Fillable nts to become a co-guardian or a replacement (Family Law Self Help Center)

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nts to become a co-guardian or a replacement (Family Law Self Help Center)

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Many family law matters involve complex and valuable legal rights which cannot adequately be protected without the assistance
of an attorney. The information provided is basic, general information that does not fit all situations. It is the duty of each self-
represented individual to know what rules of court and law apply. For more information on the law, these forms, and free classes,
visit www.familylawselfhelpcenter.org or the Family Law Self Help Center at 601 N. Pecos Road.
This Packet Is For: Someone who wa
nts to become a co-guardian or a replacement guardian.
There must already be a court-ordered guardianship already in place.
Filing Fee: $80.
The Adult and Most Relatives Have to Be Notified: The adult you want to be the
guardian over and all of the same relatives who were notified of the original
guardianship must be served with the papers you file. You will have to mail
documents to them by certified mail, return receipt requested.
The Adult You Are Seeking Guardianship Over Must Appear At The Hearing: The
adult must appear at a hearing unless a doctor certifies that the person is unable to
attend.
The Adult Will Have an Attorney Appointed: The adult is entitled to legal representation,
and the Court will appoint an attorney to represent the adult once you file these
papers if an attorney has not already been appointed.
Free Classes: You can learn the basics of guardianship law and how court cases work at a
free class. Classes are offered by the Legal Aid Center of Southern Nevada and the
UNLV Boyd School of Law. For class schedules, visit www.lacsn.org.
Use black ink and write clearly. Use the same case number from
the existing guardianship case.
Confidential Information Sheet
You must provide one form of identification for each proposed guardian. Attach a copy
of the identification you mark (social security card, driver’s license, etc.) for each.
Petition F
or Appointment of Gu
ardian
This form tells the judge about who wants to be the new guardian(s) and whether the
current guardian(s) will remain in place. The person who wants to be the new guardian
is the “Proposed Guardian” (and “Co-Guardian” if two pe
ople petiti
on). The adult is
the “Protected Person.”
Citatio
n to Appear and Show
Cause
This form sets a court date for your case. The Clerk will fill in a hearing date.
© 2018 Nevada Supreme Court
Page 1 of 2 – Confidential Information Sheet (Adult)
COURT CODE: CISG
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
____________________________________
(name of adult)
A Protected Person.
CASE NO.: ____________________
DEPT: ____________________
CONFIDENTIAL INFORMATION SHEET – GUARDIANSHIP
First Guardian (full legal name): __________________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Valid Driver’s License Number
Valid ID Card Number
Valid Passport Number
Taxpayer Identification
Number
Valid Tribal Identification Card
Number
Second Guardian (full legal name, or “n/a” if none): ___________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Valid Driver’s License Number
Valid ID Card Number
Valid Passport Number
Taxpayer Identification
Number
Valid Tribal Identification Card
Number
Adult (name of adult who needs a guardian): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Valid Driver’s License Number
Valid ID Card Number
Valid Passport Number
Taxpayer Identification
Number
Valid Tribal Identification Card
Number
*This section not required
if prior guardian already
provided identification for
the adult.
Page 2 of 2 – Confidential Information Sheet (Adult)
Placement Of Adult: Location Of Guardian(s):
Independently
With Guardian
Family/Friends
Host Family
Supportive Adult Residence / Assisted Living
Skilled Nursing Home
Licensed Group Home
Secured Facility
Out of State
Other
Nevada
Other State (list): _____________________
Proposed Guardian(s) Relationship to the
Adult:
Relative
Public Guardian
Private: License Number: ___________
Other
Adult’s Gender: Adult’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Submitted by:
(
Attach copies of the identification indicated for each guardian)
(Signature)
(Printed Name)
© 2020 Family Law Self-Help Center
Page 1 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
COURT CODE: PAPT
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of:
Person
Estate
Person and Estate
of:
_
___________________________________
(name of adult alleged to need a guardian)
A Proposed Protected Person.
