FORM MH-104 Gc Petition Er Temp Appt With Notice

• Legal Form Number: FORM MH-104
• Date: 01 January 2024
• Section: Az Mh Forms Annotated

FORM MH-104

(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 GUARDIAN [WITH LIMITED POWERS AND] WITH MENTAL hEALTH POWERS AND CONSERVATOR
(With Notice) AND APPOINTMENT OF PERMANENT GUARDIAN [WITH LIMITED POWERS AND] WITH MENTAL HEALTH POWERS AND CONSERVATOR

Pursuant to A.R.S. §§ 14-5303, -5310, -5312.01, -5401.01, and -5404, Petitioner, _________, states:

1. Pursuant to A.R.S. § 14-5302, venue for this guardianship is in this county because (subject person's name) [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 (subject person's name), [resides in this county] [does not reside in Arizona but has property in this county.

3. Pursuant to A.R.S. § 14-12203, this court has jurisdiction to appoint a guardian or conservator because [Arizona is (subject person's name)'s home state] [identify jurisdictional statement under statute].

4. Petitioner is interested in this matter because __________________.

5. The name, age, current residence, and permanent address of (subject person's name) are:

Name:

Age:

Current Residence:

Permanent Address:

[(Subject person's name) is a (child of a) (spouse of a) veteran.]

6. 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 (subject person's name).

7. The nominated guardian/conservator is [filing the affidavit required by A.R.S. § 14-5106(A)] [a financial institution or a public fiduciary and is excused from completing the affidavit required by A.R.S. § 14-5106(A)].

8. [(Subject person's name) currently has no guardian] [The current guardian, whose name and address are _____________, is not effectively performing the duties of guardian and the welfare of (subject person's name) requires immediate action].

9. [(Subject person's name) currently has no conservator.] [The current conservator, whose name and address are _____________, is not effectively performing the duties of a conservator and the welfare of (subject person's name) requires immediate action.]

10. The name(s) and address(es) of the nearest relative(s) of (subject person's name) known to Petitioner are:

Name:

Address:

Relationship:

11. (Subject person's name) 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 [his] [ her] [their] person.

12. Specifically, (subject person's name)'s impairments are __________.

13. The appointment of a guardian is necessary to provide for the demonstrated needs of (subject person's name).

[14. (Subject person's name) is the principal under a heath care power of attorney dated __________, in which (insert name) is nominated as [guardian] [conservator] [guardian and conservator]. A copy of the power of attorney is attached.]

[15. (Subject person's name) is the principal under a durable financial power of attorney dated __________, in which (insert name) is nominated as [conservator] [guardian] [guardian and conservator]. A copy of the power of attorney is attached.]

[16. (Subject person's name) has a present vested interest in (insert name of trust) and (insert name of trustee) is the current trustee of the trust.]

17. After having explored other alternatives, [Petitioner alleges a general guardianship is necessary and a limited guardianship is insufficient because all the demonstrated needs of (subject person's name) cannot be met by less restrictive means including the use of appropriate technological assistance] [Petitioner alleges a limited guardianship is necessary because some of the demonstrated needs of (subject person's name) cannot be met by less restrictive means, including the use of appropriate technological assistance, with powers limited to __________].

18. Pursuant to A.R.S. § 14-5303(B)(9), [no legal decision-making, parenting time, or visitation order was previously entered regarding (subject person's name)] [a legal decision-making, parenting time, or visitation order regarding (subject person's name), entered in (name of court), cause number __________, is attached].

19. This request for guardianship is [not] due solely to physical incapacity.

20. (Subject person's name) 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 next year, including placement in a level one behavioral health facility and medical, psychiatric and psychological treatment associated with that placement.

21. The appointment of a guardian should [not] affect (subject person's name)'s right to vote and exercise any other civil right that may be suspended by operation of law.

[22. (Subject person's name)'s right to obtain or retain a driver license should be suspended upon the appointment of a temporary guardian because (subject person's name) cannot safely operate a vehicle.]

23. The [limited] guardian should [not] be granted the authority to withhold or withdraw life sustaining treatment, including artificial food and fluid.

24. (Subject person's name) owns the following property, with an estimated current fair market value:

Cash (i.e. checking, savings, certificates of deposit, etc.)	$
Marketable securities (i.e., stocks, bonds, brokerage accounts, etc.)	$
Insurance or annuity	$
Other personal property	$
Real property	$
TOTAL	$

Annual Income

Social security or other government benefits	$
Pension(s) or retirement benefits	$
Compensation or allowance	$
Dividends or interest	$
Other	$
TOTAL	$

25. Pursuant to A.R.S. § 14-5401(A)(2), the appointment of a conservator or other protective order is necessary because (subject person's name): (a) is unable to manage [his] [her] [their] estate and affairs effectively for reasons such as mental illness, mental deficiency, mental disorder, physical illness or disability, chronic use of drugs, chronic intoxication, confinement, detention by foreign power...