FORM MH-106 GC petition to appt

• Legal Form Number: FORM MH-106
• Date: 01 January 2014
• Section: Az Mh Forms Annotated

FORM MH-106

[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 APPOINTMENT
OF 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 in this county] [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: ________________.]

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: _________________.]

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...