regarding visitors and communication
☐ Other: _______________________________________________

6.2 Specific Powers Requested

☐ Consent to or refuse medical treatment
☐ Make decisions about residential placement
☐ Access medical and other personal records
☐ Make decisions about end-of-life care (specify any limitations)
☐ Apply for government benefits
☐ Make decisions about personal care and daily activities
☐ Make decisions about social activities and associations
☐ Other: _______________________________________________

6.3 Powers NOT Requested (for Limited Guardianship)

The AIP should retain the right to:

☐ Vote
☐ Marry
☐ Execute a will
☐ Obtain a driver's license
☐ Make decisions about: _______________________________________________
☐ Other: _______________________________________________

VII. FAMILY AND INTERESTED PERSONS

7.1 Immediate Family Members

7.2 Other Interested Persons

7.3 Person with Priority

Under state law, the following persons have priority to serve as guardian (in order):

1. Person nominated by the AIP (if any): _______________________________________________
2. Spouse: _______________________________________________
3. Adult child(ren): _______________________________________________
4. Parent(s): _______________________________________________
5. Other: _______________________________________________

If the proposed guardian does not have priority, explain why the proposed guardian should be appointed:
_______________________________________________
_______________________________________________

VIII. AIP'S ESTATE AND FINANCIAL MATTERS

8.1 Need for Guardian of Estate

☐ A guardian of the ESTATE is also needed (file separate petition or combined petition)

☐ A guardian of the estate is NOT needed because:
☐ The AIP has minimal assets
☐ A financial power of attorney is in effect and functioning
☐ A representative payee handles income
☐ Other: _______________________________________________

8.2 Summary of Assets (for informational purposes)

Estimated assets: $_______________
Primary source of income: _______________________________________________

IX. AIP'S PREFERENCE

9.1 Expressed Preference

To the Petitioner's knowledge:

☐ The AIP has not expressed a preference regarding guardianship

☐ The AIP has expressed that [he/she] [does/does not] want a guardian

☐ The AIP has expressed a preference for the following person to serve:
_______________________________________________

☐ The AIP objects to the proposed guardian because:
_______________________________________________

X. PRAYER FOR RELIEF

WHEREFORE, Petitioner respectfully prays that this Court:

1. Set this matter for hearing;

2. Appoint a Court Visitor/Guardian ad Litem to investigate and report (if required by law);

3. Appoint an attorney to represent the AIP (if required by law or in the interest of justice);

4. Order a medical/psychological evaluation of the AIP (if needed);

5. Find that the AIP is an incapacitated person in need of a guardian;

6. Appoint _______________________________________________
   as Guardian of the Person of the AIP;

7. Grant the guardian the powers specified herein;

8. Grant such other and further relief as the Court deems just and proper.

XI. VERIFICATION

Under Penalty of Perjury:

I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Petitioner Signature: _________________________________

Printed Name: _________________________________

Date: _________________________________

XII. NOTARY (If Required by State)

STATE OF _______________
COUNTY OF _______________

Subscribed and sworn to (or affirmed) before me on this ___ day of _____________, 20___, by _______________________________________________.

_________________________________
Notary Public

My Commission Expires: _________________________________

[NOTARY SEAL]

EXHIBITS

☐ Exhibit A: Physician's Statement/Medical Certificate

☐ Exhibit B: Proposed Guardian's Consent to Serve

☐ Exhibit C: Proposed Guardian's Criminal Background Check (if required)

☐ Exhibit D: AIP's Existing Estate Planning Documents (Powers of Attorney, etc.)

☐ Exhibit E: Additional Supporting Documentation

FILING CHECKLIST

☐ Original petition signed and verified
☐ Filing fee: $_______________
☐ Physician's statement/certificate
☐ Proposed guardian's consent to serve
☐ Background check (if required)
☐ Copies of petition for service on all interested persons
☐ Notice of hearing (after court schedules hearing)
☐ Proof of service (after service completed)

NOTICE REQUIREMENTS

Persons who must be served with notice of hearing:

☐ The alleged incapacitated person (required in virtually all states)
☐ Spouse
☐ Adult children
☐ Parents (if no spouse or children)
☐ Siblings (in some states)
☐ Any person who has care or custody of the AIP
☐ Person named as agent in power of attorney
☐ Existing guardian or conservator (if any)
☐ Other interested persons as required by law

Method of Service:

☐ Personal service on AIP (typically required)
☐ Certified mail or personal service on others

This template is provided for informational purposes only and does not constitute legal advice. Guardianship is a significant legal action that removes fundamental rights from an individual. It should only be pursued when less restrictive alternatives are inadequate. Guardianship laws and procedures vary significantly by state. Always consult with a qualified attorney in your jurisdiction.