FORM MH-116 GD petition to appt

• Legal Form Number: FORM MH-116
• Date: 01 January 2014
• 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 MENTAL HEALTH POWERS

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

1. Pursuant to A.R.S. § 14-5302, venue for this proceeding 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 because [nominee’s name] is [state 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 excused from completing the affidavit required by A.R.S. § 14-5106(A).]

5. [The alleged incapacitated person currently has no guardian.] [The name and address of the guardian for the alleged incapacitated person are __________.]

6. [The alleged incapacitated person currently has no conservator.] [The name and address of the conservator of the alleged incapacitated person are: __________.]

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

Name:

Address:

Relationship:

8. The 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 the alleged incapacitated person.

9. After having explored other alternatives, [Petitioner requests a general guardianship and alleges that a limited guardianship is not appropriate because the alleged incapacitated person’s demonstrated needs 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 alleged incapacitated person’s demonstrated needs cannot be met by less restrictive means including the use of appropriate technological assistance. Petitioner requests a guardianship with powers limited to ____________________.]

10. Pursuant to A.R.S. § 14-5303(B)(9), Petitioner states that [no custodial order was previously entered regarding the alleged incapacitated person 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...