FORM MH-114 GD petition ER Temp appt with notice

• Legal Form Number: FORM MH-114
• Date: 01 January 2014
• Section: Az Mh Forms Annotated

FORM MH-114

[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: an Adult. NO. __________ PETITION FOR Emergency APPOINTMENT OF Temporary [LIMITED] GUARDIAN WITH MENTAL hEALTH POWERS (With Notice) AND APPOINTMENT OF PERMANENT [LIMITED] GUARDIAN WITH MENTAL HEALTH POWERS

Pursuant to A.R.S. §§ 14-5303, -5310, and -5312.01(B), 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. Petitioner is interested in this matter because ________________.

3. The name, age, current residence, and permanent address of the alleged incapacitated person are:

Name:

Age:

Current Residence:

Permanent Address:

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

5. [Alleged incapacitated person currently has no guardian.] [The name and address of the guardian of the alleged incapacitated person are: __________.] [The current guardian is not effectively performing the duties of a guardian and the welfare of the ward requires immediate action.]

6. [Alleged incapacitated person currently has no conservator.] [The name and address of the conservator of alleged incapacitated person are: __________.] [The current conservator is not effectively performing the duties of a conservator and the welfare of the ward requires immediate action.]

7. The name(s) and address(es) of the nearest relative(s) of the alleged incapacitated person known to Petitioner are:

Name:

Address:

Relationship:

8. The following is a general statement of the property owned by the alleged incapacitated person, with an estimate of its current fair market value and including any compensation, insurance, pension, or allowance to which the alleged incapacitated person is entitled, as known by Petitioner as of the date of this petition:

Cash (i.e. checking, savings, certificates of deposit, etc.)	$
Marketable securities (i.e., stocks, bonds, brokerage accounts, etc.)	$
Other Personal Property	$
Real Property	$
TOTAL	$

Annual Income

Social Security	$
Pension(s)	$
Dividends	$
Other	$
TOTAL	$

9. The nominated guardian [will not take possession or control of any of the alleged incapacitated person’s property; therefore, a bond is not required.] [will take possession or control of the following property: ___________. Therefore, bond is required in the amount of $__________.] [is a public fiduciary or financial institution exempt under A.R.S. § 14-5411(B) from bond.]

10. Alleged incapacitated person 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...