CASE NO.: ____________________
DEPT: ____________________
PETITION FOR APPOINTMENT OF SUCCESSOR / CO-GUARDIAN(S)
OVER ADULT
Petitioner(s) (first petitioner’s name) _____________________________________ and
(second petitioner’s name; or “n/a” if only one) ______________________________________
request the Court approve a Successor/Co-Guardianship for the above-named adult. In
accordance with Chapter 159 of the Nevada Revised Statutes, Petitioner(s) respectfully
represents the following to this Honorable Court:
1. The
current guardian(s) is/are:
First Guardian: ___________________________________________________________
check one: This guardian should be removed. This guardian should remain.
Second Guardian (or n/a if none) _____________________________________________
check one: This guardian should be removed. This guardian should remain.
Page 2 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
2. If a guardian should be removed, mark the reasons why: ( check all that apply):
The guardian is deceased;
The guardian wants to voluntarily resign;
The guardian has become mentally incapacitated, unsuitable or otherwise
incapable of exercising the authority and performing the duties of a guardian as
provided by law;
The guardian is no longer qualified to act as a guardian;
The guardian has filed for bankruptcy within the previous 5 years;
The guardian of the estate has mismanaged the estate of the Protected Person;
The guardian has negligently failed to perform any duty as provided by law or by
any order of the Court and:
(a) The negligence resulted in injury to the Protected Person or the estate of the
Protected Person; or
(b) There is a substantial likelihood that the negligence would result in injury to
the Protected Person or the estate of the Protected Person;
The guardian has intentionally failed to perform any duty as provided by law or
by any lawful order of the Court, regardless of injury;
The best interests of the Protected Person will be served by the appointment of
another person as guardian;
The guardian is a private professional guardian who is no longer qualified as a
private professional guardian;
The guardian over an adult has violated a right of the Protected Person as set forth
in NRS 159;
The guardian over an adult has violated a Court order or committed an abuse of
discretion regarding restricting access and/or communication with the Protected
Person.
3. Provide any additional information the Court should know in deciding whether to remove
the current guardian(s). (explain why the guardian should be removed)
__________________________________________________________________________
__________________________________________________________________________
Page 3 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
4. Petitioner(s) would like to be appointed the successor guardian(s): ( check one)
As soon as the court hearing takes place.
At a future time if/when a particular event occurs (describe the event that would
trigger the successor guardianship):
Information Regarding the Protected Person
(the person you are seeking a guardianship over, or the “adult”)
5. Adult’s full legal name: ____________________________________________________.
6. Adult’s date of birth: ___________________________; current age: _______.
7. Address. Adult’s residence address:
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
Adult’s mailing address (if different than residence address):
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
8. Residency. The adult named above has been a resident of the State of (state)
_____________________ since (date) ______________ and has lived at the above
address since (date) ______________.
Page 4 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
9. Caretaker. The adult is currently under the care of:
___________________________________________________
Name
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
The care provider above is caring for the adult because:
________________________________________________________________________
________________________________________________________________________
10. Medicaid. Does the adult receive Medicaid, or has the adult ever received Medicaid?
( check one)
Yes
No
11. Need for Guardianship. The adult still needs a guardian because (explain in detail):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________.
12. Alternatives. What less restrictive alternatives have been tried before filing this request?
( check all that apply)
Supported Decision Making Agreement
Power of Attorney
Power of Attorney for People with Intellectual Disabilities
Representative Payee Designation
Microboard / Circle of Friends
Other: _____________________________________________________________
Explain why the items marked above are not working:
Page 5 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
13. Powers Requested. If appointed, what specific powers, if any, would the guardian need?
The same powers the current guardian has.
Other:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
14. Voting Rights: ( check one)
The adult should keep his/her right to vote.
The adult does not have the mental capacity to vote because he/she cannot
communicate, with or without accommodations, a specific desire to participate in
the voting process.
15. Firearms/Guns: ( check one)
The adult should be allowed to possess a firearm.
