Fill and Sign the Code Pgm or Form

SS# or EIN# (If any) ____________________________ NOTE TO PETITIONER: A veri�ed application for appointment as guardian/limited guardian/conservator must accompa ny this form. AOC 853 may be used. In re estate of ________________________________________________________, a minor under the age of 18. Petitioner, ________________________________________, petitions this Court for appointment of a (choose one): q guardian (individual, agency, or corporation having care, custody, and control of minor and managing minor's �nancial resources); or q limited guardian (individual, agency, or corporation having care, custody, and control of minor without managing minor's �nancial resources); or q conservator (individual, agency, or corporation managing minor's �nancial resources) for the above named minor. In support of this petition, petitioner states as follows: 1. Minor's address is ____________________________________________________________________________. 2. Minor's date of birth is _________________________________________________________________________. 3. Name and address of minor's spouse is ____________________________________ _______________________ _______________________________________________________________________________________________. 4. Name(s) and address(es) of minor's living parent(s) is (are) _____________________________________ _______ _______________________________________________________________________________________________. 5. If no living parent(s), name(s) and address(es) of minor's adult next of kin is (are) __________________ _________ _______________________________________________________________________________________________. 6. Name and address of individual or facility having custody of minor is ______________ ______________________ _______________________________________________________________________________________________. 7. Facts and reasons supporting need for appointment are: _________________ _____________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________. 8. Description and value of estate: Description Value a. Real Property _________________________________ $ _________________ b. Personal Property _________________________________ $ _________________ c. Other Financial Resources: (1) Government Bene�ts _________________________________ $ _________________ (2) Insurance Entitlement _________________________________ $ _________________ (3) Anticipated Yearly Income _________________________________ $ _________________ (4) Other _________________________________ $ _________________ AOC-852 Doc. Code: PGM or Rev. 2-17 PCMPage 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 387.025, KRS 395.016 PETITION FOR APPOINTMENT OF GUARDIAN/CONSERVATOR FOR MINOR lex et justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Voluntary Case No. ____________________ Court ____________________ County ____________________ Division ____________________ 9. Petitioner's address is _________________________________________________________________________. 10. Name and address of petitioner's attorney is __________________________________________ _____________________________________________________________________________________________. 11. Name and address of person/entity desiring appointment is ____________________________________________ _______________________________________________________________________________________________. Based on the above, petitioner prays that the above named person/entity be appointed as q guardian, q limited guardian, or q conservator. A veri�ed application for appointment as guardian/limited guardian/conservator for minor completed by the above named person/entity is attached. _____________________________________________ Petitioner SUBSCRIBED AND SWORN to before me on this date, __________________________________, 2______. _____________________________________________ Name/Title AOC-852 Rev. 2-17Page 2 of 2 Copy Distribution: Minor (If 14 or older) Each Person / Entity Named in Petition Choice of Guardian by Minor age 14 or older (This choice must be made in the presence of the Court.) The undersigned, being a minor aged 14 or older, nominates as q guardian, q limited guardian, or q conservator: ____________________________________________ ____________________________________________ Name Address ____________________________________________ Min or _______________________________________________________________________________________________ Attorney Name & Address (If any) NOTE TO PETITIONER: At least �ve (5) days before the hearing, Petitioner is required to give written notice of the time, place, and purpose of the hearing to each person/entity named in the Petition (unless notice has been waived in writing) by either: Certi�ed mail, return receipt requested. Proof of receipt must be �led in the court record at the time of the hearing; OR First class mail in a sealed envelope, postage prepaid. Proof that notice was mailed must be made by Af�davit, including the date when posted, �led in the court record at the time of the hearing.