FORM MH-100 GC petition ER Temp appt without notice

• Legal Form Number: FORM MH-100
• Date: 01 January 2014
• Section: Az Mh Forms Annotated

FORM MH-100

[Attorney’s name, State Bar No.]

[Attorney’s law firm name]

[Law firm bar number]

[Address]

[Phone number]

[Attorney or firm’s e-mail address]

Attorney for: __________

SUPERIOR COURT OF ARIZONA, __________ COUNTY

In the Matter of the Guardianship of and Conservatorship for: an Adult. NO. , __________ PETITION FOR Emergency APPOINTMENT OF Temporary [limited] GUARDIAN WITH MENTAL hEALTH POWERS AND CONSERVATOR (WithOUT Notice) AND APPOINTMENT OF PERMANENT [limited] GUARDIAN WITH MENTAL HEALTH POWERS AND CONSERVATOR

Pursuant to A.R.S. §§ 14-5303, -5310, -5312.01(B), -5401.01, and -5404, Petitioner, __________, states:

1. Pursuant to A.R.S. § 14-5302, venue for this guardianship is in this county because the alleged incapacitated person [resides in this county] [is present in this county] [is admitted to an institution pursuant to an order of this Court].

2. Pursuant to A.R.S. § 14-5403, venue for this conservatorship is in this county because the person allegedly in need of protection, [resides] [does not reside in Arizona but has property] in this county.

3. Petitioner is interested in this matter because ____________________.

4. The name, age, current residence, and permanent address of the person alleged to be incapacitated and in need of protection are:

Name:

Age:

Current Residence:

Permanent Address:

[The person allegedly in need of protection is a veteran.]

5. Pursuant to A.R.S. §§ 14-5311(B) and -5410(A), [nominee’s name], whose address and telephone number are ___________, has priority for appointment as guardian/conservator because [nominee’s name] is [nominee’s priority] and is willing to act on behalf of the person alleged to be incapacitated and in need of protection. [The nominated guardian/conservator is filing the affidavit required by A.R.S. § 14-5106(A).] [The nominated guardian/conservator is (a financial institution) (the Public Fiduciary) and is excused from completing the affidavit required by A.R.S. § 14-5106(A).]

6. [The person alleged to be incapacitated and in need of protection currently has no guardian.] [The name and address of the guardian of person alleged to be incapacitated and in need of protection are: __________.] [The current guardian is not effectively performing the duties of a guardian and the welfare of the ward requires immediate action.]

7. [The person alleged to be incapacitated and in need of protection currently has no conservator.] [The name and address of the conservator of the person alleged to be incapacitated and in need of protection are: __________.] [The current conservator is not effectively performing the duties of a conservator and the estate or affairs of the protected person require immediate action.]

8. The name(s) and address(es) of the nearest relative(s) of the person alleged to be incapacitated and in need of protection known to Petitioner are:

Name:

Address:

Relationship:

9. The person alleged to be incapacitated and in need of protection is impaired by reason of mental illness, mental deficiency, mental disorder, physical illness or disability, chronic use of drugs, chronic intoxication or other cause (other than minority) to the extent that the individual lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the individual’s person. Specifically, the impairments are __________. The appointment of a guardian is necessary to provide for the demonstrated needs of the person alleged to be incapacitated and in need of protection.

10. After having explored other alternatives, [Petitioner requests a general guardianship and alleges that a limited guardianship is not appropriate because the demonstrated needs of (name of person alleged to be incapacitated and in need of protection) cannot be met by less restrictive means including the use of appropriate technological assistance.] [Petitioner requests a limited guardianship and alleges that some of the demonstrated needs of (name of person alleged to be incapacitated and in need of protection) cannot be met by less restrictive means including the use of appropriate technological assistance. Petitioner requests a guardianship with powers limited to _________________.]

11. Pursuant to A.R.S. § 14-5303(B)(9), Petitioner states that [no custodial order was previously entered regarding the person alleged to be incapacitated and in need of protection in a child custody action or similar proceeding in this state or any other jurisdiction.] [(Petitioner’s name) (The nominated guardian) is a parent or the nonparent custodian of the person alleged to be incapacitated and in need of protection and there was a previous custodial order regarding the person alleged to be incapacitated and in need of protection arising from [name of court] in case number __________.]

12. Based upon the impairment(s) of the person alleged to be incapacitated and in need of protection, the person’s right to retain or obtain a driver license, vote, and exercise any other civil right that may be suspended by operation of law will be affected by the appointment of a guardian. [Petitioner requests that the alleged incapacitated person’s right to obtain or retain a driver license be suspended upon the appointment of a temporary guardian because (he) (she) cannot safely operate a vehicle.] [Petitioner requests that the person alleged to be incapacitated and in need of protection’s right to (drive) (vote) (insert other civil right __________) will not be affected by the appointment of a guardian.]

13. [Name of person alleged to be incapacitated] is incapacitated as a result of a mental disorder as defined in A.R.S. § 36-501(25) and is likely to be in need of inpatient mental health care and treatment within the...