The adult should not be allowed to possess a firearm. The adult is a danger to
him/herself or others because of a mental condition, or the adult does not have the
capacity to contract or manage his/her own affairs because of a mental condition.
16. Driving: ( check one)
The adult should be allowed to drive.
The adult should not be allowed to drive.
17. The adult ( check one) is is not a party to any pending criminal or civil lawsuit.
Explain if the adult is a party to litigation:
18. This guardianship ( check one) is is not sought for the purpose of initiating a
lawsuit. Explain if guardianship is sought to initiate lawsuit:
________________________________________________________________________
________________________________________________________________________
Page 6 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
19. Abuse/Neglect Report: ( check one)
The guardianship IS NOT requested because of an investigation of abuse, neglect,
exploitation, isolation or abandonment of the adult.
The guardianship IS requested because of an investigation of abuse, neglect,
exploitation, isolation or abandonment of the adult. The investigating agency is
(name of agency) _________________________________, which is ( check
one) law enforcement a state agency a county agency.
20. Documents. The adult executed the following documents, copies of which will be filed
with this Petition: ( check all that apply)
Written nomination of guardian. The nominated guardian is (name of person
nominated to serve as guardian) __________________________________________
_____________________________________________________________________.
NOTICE: The Court will check the Nevada Secretary of State Lockbox to determine if
a guardian has already been designated by the proposed protected person.
Durable power of attorney for financial matters. The agent is ____________________
_____________________________________________________________________
Durable power of attorney for health care. The agent is _________________________
_____________________________________________________________________
Revocable or living trust. The agent is ______________________________________
_____________________________________________________________________
None of the above.
Unknown if the adult has executed any of the above documents.
*Copies of any of the above should be submitted confidentially to the Court for review.
21. Assets. The value of the proposed person’s assets is estimated at: ( check one)
Less than $10,000. If the guardianship is granted, the court should treat this case as
“summary administration” and not require annual accountings or a final accounting.
More than $10,000.
Page 7 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
Information Regarding the First Petitioner
22. Full legal name: ______________________________________________________.
23. Date of birth: ___________________________; current age: _______.
24. Relationship to adult in need of a guardian: _____________________________________.
If you are the spouse, the date of marriage was: (date) ____________________________.
25. Residence address:
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
Mailing address (if different than residence address):
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
26. If you do not live in the State of Nevada: ( check one)
A person or care provider in this State is providing continuing care and supervision
for the adult;
The adult is in a secured residential long-term care facility in this State;
The guardian will move to the State of Nevada within 30 days of appointment; or
The proposed protected person will move to the guardian’s state of residence within
30 days of appointment.
[NOTE: If a nonresident is appointed as guardian for an adult, the guardian must
designate a registered agent in the State of Nevada in the same manner as a
represented entity pursuant to Nevada Revised Statutes Chapter 77.]
27. Qualifications. (Answer each item listed; “Has” answers must be explained)
The Petitioner: ( check one for each)
has has not been convicted of a crime of moral turpitude, a crime involving
domestic violence or a crime involving the abuse, neglect,
exploitation, isolation or abandonment of a child, his or her spouse,
his or her parent or any other adult.
Explain if Yes: ___________________________________________
________________________________________________________
Page 8 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
has has never been convicted of a felony.
Explain if Yes: Petitioner was convicted of (describe conviction)
________________________________________________________
Petitioner ( check one) □ was / □ was not placed on parole and (
check one) □ was / □ was not placed on probation for that felony.
has has never been suspended for misconduct or disbarred from the practice of law,
the practice of accounting or any other profession which involves the
management or sale of money, investments, securities or real property
and requires licensure in Nevada or any other state.
Explain if Yes: ___________________________________________
________________________________________________________
has has not filed for bankruptcy within the past 7 years.
is is not a party to pending criminal or civil litigation.
