Fillable Form PBGCA11f COURT OF ARIZONA PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN

Fill Online, Printable, Fillable, Blank Form PBGCA11f COURT OF ARIZONA PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN Form

Use Fill to complete blank online MARICOPA COUNTY TELECOMMUNICATIONS (AZ) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form PBGCA11f COURT OF ARIZONA PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN

On average this form takes 34 minutes to complete

The Form PBGCA11f COURT OF ARIZONA PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN form is 16 pages long and contains:

  • 0 signatures
  • 91 check-boxes
  • 92 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Maricopa County Telecommunications

BROWSE MARICOPA COUNTY TELECOMMUNICATIONS (AZ) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED Page 1 of 10
APE
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 Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
In the Matter of
Case Number PB:
Guardianship and Conservatorship of:
PETITION FOR PERMANENT
APPOINTMENT OF GUARDIAN
and CONSERVATOR FOR AN
ADULT, or
a Minor at least 17.5 years of age,
to become effective at age 18
Name of Person to be Protected
UNDER OATH OR BY AFFIRMATION:
INFORMATION REQUIRED BY ARIZONA LAW (A.R.S. § 14-5303 and 5404)
1. INFORMATION ABOUT THE PETITIONER (the person filing this petition)
(My) Name:
Address:
Telephone:
Date of Birth:
My interest in or relationship to the person to be protected is:
(examples: mother, father, sister, brother, grandparent, legal guardian)
FOR CLERK’S USE ONLY
Case No. ___________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 2 of 10
2. INFORMATION ABOUT THE PERSON TO BE PROTECTED (also known as “the
proposed protected person” or “the ward”)
Name:
Address:
Telephone:
Date of Birth:
3. INFORMATION ABOUT THE PROPOSED GUARDIAN AND CONSERVATOR:
(Complete this only if the proposed guardian/ conservator is someone other than Petitioner.)
Name:
Address:
Telephone:
Date of Birth:
Relationship to the person to be protected is:
(examples: mother, father, sister, brother, grandparent, legal guardian)
A.
The proposed guardian and conservator has priority for appointment as a
conservator under Arizona law A.R.S. § 14-5410, because he or she is:
(Already) A conservator, guardian of property or other similar fiduciary
appointed or recognized by the appropriate court of any other jurisdiction in
which the person to be protected resides.
An individual or corporation nominated by the protected person if the protected
person is at least fourteen years of age and has, in the opinion of the court,
sufficient mental capacity to make an intelligent choice.
The person nominated to serve as conservator in the protected person's most
recent durable power of attorney.
The spouse of the protected person.
An adult child of the protected person.
A parent of the protected person, or a person nominated by the will of a
deceased parent.
Any relative of the protected person with whom the protected person has
resided for more than six months before the filing of the petition.
The nominee of a person who is caring for or paying benefits to the protected
person.
If the protected person is a veteran, the spouse of a veteran or the minor child
of a veteran, the department of veterans' services.
A fiduciary who is licensed pursuant to Arizona law, A.R.S. § 14-5651, other
than a public fiduciary.
Case No. ___________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 3 of 10
A public fiduciary who is licensed pursuant to Arizona law A.R.S. § 14-5651.
OTHER. Explain:
B. The proposed guardian and conservator named above has priority for
appointment as a guardian under Arizona law A.R.S. § 14-5311, because he
or she is:
The spouse of the incapacitated person;
An individual nominated by the incapacitated person to be the guardian;
An adult child of the incapacitated person;
The parent of the incapacitated person;
A relative of the incapacitated person and has lived with the person more than six
months before filing this petition;
Nominated by someone who is caring for or is paying benefits for the incapacitated
person;
Is a private fiduciary, a professional guardian, conservator, or the Arizona Veterans'
Service Commission.
Other (explain):
4. REASONS FOR GUARDIANSHIP
: The person to be protected needs a guardian
because he or she is incapacitated as defined by Arizona Law, A.R.S. §14-5101(1), to the
extent that he or she lacks sufficient understanding or capacity to make or communicate
responsible decisions concerning his or her own self-interests. Appointment of a guardian
