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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: A non-paren
t who wants to become a co-guardian or a replacement
guardian. There must already be a court-ordered guardianship in place.
Filing Fee: $80.
Most Relatives Have to Be Notified: 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 Child Must Appear At The Hearing: The child must appear at a hearing. If you do
not bring the child, your case will be delayed.
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 guardian. Attach a copy of the
identification you mark (social security card, driver’s license, etc.) for each.
Petition F
or Appointment of Successor/Co-Guardia
n
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 people petition). The
child is the “Protected Minor.”
Citation to Appear and Show Cause
This form sets a court date for your case. The Clerk will fill in a hearing date.
1 Child
© 2018 Nevada Supreme Court
Page 1 of 2 – Confidential Information Sheet (Child)
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 child)
A Protected Minor.
CASE NO.: ____________________
DEPT: ____________________
CONFIDENTIAL INFORMATION SHEET – GUARDIANSHIP
First Guardian (full legal name): __________________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Second Guardian (full legal name, or “n/a” if none): ___________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
Child (child’s full legal name): ________________________________________
Identification Attached (check one and attach a copy):
Social Security Number
Birth Certificate
Valid Driver’s License Number
Valid Identification Card
Number
Valid Passport Number
*This section not
required if prior
guardian already
provided identification
for the child.
© 2018 Nevada Supreme Court
Page 2 of 2 – Confidential Information Sheet (Child)
Placement Of Child: Location Of Guardian(s):
With Guardian
Secured Facility
Group Home
Host Family
Family/Friends
Out of State
Other
Nevada
Other State (list): _____________________
Proposed Guardian(s) Relationship to the
Child:
Relative
Private: License Number: ___________
Other
Child’s Gender: Child’s Date Of Birth:
Male
Female
Date of Birth: _______________________
Date Child Turns 18: _________________
Submitted by:
(
Attach copies of the identification indicated for each guardian)
(Signature)
(Printed Name)
© 2020 Family Law Self-Help Center
Page 1 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
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 the:
Person
Estate
Person and Estate
of:
_
___________________________________
(name of child)
A Protected Minor.
CASE NO.: ____________________
DEPT: ____________________
PETITION FOR APPOINTMENT OF SUCCESSOR / CO-GUARDIAN(S)
OVER A CHILD
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 minor. In
accordance with Chapter 159A 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 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
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 Minor;
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 Minor or the estate of the
Protected Minor; or
(b) There is a substantial likelihood that the negligence would result in injury to
the Protected Minor or the estate of the Protected Minor;
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 Minor 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 has violated a right of the Protected Minor as set forth in NRS
159A;
The guardian has violated a Court order or committed an abuse of discretion
regarding restricting access and/or communication with the Protected Minor.
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 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
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):
Petitioner’s Information (the first proposed guardian)
5. Full legal name: ______________________________________________________.
6. Date of birth: ___________________________.
7. Relationship to child: _____________________________________.
8. Residence address:
_________________________________________
Address
_________________________________________
City, State, Zip Code
Mailing address (if different than residence address):
_________________________________________
Address
_________________________________________
City, State, Zip Code
Page 4 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
9. 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: ___________________________________________
________________________________________________________
has has never been convicted of a felony.
Explain if Yes: 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 not filed for bankruptcy within the past 7 years.
is is not a party to pending criminal or civil litigation.
Explain if Yes: ___________________________________________
________________________________________________________
Co-Petitioner’s Information (the second proposed guardian)
Not Applicable (check if there is only one proposed guardian, and go to #15)
10. Full legal name: ______________________________________________________.
11. Date of birth: ___________________________.
12. Relationship to child: _____________________________________.
13. Residence address:
_________________________________________
Address
_________________________________________
City, State, Zip Code
Page 5 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
Mailing address (if different than residence address):
_________________________________________
Address
_________________________________________
City, State, Zip Code
14. 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 not filed for bankruptcy within the past 7 years.
is is not a party to pending criminal or civil litigation.
Explain if Yes: ___________________________________________
________________________________________________________
Child’s Information
15. Child’s full legal name: ____________________________________________________.
16. Child’s date of birth: ___________________________; current age: _______. The child
will become 18 years old on (date) ____________________.