Explain if Yes: ___________________________________________
________________________________________________________
Information Regarding the Co-Petitioner
□ Not Applicable (check if there is only one proposed guardian, and go to #34)
28. Full legal name: ______________________________________________________.
29. Date of birth: ___________________________; current age: _______.
30. Relationship to adult in need of a guardian: _____________________________________.
If you are the spouse, the date of marriage was: (date) ____________________________.
31. Residence address:
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
Mailing address (if different than residence address):
___________________________________________________
Address
___________________________________________________
City, State, Zip Code
Page 9 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
32. If you do not live in the State of Nevada: ( check one)
A person or care provider in this State is providing continuing care and supervision
for the adult;
The adult is in a secured residential long-term care facility in this State;
The guardian will move to the State of Nevada within 30 days of appointment; or
The proposed protected person will move to the guardian’s state of residence within
30 days of appointment.
[NOTE: If a nonresident is appointed as guardian for an adult, the guardian must
designate a registered agent in the State of Nevada in the same manner as a
represented entity pursuant to Nevada Revised Statutes Chapter 77.]
33. Qualifications. (Answer each item listed; “Has” answers must be explained)
The Co-petitioner: ( check one for each)
has has not been convicted of a crime of moral turpitude, a crime involving
domestic violence or a crime involving the abuse, neglect,
exploitation, isolation or abandonment of a child, his or her spouse,
his or her parent or any other adult.
Explain if Yes: ___________________________________________
________________________________________________________
has has never been convicted of a felony.
Explain if Yes: The Petitioner was convicted of (describe conviction)
________________________________________________________
The Petitioner ( check one) □ was / □ was not placed on parole and
( check one) □ was / □ was not placed on probation for that felony.
has has never been suspended for misconduct or disbarred from the practice of law,
the practice of accounting or any other profession which involves the
management or sale of money, investments, securities or real property
and requires licensure in Nevada or any other state.
Explain if Yes: ___________________________________________
________________________________________________________
has has not filed for bankruptcy within the past 7 years.
is is not a party to pending criminal or civil litigation.
Explain if Yes: ___________________________________________
________________________________________________________
Page 10 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
General Information
34. Compensation. Are you currently being paid for services as a guardian to more than one
protected person who is not related to you by blood or marriage? ( check one):
No, I am not being paid for services as a guardian.
Yes, I am being paid for services as a guardian.
35. A Certificate of Incapacity is already filed and the information remains the same; or
will be updated and filed.
36. Confidential Information Sheet – Guardianship must be completed and filed. You must
provide at least one form of identification (listed on the sheet) for each successor guardian.
37. Exhibit A: List of All of the Adult’s Relatives must be completed and attached to
petition.
38. Exhibit B: Information Regarding the Adult’s Estate must be completed and attached to
petition if you are requesting guardianship over the adult’s estate. If you are appointed the
Guardian, the Court will determine how to safeguard the protected person’s funds. The
Court will decide whether to:
Require the funds to be placed into a blocked account.
Require you to obtain a bond in an amount equal to the total amount of the
proposed protected person’s liquid assets.
39. Attach any other documentation that supports your request for guardianship.
40. Other: In addition to the above, the Court should also consider (explain anything else the
judge should know when considering your request for guardianship):
Petitioner(s) request that this guardianship be granted, that the relief requested be granted
as stated herein, and for such other and further relief as the Court may deem just and proper.
DATED (month) ________________________ (day) _______, 20___.
(Second Petitioner’s Signature)
(Printed Name)
(First Petitioner’s Signature)
(Printed Name)
Page 11 of 11 – Petition for Appointment of Successor/Co-Guardian Over an Adult
VERIFICATION
I, (name of first petitioner) ________________________________________, declare
that I am the Petitioner in the within action; that I have read the foregoing Petition For
Appointment of Successor/Co-Guardians and know the contents thereof; that the same is true of
my knowledge except as to those matters therein stated upon information and belief and as to
those matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
__________________________________________
FIRST PETITIONER’S SIGNATURE
VERIFICATION
I, (name of second petitioner) ________________________________________, declare
that I am the Co-Petitioner in the within action; that I have read the foregoing Petition For
Appointment of Successor/Co-Guardians and know the contents thereof; that the same is true of
my knowledge except as to those matters therein stated upon information and belief and as to
those matters, I believe them to be true.
