FORM MH-116 Gd Adult Petition to Appt

• Legal Form Number: FORM MH-116
• Date: 01 January 2024
• Section: Az Mh Forms Annotated

FORM MH-116

(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 APPOINTMENT OF GUARDIAN [WITH LIMITED POWERS AND] WITH MENTAL HEALTH POWERS

Pursuant to A.R.S. §§ 14-5303 and -5312.01, 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 in this county pursuant to an order of this court.]

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

3. Petitioner is interested in this matter because ____________________.

4. 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.]

5. Pursuant to A.R.S. § 14-5311(B), (nominee's name), whose address and telephone number are __________, is willing to act and has priority for appointment because (state the nominee's priority).

6. The nominated guardian 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)].

7. [(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].

8. [(Subject person's name) has no conservator.] [The name and address of the conservator for (subject person's name) are: __________.]

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

Name:

Address:

Relationship:

[Repeat as necessary.]

10. (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 [he] [she] [they] lacks sufficient understanding or capacity to make or communicate responsible decisions concerning [his] [ her] [their] person.

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

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

[13. (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.]

[14. (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.]

[15. (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.]

16. 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 __________].

17. 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].

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

19. (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.

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

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

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

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