is necessary or desirable to provide continuing care and supervision of the person, and is
in his or her best interests
.
THE PERSON TO BE PROTECTED IS INCAPACITATED AND IN NEED OF
CONTINUING CARE AND SUPERVISION DUE TO:
(Check all that apply):
Mental illness, mental deficiency, mental disorder; Chronic use of drugs;
Physical illness or disability; Chronic intoxication;
Other (explain):
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 4 of 10
5. TYPE OF GUARDIANSHIP: LIMITED OR GENERAL: (A.R.S. § 14-5303(B)(8))
A. A LIMITED GUARDIANSHIP is requested with the following specific powers:
1. Authority for the guardian to:
Consent to Medical Treatment Consent to Make Living Arrangements
Arrange Education or Training Consent to Marriage
Apply for Public Assistance or Social Services
Consent to Outpatient Mental Health Care and Treatment
2. INPATIENT Mental Health Powers: The ward is incapacitated as a result of mental
health disorder as defined in A.R.S. § 36-501.
Authority is requested for the Guardian to place the ward in an Inpatient
Psychiatric Facility for inpatient mental health care and treatment. This request is
supported by the opinion of a licensed psychiatrist or psychologist, included and
made part of this document.
3.
OTHER LIMITED POWERS REQUESTED:
(List and Describe)
Continues on attachment “Powers Requested”, made part of this document.
(OR)
B. GENERAL GUARDIANSHIP is requested. As required by Arizona law, A.R.S.
§14-5303(B)(8)
, less restrictive alternatives to “general” guardianship, including
technological assistance, have been considered, however: (
Check the box if true*)
The proposed ward is incapacitated in a manner or to an extent that a limited
guardianship would not adequately protect and provide for the proposed ward’s
care and well-being.
(Optional additional information)
* For the court to order a general guardianship, you must check the box and be prepared
to offer clear and convincing evidence that less restrictive means of meeting the
proposed ward’s demonstrated needs would not be sufficient. (A.R.S. § 14-5304(B))
NOTE: A general or “non-limited” guardianship includes authority to consent to
outpatient mental health treatment but the Court must specifically grant authority to
place the ward in an inpatient mental health facility. Check the box below if the best
interests of the incapacitated person require the Guardian to have this authority.
INPATIENT Mental Health Powers: Authority is requested for the Guardian to
place the ward in an Inpatient Psychiatric Facility for inpatient mental health care
and treatment. This request is supported by the opinion of a licensed psychiatrist or
psychologist, included with and made part of this document.
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 5 of 10
C. (Limited or General) DRIVING PRIVILEGES AND VOTING RIGHTS: (A.R.S. §§14-
5304)
1. The proposed ward’s incapacity does not prevent or interfere with safe
operation of a motor vehicle. Petitioner requests that the court not suspend
the ward’s privilege to obtain or retain a driver’s license. Medical or other
evidence will be presented in support of this statement and request.
2. The Petitioner believes the proposed ward has sufficient capacity and
understanding to exercise the right to vote. On behalf of the proposed ward, the
Petitioner hereby petitions the court to consider the issue and hold a hearing
at the same time as this Petition.
Clear and Convincing evidence will be presented that the proposed ward
has sufficient understanding to exercise the right to vote.
6. REASONS FOR CONSERVATORSHIP: In accord with Arizona Law, A.R.S. §14-5401,
the person to be protected needs a conservator because he or she has property which will
be wasted or used up unless proper management is provided, AND:
(Check all that apply)
Funds are needed for the support, care and welfare of the protected person;
Funds are needed for the support, care and welfare of others who are entitled to receive
support from the protected person.
THE PERSON TO BE PROTECTED CANNOT PROVIDE PROPER MANAGEMENT DUE
TO:
(Check all that apply):
Mental illness, mental deficiency, or mental disorder Physical illness or disability
Chronic use of drugs Chronic intoxication
Confinement Detention by a foreign power
Disappearance (The person whose property needs protection cannot be found at this time.)
7. LIMITED OR SINGLE TRANSACTION CONSERVATORSHIP (Check box if applicable).
Conservatorship is needed for only a single transaction or for only the following
limited purposes: (Explain in detail)