I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.
__________________________________________
SECOND PETITIONER’S SIGNATURE
EXHIBIT A: List All of the Adult’s Relatives
Spouse:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Parents:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Brothers and Sisters:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Grandparents:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Children:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Grandchildren:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Grandparents:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
EXHIBIT B: Information Regarding the Proposed Protected Person’s Estate
Complete this page only if you are requesting guardianship over the estate.
1. The proposed protected person ( check all that apply)
Has no assets or income
Has assets and income (list below)
Is entitled or will be entitled to assets or income (list below)
2. The proposed protected person receives income from the following: (include all income,
including Social Security, Department of Veteran’s Affairs, pensions, etc. If none, write
“N/A”. If there are not enough lines below, write “SEE ATTACHED” and attach a page
with the additional income sources.) (check and answer all that apply)
Social Security Yes No monthly: $_______________________
Veterans Affairs Yes No monthly: $_______________________
a. __________________________________ monthly: $_______________________
b. __________________________________ monthly: $_______________________
c. __________________________________ monthly: $_______________________
3. Is there a Representative Payee receiving benefits on behalf of the proposed protected
person? No Yes, the person is (name) ____________________________________.
4. The proposed protected person’s assets are: (include all assets including checking / savings
/ investment accounts, real estate, vehicles, inheritances, including insurance policies, etc.
If none, write “N/A”. If there are not enough lines below, write “SEE ATTACHED” and
attach a page containing the additional assets.)
a. __________________________________ value: $_______________________
b. __________________________________ value: $_______________________
c. __________________________________ value: $_______________________
d. __________________________________ value: $_______________________
e. __________________________________ value: $_______________________
f. __________________________________ value: $_______________________
g. __________________________________ value: $_______________________
h. __________________________________ value: $_______________________
i. __________________________________ value: $_______________________
You will be required to file a detailed Inventory listing all of the protected person’s assets
within 60 days of your appointment.
© 2020 Family Law Self-Help Center
Page 1 of 2 – Citation to Appear and Show Cause (Successor/Co-Guardianship)
COURT CODE: CITA
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
_
___________________________________
_
___________________________________
_
___________________________________
_
___________________________________
_
___________________________________
_
___________________________________
Protected Person/Minor(s).
CASE NO.: ____________________
DEPT: ____________________
CITATION TO APPEAR AND SHOW CAUSE (SUCCESSOR/CO-GUARDIANSHIP)
TO: (Name of Protected Person or Protected Minor(s))
ALL KNOWN RELATIVES:
(Write each relative’s name on a separate line)
ANY PERSON HAVING THE CARE, CUSTODY, AND CONTROL OF THE
PROTECTED PERSON/MINOR
© 2020 Family Law Self-Help Center
Page 2 of 2 – Citation to Appear and Show Cause (Successor/Co-Guardianship)
DIRECTOR OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
DEPARTMENT OF VETERANS AFFAIRS
PLEASE TAKE NOTICE that the following person(s) (proposed guardian’s name)
_____________________________________________ and (proposed co-guardian’s name)
_____________________________________________ petitioned the cou
rt to be appointed the
successor/co-guardian(s) of the protected person/minor(s) named above. The proposed
guardian(s) may be awarded the full management, care, and control of the protected
person/minor(s).
The protected adult person may be determined to be incapacitated or of limited capacity,
and a guardian may be appointed for the proposed protected person/minor(s).
The rights of the protected person/minor(s) may be affected as specified in the petition.
The protected person/minor(s) has the right to appear at the hearing and to oppose the
petition.
The protected person/minor(s) has the right to be represented by an attorney, who may be
appointed by the court if the proposed protected person is unable to retain one.