17. Petitioner(s) believe the child ( check one) will / will not need a guardian when
the child turns 18 years old. If yes, explain why a guardian will still be needed:
______________________________________________________________________.
Page 6 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
18. The child has been a resident of the State of (state) __________________________ since
(date) ________________________.
19. The child currently lives at the following address:
_________________________________________
Address
_________________________________________
City, State, Zip Code
The child has lived at the above address since (date) ________________________.
20. The child has lived at the following places with the following people within the last 5
years (list the places the child has lived in the last 5 years):
Time Period (mo/yr
– mo/yr)
Name of Person the Child
Lived With:
City and State
i.e., 5/17-9/17 Sue Jones (grandma) Las Vegas, NV
________ - _______
________ - _______
________ - _______
________ - _______
________ - _______
The names and current addresses of each non-parent the child lived with during the last
five years are:
21. Participation in Other Cases. Have Petitioner(s) ever participated in any case other than
this one concerning the child as a party, witness, or in some other capacity? (☒ check one)
No.
Yes, I have participated in the following cases concerning the child (provide all
specifics including the state, the court name, the case number and the date of the child
custody order, if any):
Page 7 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
22. Knowledge of Other Cases. Do Petitioner(s) know of any other case that could affect
this case, such as other custody cases, domestic violence cases, protection order cases, or
adoptions / terminations? (☒ check one)
No.
Yes, the following cases that could affect this case (provide all specifics including the
state, the court name, the parties involved, the case number and the type of case):
23. Current Custody Case: Is there a custody order concerning the child? (☒ check one)
No.
Yes, there is a current order concerning custody of the child. The order is from the State
of _________________ and was filed on (date) _______________. If the order was
not registered with this Court, a copy of the order will be filed with this Petition.
24. Persons Who Can Claim Custody / Visitation. Is there anyone other than Petitioner(s)
or other parties to this case who has custody of the child or who can claim a right to
custody or visitation with the child? (☒ check one)
No.
Yes, the following people have custody or can claim custody/visitation of the child:
(list names and addresses of anyone who claims custody/visitation rights):
25. The child is currently under the care of (name and address of person caring for the child):
_________________________________________
Name
_________________________________________
Address
_________________________________________
City, State, Zip Code
Page 8 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
The person above is caring for the child because (explain why the child is under the care
of the person above):
________________________________________________________________________
________________________________________________________________________
26. Does the child receive Medicaid, or has this child ever received Medicaid? (☒ check one)
No
Yes
27. Is the child a member of a federally recognized tribe? (☒ check one)
No
Yes, the tribe is (write tribe’s name) __________________________________
28. Is the child a citizen of another country? (☒ check one)
No
Yes, the child is a citizen of (write country name) __________________________
29. Is the child a party to any pending criminal or civil lawsuit? (☒ check one)
No
Yes (explain) _______________________________________________________
30. Are Petitioner(s) seeking guardianship in order to initiate litigation? (☒ check one)
No
Yes (explain) _______________________________________________________
Page 9 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
Child’s First Parent
31. The first parent is (name) __________________________________________________.
( check if applicable)
This parent is deceased.
This parent’s parental rights over the child were terminated by a court order.
32. This parent currently lives at the following address:
_________________________________________
Address
_________________________________________
City, State, Zip Code
Mailing address (if different than residence address):
_________________________________________
Address
_________________________________________
City, State, Zip Code
33. Consent ( check one):
This parent agrees to this guardianship and will file a proper notarized consent.
This parent does not consent to the guardianship, or cannot be located to consent.
34. This parent is unable to care for the child because (explain):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Child’s Second Parent
35. The second parent is (name)
_________________________________________________. ( check if applicable):
This parent is deceased.
This parent’s parental rights over the child were terminated by a court order.
Page 10 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
This parent is an unknown father. There is no father listed on the child’s birth
certificate. There has never been a court order regarding child support, custody, or a
finding of paternity.
36. This parent currently lives at the following address:
_________________________________________
Address
_________________________________________
City, State, Zip Code
Mailing address (if different than residence address):
_________________________________________
Address
_________________________________________
City, State, Zip Code
37. Consent ( check one):
This parent agrees to this guardianship and will file a proper notarized consent.