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 6 of 10
8. INFORMATION ABOUT OTHER CONSERVATOR OR GUARDIAN:
To the best of my knowledge: (Check one box.)
No Guardian or Conservator has been appointed in any other court, and no court
proceedings are pending for such appointment;
OR
Someone has been appointed Guardian and/or Conservator, or court
proceedings are pending.
(If “yes”, provide details below.)
Name:
Address:
Telephone:
Date of Birth:
Relationship to the person to be protected is:
Was appointed GUARDIAN CONSERVATOR for the ward named in #2 above in:
Name of Court:
Located in:
City and State:
Date Appointed:
Other Details:
9. INFORMATION ABOUT OTHER COURT or AGENCY INVOLVEMENT
A. Other Court Cases (Mark the box beside the statements below that are TRUE.)
1. Divorce, Legal Separation, or Paternity cases with court orders
There are NO Divorce, Legal Separation, or Paternity court orders or cases, that include legal
decision-making (custody) or parenting time (visitation) matters for the alleged incapacitated person.
YES, a Court Order exists for a Divorce, Legal Separation, or Paternity case involving the alleged
incapacitated person.
● The name of Arizona or other state Court where the above case is located:______________.
● The name of the Arizona or other state case number for the above case is ______________.
The above case involved legal decision-making (legal custody) or parenting time (visitation).
●The petitioner or proposed guardian in the above-named case is:
A parent of the alleged incapacitated person – or
A non-parent who has been awarded legal decision-making for the alleged
incapacitated person.
I attached a copy of the most recent court order regarding legal decision-making (legal
custody) or parenting time (visitation) from the (Divorce, Legal Separation or Paternity)
mentioned above. (On the top margin of the attached court order copy, write “Attachment for
Question 2.A.)
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 7 of 10
2. Other Guardianship or Conservatorship cases with court orders
No Guardian or Conservator was appointed by court order in any other court, and no
Guardianship and/or Conservatorship court proceedings are pending for such appointment;
Someone was appointed Guardian and/or Conservator, or Guardianship and/or Conservatorship
court proceedings are pending. (If “yes”, provide details below.)
Name:__________________________________
Address:______________________________________________________________
Telephone:________________________ Date of Birth:_________________________
Relationship to the person to be protected is:_________________________________
Was appointed GUARDIAN or CONSERVATOR for the alleged incapacitated.
Name of Court:___________________________________________________________________
Located in: City and State:________________________________________________________
Date Appointed:__________________________ Other Details:___________________________
______________________________________________________________________________
______________________________________________________________________________
B. Agency Involvement (Place a check mark beside the statements below that are true.)
A state or local agency is, or has NOT been involved or concerned with the alleged incapacitated
person.
Yes, a state or local agency is, or has been involved or concerned with the alleged incapacitated
person.
The following state or local agency has a case with or has checked on the alleged
incapacitated person: (Mark the box beside the agency involved, and write in the date of
involvement)
Division of Aging and Adult Services ________________________________
Department of Child Safety
Division of Developmental Disabilities
Police
Other Agency: ____________________________
10. INFORMATION ABOUT NEAREST RELATIVE:
The nearest known relative is the petitioner the proposed conservator or NEITHER.
Name:
Address:
Telephone:
Relationship to the person to be protected is:
11. ASSETS OF THE PROPOSED PROTECTED PERSON (“the ward”): (Check one box)
The ward has no substantial assets or income. No bond is required;
OR
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 8 of 10
The ward has assets and/or annual income in the approximate amount of
$
List/Describe:
12. APPOINTMENT OF PHYSICIAN (or other health professional authorized or required by
A.R.S. § 14-5303(c) or § 14-5312(B): (Guardianship cannot be established for an adult unless
the adult is examined by a medical doctor, registered nurse or psychologist, whose written