At any time after the filing of a Petition to Appoint Guardian, the court may appoint: (1)
an attorney; (2) a guardian ad litem or an advocate; or (3) an investigator, if found to be
appropriate or necessary in the best interest of the protected person/minor(s).
DATE AND TIME OF COURT APPEARANCE
(the court clerk will fill this out)
YOU
ARE DIRECTED TO APPEAR AND SHOW CAUSE why a successor/co-
guardian should not be appointed for the protected person on the:
_____ day of ____________________, 20____, at _______ □ a.m. □ p.m., at the courthouse of
the 8
th
Judicial District Court, in Courtroom number _____, located at
Regional Justice Center, 200 Lewis Avenue, Las Vegas, NV 89101
Family Court, 601 N. Pecos Rd., Las Vegas, NV 89101
DATED this _____ day of ___________________, 20___.
CLERK OF COURT
BY: ____________________________________
DEPUTY CLERK
NOTE: The protected person/minor(s) and the proposed guardian(s) must appear at the
scheduled hearing; all other interested parties do not need to appear unless they wish to oppose
the guardianship and enter an objection.
Mail: Send your forms and filing fee to Clerk of Court, 601 N Pecos, Las Vegas, NV 89101.
Online: You can upload your documents at https://nevada.tylerhost.net/OfsWeb/. There is a
$3.50 fee to e-file your documents.
In person: Bring your forms and filing fee to the Family Courthouse. File them at the Clerk’s
Office on the 1
st
floor (you will need to get a ticket for filing when you arrive).
You must make sure to serve all required people. There are different ways to serve different people:
The adult you want to be the guardian over has to be
personally served
.
Someone who is not involved in this case must hand-deliver a copy of the file-stamped Petition
and Citation to the adult. Do this even if the adult doesn’t understand what’s happening.
The rest of the relatives
can sign and notarize a
consent
agreeing to make you the
guardian. If they won’t consent, send them a copy of the file-stamped Petition and Citation by
certified mail, return receipt requested
. Use the “green cards” at the post office. You
must serve or get consents from:
o All the relatives age 14 and older listed on Exhibit A.
o Medicaid (if the adult receives Medicaid – address is provided on the form)
o Veteran’s Affairs (if the adult receives VA benefits – address is provided on the form)
o The Hospital/Care Facility where the adult is located (if applicable)
YOU MUST SERVE ALL OF THE PEOPLE LISTED ABOVE; NO EXCEPTIONS!
Declaration of Service (required). This is the proof that the adult was served with the
Petition and Citation. Whoever served the adult fills out this form.
Consents (if applicable).
The SHC has consent forms available for any relative who will
sign and notarize a consent agreeing to make you the guardian.
Certificate of Mailing (required for anyone who won’t consent). This is the proof that
other relatives and agencies were served with the Petition and the Citation. Attach copies of
the signed green cards.
Physician’s Certificate (not included, ask for the form if you need it).
This form was already filled out by a doctor, psychiatrist, or a government agent authorized to
conduct investigations when the guardianship was originally approved. You can file an updated
one if you feel it is needed, or you can rely on the original one that was filed.
Bring the adult with you (unless the physician’s certificate excuses the adult’s attendance).
An attorney will be there to represent the adult.
© 2018 Nevada Supreme Court
Page 1 of 2 – Declaration of Service on Proposed Protected Person
COURT CODE: AOS
Your Name: _________________________
Address: ____________________________
City, State, Zip: ______________________
Phone: ______________________________
Email: ______________________________
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
_
___________________________________
(name of adult alleged to need a guardian)
A Proposed Protected Person.
CASE NO.: ____________________
DEPT: ____________________
DECLARATION OF SERVICE ON ADULT PROPOSED PROTECTED PERSON
A copy of the Petition for Appointment of Guardian and the Citation to Appear and Show Cause
must be personally served to the adult who allegedly needs a guardian.
A neutral person, not involved in this case or related to the parties, must personally serve the
documents directly to the adult. If that is not possible, the server can personally serve the
documents on someone of suitable age and discretion who lives with the adult.
