Fillable Form 210.290: (Administrative Office of the Courts)

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Form 210.290: (Administrative Office of the Courts)

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BROWSE ADMINISTRATIVE OFFICE OF THE COURTS (KY) FORMS

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COMMONWEALTH OF KENTUCKY PETITIONER
VS.
_______________________________________________ RESPONDENT
AOC- 745 Doc. Code: AAF
Rev. 7-18
Page 1 of 2
Commonwealth of Kentucky
Court of Justice www.courts.ky.gov
KRS 387.530(2); 387.720; 395.130;
210.290
APPLICATION FOR APPOINTMENT
OF FIDUCIARY FOR DISABLED PERSONS
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District
Case No. ____________________
Court ____________________
County ____________________
Division ____________________
1. Comes now __________________________________________________, Applicant herein, and requests to be
appointed as _____________________________________ for Respondent.
2. Applicant states his/her relationship to Respondent is ______________________________________________.
3. Applicantstateshis/herqualicationsforappointmentareasfollows:__________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
4. Applicantoersassuretyonhis/herbondthefollowing:____________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
5. Respondent owns thefollowingestate, including government benets, insurance entitlements, and anticipated
yearly income (state if none or unknown):
ESTATE VALUE
Real Property $_________________________
Personal Property $_________________________
Yearly Income $_________________________
Source of Yearly Income _____________________________________________________________________
_________________________________________________________________________________________
6. IfApplicantistheCabinetforHealthandFamilyServices,pleaseattach,orprovidetheCourtpriortothenal
hearing in this matter, a reportindicatingtheaveragecaseloadofeacheldsocialworker.
7. Applicant states that all statements in the foregoing are true.
Applicant’s Name: _______________________________________________________________________________
Address: ______________________________________________________________________________________
___________________________________________________________________________________
Telephone Number: ______________________________
_____________________________, ________ ____________________________________________
Date Applicant’s Signature
* * * * * * * * * * * *
SUBSCRIBED and SWORN to before me this ___________ day of _______________________________, 2_______.
My Commission expires:____________________________.
____________________________________________ ____________________________________________
County, Kentucky Name/Title
WAIVER OF NOTICE AND REQUEST
FOR APPOINTMENT OF FIDUCIARY
The undersigned hereby waive notice of hearing and the right to appointment and request the Court to make the
appointment herein applied for:
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
To be completed if Applicant is represented by counsel:
Attorney’s Name: ________________________________________________________________________________
Address: ______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Telephone Number: ______________________________
_______________________________ ________ , ____________________________________________
Date Attorney Signature
AOC-745
Rev. 7-18
Page 2 of 2
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Form 210.290: (Administrative Office of the Courts)

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Completed 19 November 2020

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