report is filed with the court before the hearing. If authority to consent to inpatient mental
health care is requested, the report or a separate report recommending such authority must
be prepared by a licensed psychiatrist or psychologist.)
The proposed protected person will be examined by a physician or other health professional
authorized by Arizona law A.R.S. § 14-5303(C) or 5312 (B)), whose written report I will file
with the court. The examiner will also indicate whether the protected person’s driving privileges
should be suspended and whether inpatient mental health treatment is recommended.
The person I say is in need of protection will be examined by:
Name:
Address:
Telephone Number:
Email:
Professional Title:
Medical Doctor Registered Nurse Psychologist
13. APPOINTMENT OF AN ATTORNEY (Guardianship or conservatorship cannot be
established for an adult who does not have an attorney appointed by the Court to represent his
or her interests in court.) (Check one box only and fill in the information requested):
The person I say is incapacitated already has an attorney who I request be appointed to
represent him or her in court regarding the proposed guardianship and conservatorship:
Name of Attorney:
Address:
Telephone Number:
Bar #
Email Address:
The prior relationship (if any) between the attorney and the Petitioner or the Ward consists of:
(Explain)
OR
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 9 of 10
The incapacitated person does not have an attorney to represent him or her in court.
I will contact the Office of Public Defense Services at (602) 506-7228, after I file
this paperwork to arrange for a lawyer to be appointed by the court.
REQUIRED STATEMENTS TO THE COURT: (Note: All of these statements must be true
for this court to have the authority to grant your Petition.)
14. TRUE Venue (the court in which you are filing this Petition) is proper in this
county because the proposed protected person lives in or is present in
this county and has assets in this county.
15. TRUE The proposed guardian and conservator has completed the Affidavit of
Person to be Appointed as Guardian and Conservator of an Adult
and is filing that Affidavit with this Petition as required by Arizona law,
A.R.S. § 14-5106.
16. TRUE I or the person I request to be appointed in section 3 is a suitable and
proper person to act as guardian and conservator and is entitled to
consideration for appointment under Arizona Law, A.R.S. § 14-5106,
5311, and/or 5410.
17. PERSONS ENTITLED TO NOTICE of this matter under Arizona law §14-5405 and to whom
I will give notice of this case:
(See instructions.)
Name Address Relationship to the Ward
A.
B.
C.
D.
(17) Continues on attachment “Persons Entitled to Notice”, made part of this document.
REQUESTS TO THE COURT: Petitioner asks the court to:
1. Appoint a lawyer to represent the proposed protected person’s interests, a physician or other
health professional authorized by A.R.S. § 14-5303 or 5312 to report on his or her physical
and
m
ental condition, as well as a court investigator.
2. After Petitioner gives notice of the hearing to all interested persons and to those required by
law, hold a hearing to determine if the Court should order a Guardianship and Conservatorship;
3. Make a finding that the person is incapacitated, needs a guardian, and if applicable, make a
f
inding that the incapacitated person requires inpatient mental health care.
4. Make a finding that the person needs protection under law including a conservator;
Case No. ____________________
© Superior Court of Arizona in Maricopa County PBGCA11f - 080816
ALL RIGHTS RESERVED
APE
Page 10 of 10
5. If a general guardianship is ordered, make a finding that less restrictive means, including
technological assistance were considered, but not adequate or appropriate;
6. Appoint the person proposed in this petition as Guardian of the protected person and
Conservator of his or her estate;
7. Make any other orders the Court decides are in the best interests of the proposed
incapacitated and protected person.
UNDER OATH OR AFFIRMATION
I swear or affirm under penalty of perjury that the contents of this document are true and correct to the
best of my knowledge and belief.
Date Signature
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this:
(date)
by .
(notary seal) Deputy Clerk or Notary Public
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form PBGCA11f COURT OF ARIZONA PETITION FOR PERMANENT APPOINTMENT OF GUARDIAN

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 4 March 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document