The proposed guardians or relatives cannot do this.
The person who serves the documents must complete this form.
I, (name of person who served the documents) _______________________________________,
declare (complete EVERY SECTION below):
1. I am not a party to or interested in this action and I am over 18 years of age.
2. I am not a licensed process server; I am a natural person serving legal process without
compensation, not more than three times per year, on behalf of a litigant who is a natural
person, and therefore I am not required to be licensed pursuant to NRS 648.063(2) (2017
Nevada Laws Ch. 126 (A.B. 128)).
© 2018 Nevada Supreme Court
Page 2 of 2 – Declaration of Service on Proposed Protected Person
3. What Documents You Served. I served a copy of the ( check all that apply)
Petition for Appointment of Guardian
Citation to Appear and Show Cause
Other: ____________________________________________________________
4. Who & Where You Served. I personally delivered and left the documents with:
( check one)
The Adult Who Is the Subject of This Case. I served the documents on the
adult at the location below. (complete the details below)
_________________________________________
Name of Person Served
_________________________________________
Address Where Served
_________________________________________
City, State, Zip Code
A Person Who Lives with the Adult. This is a person of suitable age and
discretion who lives with the adult. (complete the details below)
_________________________________________
Name of Person Served
_________________________________________
Address Where Served
_________________________________________
City, State, Zip Code
5. When You Served. I personally served the documents on (date you served the
documents) (month) ___________________________ (day) _______, 20____ at the
hour of (time) ____:____ a.m. p.m.
I declare under penalty of perjury under the law
of the State of Nevada that the foregoing
is true and correct.
DATED (month) ___________________________ (day) _______, 20____.
Server’s Signature:
Server’s Printed Name:
Residential / Business Address:
City, State, Zip:
Server’s Phone Number:
© 2020 Family Law Self-Help Center
Page 1 of 2 – Certificate of Mailing (Successor/Co-Guardianship)
COURT CODE: CERT
Your Name:
Address:
City, State, Zip:
Telephone:
Email Address:
Self-Represented
DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Guardianship of the:
Person
Estate
Person and Estate
of:
_
___________________________________
_
___________________________________
_
___________________________________
_
___________________________________
_
___________________________________
_
___________________________________
Protected Person/Minor(s).
CASE NO.: ____________________
DEPT: ____________________
CERTI
FICATE OF MAILING FOR THE
PETITION FOR APPOINTMENT OF GUARDIANS
I HEREBY CERTIFY that I served the: ( check all that apply):
Petition for Appointment of Successor/Co-Guardian
Citation to Appear and Show Cause
Other: ________________________________
on (month) _____________________ (day) _____, 20___, by depositing a copy of the same in
the U.S. Mail, enclosed in sealed envelopes, prepaid Certified Mail, Return Receipt Requested,
addressed to:
Relatives / Required Notices:
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
© 2020 Family Law Self-Help Center
Page 2 of 2 – Certificate of Mailing (Successor/Co-Guardianship)
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
Name: ____________________________
Address: __________________________
____________________________
If the adult/child is in a hospital or in a public or private care facility, mail to the care provider:
Name: ____________________________
Address: ___________________________
____________________________
If the adult/child receives or has received Medicaid, check the following box and mail to:
Director of the Department of Health and Human Services
4126 Technology Way, Suite 100
Carson City, Nevada 89706-2009
If the adult/child receives Veteran’s benefits or payments, check the following box and mail to:
Department of Veteran’s Affairs
5460 Reno Corporate Drive
Reno, Nevada 89511
I declare under penalty of perjury
under the law of the State of Nevada that the
foregoing is true and correct.
DATED (month) ________________________ (day) _______, 20___.
ATTACH THE SIGNATURE RECEIPTS (GREEN CARDS FROM THE
POST OFFICE) TO THIS FORM WHEN RECEIVED
(Signature)
(Printed Name)
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Completed 9 February 2021

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