This parent does not consent to the guardianship, or cannot be located to consent.
38. This parent is unable to care for the child because (explain):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
General Information
39. A guardianship is still needed for the child because (explain in detail):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Page 11 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
40. The child’s parent or legal guardian ( check one) has / has not nominated a
guardian in writing. The nominated guardian is (name)
___________________________.
41. Abuse/Neglect Report: ( check one)
The guardianship IS NOT requested because of an investigation of abuse or neglect
conducted by Child Protective Services (CPS) or law enforcement.
The guardianship IS requested because of an investigation by Child Protective
Services (CPS) or other similar agency. The investigating agency is (name of
agency) ________________________________________. The caseworker’s name
is (caseworker name) _____________________________________________. The
investigating agency ( check one) does / does not approve of this
guardianship and the placement of the child with the proposed Guardians.
42. Compensation. Are Petitioner(s) 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, Petitioner(s) is not/are not being paid for services as a guardian.
Yes, Petitioner(s) is/are being paid for services as a guardian for (number) ______
children.
43. Petitioner(s) is/are competent and capable of acting as guardian of the protected minor
and hereby consents to act in this capacity.
44. Confidential Information Sheet – Guardianship must be completed and filed. You
must provide at least one form of identification (listed on the sheet) for each proposed
guardian.
45. Exhibit A: List of All of the Child’s Relatives must be completed and attached to this
petition.
46. Exhibit B: Information Regarding the Child’s Estate must be completed and attached
to this petition if you are requesting guardianship over the child’s estate. If you are
Page 12 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
appointed the Guardian, the Court will determine how to safeguard the child’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 child’s
liquid assets.
47. Other Exhibits: If you have a letter from a governmental agency in this state which
conducts investigations, or a certificate signed by any other person whom the court finds
qualified to execute a certificate, the letter/certificate must be attached to this petition.
Petitioner(s) request(s) 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 13 of 13 – Petition for Appointment of Successor/Co-Guardian (1 Child)
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 Child’s Relatives
Parent:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Parent:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Grandparents:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown □ Deceased
Brothers and Sisters:
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown
Name: ____________________________
Address: __________________________
____________________________
□ Address Unknown
EXHIBIT B: Information Regarding the Proposed Protected Minor’s Estate
Complete this page only if you are requesting guardianship over the estate.
1. The proposed protected minor ( 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 minor 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)
Child Support Yes No monthly: $_______________________
Social Security Yes No monthly: $_______________________
Veterans Affairs Yes No monthly: $_______________________
a. __________________________________ monthly: $_______________________
b. __________________________________ monthly: $_______________________
3. Is there a Representative Payee receiving benefits on behalf of the proposed protected
minor? No Yes, the person is (name) ____________________________________.
4. The proposed protected minor 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 court 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).
The SHC has consent forms available for any relative who will sign and notarize a
consent agreeing to make you the guardian.
If the child is 14 or older, the child must sign a consent.
Any relative can sign a notarized consent if they want you to be the guardian and
will waive formal service of the documents. Any relative who will not sign a consent
must get the Petition and the Citation by certified mail, return receipt requested.
Anyone who signs a consent and waives service does not have to be served in the next step.
Anyone who will not consent must receive a copy of the file-stamped Petition and the
Citation by
certified mail, return receipt requested
. Use the “green cards” at the post
office. You must make sure to serve:
o The child’s mother and father.
o All the relatives age 14 and older listed on Exhibit A. This includes
grandparents on both sides and siblings.
o Medicaid (if the child receives Medicaid – address is provided on the form)
YOU MUST SERVE ALL OF THE PEOPLE LISTED ABOVE; NO EXCEPTIONS!
Consents (if applicable).
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 to the form.
Bring the child with you. The judge cannot decide the case unless the child is present.
Parents and relatives can come too. The judge will talk to each person who is there to decide
whether to approve the guardianship, deny the guardianship, or set it for trial.
© 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: ____________________
CERTIFICATE 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
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Completed 9 February 2021

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